1. 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

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

3. Older Persons and Rehabilitation
2015 to 2020
Hospital Services

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

5. 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

6. 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

7. 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

8. Older Persons and Rehabilitation
2015 to 2020
Community

9. 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 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%.

10. 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.

11. 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.

12. 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.

13. 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%

14. Older Persons and Rehabilitation
2015 to 2020
Allied Health

15. 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

16. 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

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

18. 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

19. 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

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

21. 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