Flexible Allied Health Service Delivery in
Residential Aged Care
Delivering health solutions through general practice
Melbourne East GP Network
606 GPs
143 Practices
29 suburbs in 4 Local Government Authorities
Our Population
• 20.8% of the
population is aged >
60 years
• There are around
4700 residential aged
care beds…….
• …...in around 76
facilities
ACAI
•Euterpe Oleracea
•Amazonian palm
tree
• a “magic berry”
ACAI
ACAI
•Aged Care Access Initiative
•DoHA funding in 2 parts
•Incentive payment to GPs based on number of services
provided to residents in RACFs, managed through
Medicare
•Money for allied health services for residents of RACFs,
doled out via SBOs to divisions/networks
•Princely sum of approximately $26 per residential bed ..….
ACAI
•$ can be used for individual or group services
•Can’t be used for education of staff, unless it
relates specifically to the care of the individual
resident receiving the service
•Has eligibility criteria, depending on resident being
high or low care
ACAI
What do we do?
Therapy services to individual residents
•Physiotherapy
•Occupational Therapy
•Speech Pathology
•Dietetics
•Nurse Wound Consultancy
•Psychologists (this FY)
Sound Clinical Governance
Initial Credentialing
•Police Check
•Professional Indemnity
•Qualifications
•Registration (as required by legislation)
•Experience
•Aged Care Specific
•Minimum of 2 years post registration
•CPD
•Meeting requirements of professional body
•Relevance
Initial Credentialing
•Peer Professional Reviewers
•Public sub acute sector
•Management/supervisory roles
Initial Credentialing
• 2 Referees requested:
•GP
•DON/ Manager of RACF
•Manager of a sub acute service
•A peer already credentialed with
the program
Annual Re - Credentialing
•Statutory declarations
•Indemnity and registration checks
Referral Process
Referral
•From General Practitioner
•Minimal referral paperwork from the RACF
and the GP, recognising that GPs are time
poor, that there is a record at the Facility,
and that Allied Health Professionals are
exactly that – professionals.
Referral
Allocation on the basis of:
• GP request
• Existing Relationship with the Facility
• Geography
How well is it working?
•RACFs engaged = 51(out of approx 76)
•Referrals =Average 23/month, > 400 to
date, for 295 residents
•AHPs = 58
How well is it working?
What do we report?
•Number and colour of jelly beans in
each jar!!!!!
•DoHA has no interest in the outcomes
How well is it working?
Survey January 2010
•Approximately 85 completed referrals from March
– December 09 were selected for review
Feedback from 4 groups
•GPs
•RACFs
•AHPs
•Residents/Family/Carers
How well is it working?
Looked at:
•Satisfaction with quality of treatment and
the outcomes
•Adequacy of the time allocation
•Satisfaction with communication
•Outcomes and clinical diagnoses
How well is it working?
Quality of treatment and outcomes
•RACFs: 93% rated this 3 – 5, 56% rated as 5
•GPs: 80% rated this 3 – 5, 33% rated as 5
•Resident/Family – 100% felt the therapy had
made a difference to their health and wellbeing
How well is it working?
Satisfaction with communication
•RACFs: 93% rated this 3 – 5, 56% rated as 5
•GPs: 73% rated this 3 - 5
•Resident/Family – 100% felt therapist had
communicated the reasons for the treatment
How well is it working?
Adequacy of time allocation
•RACFs: 75% felt allocation was adequate
•GPs: 47% felt allocation was adequate
•Resident/Family – 74% felt extra therapy
would not have been of benefit
•AHPs: 91% felt allocation was adequate*
*at odds with comments and with outcomes reported
How well is it working?
Outcomes and clinical diagnoses
•Received from RACFs and AHPs
•Not an exact population – more like snapshots
– so hard to get direct comparisons of what the
outcome was from RACF and AHP perspective
for the same group of patients
ACAI
Diagnoses (indicative)
• Fractures
–
–
–
–
# humerus
# NOF
Bilateral # tibial plateaux
# Cx spine
• CVA
– Hand contractures
• Wounds
– Ulcers
– Burns
• Decreased mobility
• Post psychiatric IP
admission
• Falls
• Malnutrition
• THJR
• Dysphagia/dysarthria
How well is it working?
Outcomes (AHPs)
•Occupational Therapy – goals met in 100% of cases
•Speech Pathology – goals met in 100% of cases
•Nurse Wound consultant – goals partially or
completely met in 100% of cases
How well is it working?
How well is it working?
In Summary
Thank you!
Any questions?
Anita Hill
Program Coordinator,
Aged Care and Clinical Education
Melbourne East GP Network
ahill@megpn.com.au