Could geriatric hospitals ease pressure on healthcare? Maybe – but improving care for older people is key

Australia is grappling with an augment in hospital visits among older people. 2015–16 and 2019–20Hospitalizations among people aged 75–84 increased by an average of 3% per year, the largest augment among all age groups.

The increasing demand is putting significant pressure on the healthcare system, contributing to impoverished patient flow, longer stays in emergency departments (EDs), and even ambulance overruns. This happens when paramedics are forced to wait at the hospital entrance and cannot transfer a patient to the ED in a timely manner.

In response, some health system leaders have recently called for the creation of independent geriatric hospitals to specifically meet the needs of older patients.

But is this a good idea? While there may be some benefits, the call for specialist geriatric hospitals signals that Australia is failing to provide adequate care for older people.

Geriatric care in Australia

Across Australia, geriatric care is often provided in sub-acute hospitals, specialist units, wards and clinics, following the acute part of the hospital stay.

One path is geriatric assessment and management serviceswhich aim to improve the functioning of patients with age-related health problems, such as frailty and cognitive decline, following surgery or other medical incident.

In most states, geriatric evaluation and management services may also be available delivered to your home.

Looking at the data from public hospitals across the countrywe can see that service levels vary across the state. We calculate that in 2020–21, geriatric assessment and management services with at least one night’s stay accounted for 45% of sub-acute care admissions in Victoria and 20% in South Australia, but only about 8% in the Australian Capital Territory and Fresh South Wales.

These hospital-based services take a holistic approach to assessing multiple aspects of an older person’s health, such as mobility, mental health, medication management, nutrition and social support, to tailor individual care plans that support older people live at home longerwith a better quality of life.

On the other hand, lack of access to community-based geriatric care – such as home care packages – is often seen as a factor that increases the need for specialist geriatric care in hospitals and increases the length of hospital stay.

We know that current waiting time For a level 4 (highest) package, the period is between 9 and 12 months, although the government has committed to shortening this period with modern reforms to aged care.

Without adequate support at home, older people often end up in hospital, where they sometimes have to spend weeks or months waiting to be transferred to a care facility.

Pros and cons of geriatric hospitals

A specialist geriatric hospital could be designed around the needs of older patients. It could include specialist medical and support services, but also an adapted physical environment, such as clear signage and silent spaces.

It is significant to consider who will staff these stand-alone geriatric hospitals. Geriatric patients will still need specialists other than geriatricians, so cardiologists, for example, will need to specialize in geriatric cardiology. Alternatively, separating care in this way could mean that geriatric patients receive lower-quality cardiology care (and other specialties).

Would additional capacity in a stand-alone hospital support with healthcare system pressures? The plain answer is yes, but as with adding capacity to the hospital system, if this unlocks unmet demand and draws even more patients into hospitals from the community and aged care, it is unlikely to support with ED congestion.

It is also worth considering whether an independent hospital could have its own geriatric emergency department. It is unlikely that an emergency department in this context would reach the patient volumes required by emergency departments to maintain quality and efficiency. However, without one, transfers from existing emergency departments would further strain constrained ambulance resources.

So would a stand-alone geriatric hospital be more cost-effective than spending the same budget to build it in a different way? By focusing on specific populations where the impact would be greatest, we could make the business plan work.

Dementia Care: A Potential Target for Specialist Hospitals

Psychogeriatric care – mental health care older adults – is a prime example of where federal funding gaps are failing patients. This is particularly true for those with behavioral and psychological symptoms of dementia.

Families are not well supported in the community to cope with the enormous burden of care, and social services are not equipped to provide adequate support for these people. As a result, patients end up trapped in the social safety net of a public hospital bed.

These beds often provide non-specialist care for dementia patients. An unfamiliar and over-stimulating environment, coupled with staff who may misinterpret the behavior of these patients, only makes difficult behavior worseThis, in turn, makes it challenging for caregivers of older people to accept such a person.

There are currently anecdotally 50 to 70 patients in South Africa with symptoms suggestive of dementia who are stuck in hospital, with no urgent medical reason to be there, waiting for a place where they can be safely discharged, such as aged care. In our experience, the average length of stay for these patients is 50 to 60 days and contributes to bottlenecks in the ED. These numbers will only augment as the population ages.

A stand-alone dementia hospital could link the states and the Commonwealth in caring for people with behavioral and psychological symptoms of dementia. It cannot replace residential care for older people, but it could support with the transition by improving the hospital experience for people with special age-related needs.

However, it is imperative to maintain existing multidisciplinary approaches, such as geriatric assessment and management services, to avoid isolating or separating care from those who are already vulnerable.

Improving existing hospitals for the elderly

While there may be some justification for the call for stand-alone geriatric hospitals, it ultimately highlights Australia’s failure to provide adequate and integrated hospital and aged care.

Commonwealth Government recently announced significant changes to funding for older people’s care and modern support for home care. Existing hospital services would certainly work better if patients had more options to which they could be referred after their hospital stay.

Upcoming Commonwealth Aged Care Act is expected to reform many aspects of care for older Australians. However, without further detail and collaboration between the federal government and the states and territories, integrated service planning is not possible.

In the meantime, existing hospitals could begin to transform into places better suited to the needs of older people.