Meeting the Needs of our Older People in the Waikato Barb Garbutt Director Older Persons, Rehabilitation and Allied Health Lesley Thornley Allied Health Professional Lead Older Persons, Rehabilitation and Allied Health Directorate Belinda Macfie Nurse Director Meeting the Needs of our Older People in the Waikato 13 October 2017

Older Persons and Rehabilitation 2015 to 2020 Vision: Healthy People. Excellent Care

Older Persons and Rehabilitation 2015 to 2020 Hospital Services

Older Persons and Rehabilitation Inpatient Services Admission to the service: “What matters most?”

As an Inpatient Focus on patient experience/satisfaction and outcomes Consumer advisor reports monthly Processes to enhance care such as the fasting clock, ending PJ paralysis, delirium resources, mobility charts which are adopted across the hospital and across Midland

Partnership with Maori Focus on ensuring Maori patients receive what they deem to be culturally-appropriate care Partnership with Maori champions Use of tikanga and te reo Strong Kaitiaki involvement on wards, as part of the team, from referrals Feedback sought from patients

Planning for Discharge New process called SAFER: Senior doctor rounds All patients have an estimated date of discharge Flow of patients early Early discharge – focusing on getting ready the day before discharge Reviewing long stay patients

Older Persons and Rehabilitation 2015 to 2020 Community

Over 65 NASC Services Growth of service co-ordinators Locality based model Hospital inpatient assessments wait time reduced Increase in assessments and interventions Seeing all newly referred clients within 20 working days Growth from 10 service co-ordinators to 33 needs assessor service co-ordinators for 9,000 clients. Locality based model with presence in Whitianga, Thames, Raglan, Hamilton, Te Kuiti, Taumarunui, Tokoroa, Matamata and Te Aroha and covering all the areas in between. Hospital inpatient assessments wait time reduced 5 working days to an average of 1.2 working days, saving approximately 200-300 bed days per month. Disability Support Link Health of Older People team completed a total of: 2,124 initial assessments over the 2016/17 period (compared to 1,865 initial assessments in 2015/16) and 36% more interventions totalling 10,305 in 2016/17 (compared to 7,542 in 2015/16) The current focus is on seeing all newly referred clients within 20 working days. Current compliance with this target is 79%.

REACH (Realising Employment through Active Coordinated Healthcare) Innovative partnership between Waikato DHB and the Ministry of Social Development Collaborative approach Proactive wellness model of care. Trial until June 2018 Employment outcomes for 20% of clients Blueprint for alternative service delivery model Innovative partnership between DHB and Ministry of Social Development (MSD). Social investment approach for jobseekers with health condition or disability. Collaborative holistic client centred approach to health and social care. Proactive wellness model of care using Individual employment placement support for 12 weeks duration. Trial until June 2018, under evaluation by PhD student at the University of Auckland. Target is employment outcomes for 20% clients as a minimum. Blueprint for alternative service delivery model, including paperless service utilising remote working practices across agencies.

Disability Support Services for Under 65 Year Olds Eligibility criteria Experience based design Support for over 3,000 people Community based co-ordinator Maori NASC Eligibility criteria includes intellectual, physical, sensory disabilities and or autistic spectrum disorders. Disability Support Link is leading the national disability transformation by undertaking service improvement through ‘ experience based design’ guided by all stakeholders at every touch point of our processes. We support over 3,000 people over the Waikato DHB. We have one coordinator based in Thames/Hauraki and has proven very beneficial to the local community. We will be looking to extend this model in South Waikato. Disability Support Link has a Maori NASC the only one in the country.

START Criteria for START Up to six weeks input Guidance of registered nurses Interdisciplinary team involvement Individualised goal orientated plans Waikato clients have a geriatrician review Available to patients over the age of 65 years including those following an ACC related injury. Up to six weeks input, up to x four visits a day, x seven days/week. Healthcare assistants/support workers under the guidance of registered nurses. Interdisciplinary team involvement (geriatrician, physiotherapy, occupational therapy, nursing and administrative support). All clients have individualised goal orientated plans, using principles of functional rehabilitation. Waikato clients have geriatrician review on commencement, if issues arise and on discharge.

START START reduces the hospital admission by 27.3% or 5.9 days for the over 65 year old For ACC cases it reduces the days by 5.7 days (21.4% reduction) In the six months following, START can reduce the time an older person spends in hospital by around 40%

Older Persons and Rehabilitation 2015 to 2020 Allied Health

IDT emphasis on patient determined goals Integration of Allied Health Services with Older Persons and Rehabilitation IDT emphasis on patient determined goals Integration with Primary care: Community strength and balance On Your Feet Productive partnerships: Ortho rehabilitation Combined stroke ACC pathway Criteria for entry to service

Using Technology to Deliver Services Telehealth Mobile units for consultation Staff support/supervision Inter-service training Smart health Community START Older Persons and Rehabilitation outpatients

Older Persons and Rehabilitation Institute of Healthy Ageing 2015 to 2020 Institute of Healthy Ageing

Patron: Sir Professor Peter Gluckman …to provide a research framework that encourages the development and implementation of best clinical and management practice so that healthy ageing is promoted and supported within the Waikato, the Midland region, nationally and internationally … Patron: Sir Professor Peter Gluckman

Institute of Healthy Ageing Currently six fellows of the Institute of Healthy Ageing completing their PhD in partnership with the DHB. There will be four additional fellowships offered in the next 12 months. Fellows are supported by both Waikato and Auckland University scholarships Governance Group Bupa Fellow in Rehabilitation

Older Persons and Rehabilitation 2017 to 2020 ...Where to next?...

The Next Five Years! So much to do … Community geriatrician/nurse practitioner Expanded support at home Using InterRAI data to inform service development Frailty research Case management Workforce development and innovation Exploring increased use of virtual health/ technology Collaboration with Government departments, e.g. ACC Increasing the voice of patients/clients within service delivery