Bendigo Hospital aged care patients are benefiting from a new initiative to help their transition into residential care.
The Inpatient Care Coordinator (IPCC) makes sure the transition from hospital to nursing home happens as efficiently as possible. This allows acute beds to be vacated in a timely manner so patients in the Emergency Department or those with a booked admission can access them.
This transition is often an emotionally taxing and difficult process to navigate for patients and their loved ones. Bendigo Health Inpatient Care Coordinator (IPCC) Jodie Austin said “it’s incredibly rewarding to help families along at every step.”
Since the introduction of a dedicated full-time IPCC in May 2023, the hospital has seen improvements in patient flow, impact on social worker load and a positive relationship form with residential aged care facilities.
Within the first eight weeks, 50 patients were discharged to Residential Aged Care Facilities (RACF) and overall to date 83 patients have been discharged to RACF, with another 34 currently in stages of transition.
Belinda Lee, Acting Director of Nursing Medical Services, said the introduction of the inpatient care coordinator has made a significant impact on improving patient flow at Bendigo Health.
“The overall time it takes to transition an older person into RACF has reduced significantly and the beds that were previously blocked due to delays are now used for patients who are waiting in the emergency department for admission,” said Belinda.
“In addition, the feedback communicated from nursing and allied health staff, patients and their families and the residential aged care facilities has been overwhelmingly positive as there is now a dedicated role in place to coordinate and support the patients' journey into residential aged care,” she said.
Through building relationships with private and public aged care facilities, Jodie and her colleague Andrew Spencer, have developed direct pathways for patients who have found themselves in hospital and are now in need of a RACF on discharge.
Each RACF have different qualities to offer. Knowing the patient and respecting their individual care needs and desires helps the patient and their loved ones choose the best facilities for them.
“The feedback we’ve had from nursing homes is they appreciate being able to ring Bendigo Health and contact a consistent person, the IPCC, who is co-ordinating the transfer to their facility. This role has saved a lot of time, improved ease of communication and made RACF transitioning more efficient.”
Before the implementation of the IPCC; part of the Timely Excellent Care Collaboration (TECC) initiative, there was no member in the multidisciplinary team solely focused on supporting patients through this process.
Having a dedicated staff member who can respond promptly to patient/family questions and concerns has meant the process of transitioning patients is less drawn out.
An unplanned health event can see a formerly independent elderly person suddently navigating significant life decisions from a hospital bed. This coupled with the grief of losing independence, living separate from a spouse or leaving the family home is confronting. The situation is always easier if the patient and their families are preprepared with desired outcomes and agreed decision makers in place.
Meredith Milic recently helped her 93 year-old mother Mrs Langley on her journey into aged care after she suddenly became ill. “We didn’t know what to do next as we’ve never walked this path before. We had no understanding, we were unsure of everything.
“Jodie and Andrew helped us along the pathway of navigating how we go about making choices for mum, what was available for us, the process, going and looking at care homes - they kindly took us by the hand and guided us through something that was scary, enormous, challenging and emotional. They just gently guided us through
as a family with a lot of respect, care and a huge amount of empathy,” said Meredith.
“It really is wonderful when our patients find a new place of residence that meets their needs, and allows them to live a life true to who they are, and their values,” said Jodie.
Meredith agrees: “Mum is just living her best life now, with Jodie and Andrew’s gentle information and care. It was like you had a couple of extra family members along to support you in making what are some really challenging decisions.”