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One in 20 patients ready to go - but stuck in hospital

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More than five per cent of South Australia’s hospital beds are occupied by patients who no longer need hospital care.

Last week, 149 patients who had already been assessed as ready for discharge were waiting in hospital beds for placement in the aged care sector.

SA Health will meet with aged care providers and advocates this afternoon to discuss the problem.

According to the South Australian Salaried Medical Officers’ Association (SASMOA), a lack of supported aged residential care beds in South Australia is a major and growing cause of bed blockage in the hospital system.

“If elderly patients are unable to be discharged into supported aged residential care bed, they remain in the hospital, and this creates bed blockage,” association spokesperson Bernadette Mulholland told InDaily.

Aged and Community Services SA & NT CEO Alan Graham acknowledged the number of aged care patients waiting in hospital beds was concerning.

“No-one wants an older person to be in an environment like a hospital ward when there is no need for them to be there,” he said.

“We hate to use the term bed blockers because they’ve got every right to be there.

“We do need to find out from the providers, in conversation with the Health department, as to why (this occurs).”

Graham said several factors were contributing to high numbers of patients waiting in hospital for places in aged care.

He told InDaily that a low availability of aged care places, particularly in areas preferred by the families of the patients, was a significant part of the problem.

“You can understand, from the family’s perspective (that) if you live in the northern suburbs you don’t want them to be placed somewhere in the south,” he said.

“Generally, of course, rooms only become available when people pass away or move out, so the availability isn’t necessarily immediately there.”

A statement from SA Health said that while the process to assess aged care patients was relatively fast, it was working with stakeholders to speed up the discharge of elderly patients to aged care services.

“In July, patients at the Royal Adelaide and the Lyell McEwin Hospitals waited an average of between one and four days to receive an Aged Care Assessment Team assessment,” the statement reads.

“SA Health is working with the aged care sector to place these patients in an appropriate residential facility or assist them to return home.”

Australian Nursing and Midwifery Foundation CEO Elizabeth Dabars said much of the patient backlog could be avoided if more nurses were employed in the aged care sector.

“We need to enhance the staffing cohort and the other resources and supports available in residential aged care facilities in order to avoid (patients) from  … having to be hospitalised in the first place,” she said.

“It’s only the very basics of your personal hygiene and other care can be taken care of in that residential facility.”

She said that often, elderly patients were admitted to hospital with conditions that weren’t “technically hospital-worthy” because of low medical staffing in aged care facilities.

But Graham rejected the argument outright.

“No, that’s got nothing to do with it,” he said.

“Particularly in the metro area, all of the facilities would be appropriately staffed.

“There may well be occasional instances where an aged care provider that may be short of a registered nurse because someone has resigned, or something like that, but that’s not fundamentally the problem.”

Both the doctors’ and nurses’ unions want government to step in.

Dabars said the State Government should fund advanced practice nurses, allocated to particular geographical areas, to regularly visit aged care facilities.

This would help avoid hospitalisation for aged care residents, she said.

Meanwhile, SASMOA wants the federal government to ensure more aged care places are available outside of hospital.

“What is needed is immediate assistance from the Federal Government … to ensure that the elderly in South Australia who are sitting in hospitals awaiting supported aged residential care bed are given access to these beds in a timely manner,” Mulholland said.

“This is certainly a matter that the Federal Government needs to focus on urgently.

“(Its) failure to address this demand is impacting on the community of South Australia as a whole including families who want to see their elderly loved ones cared for in the appropriate setting not left to linger in a dangerously overcrowded and swamped hospital.”

Doctors have blamed a shortage of available beds, in part, for extreme overcrowding and “ramping” at emergency departments over the past several months.

They say overcrowding has caused mental health patients to be confined for several days in emergency departments and to be “chemically restrained” while waiting for acute psychiatric beds to become available.

Overcrowding has also been blamed for the need to carry out physical examinations of some patients in public waiting rooms and for  hundreds of violent threats against medical staff.

Earlier this month, Health Minister Jack Snelling announced 12 acute psychiatric beds would be reopened to help ease pressure on emergency departments.

The Federal Government funded 347 transition care places in South Australia during the last financial year at a cost of $21 million.

“As at 30 June 2013, South Australia had 117.8 operational aged care places for every 1,000 people aged 70 years and over –  the second highest ratio  in the country — compared to 111.7 nationally,” said Assistant Minister for Social Services Mitch Fifield.

“The Australian Government has a plan in place to increase aged care places by  to a ratio of 125 places for every 1,000 people aged 70 years and over by 2021–22.

“Residential aged care providers consider a number of factors before admitting residents from hospital, transition care or from their own home, including whether the person can be appropriately cared for within their facility.”

In the first week of September, 116 patients who had been assessed as ready to leave hospital were waiting there for placement in home-based or residential aged care.

There are around 150 public and private aged care providers in South Australia, ranging from single-resident operations to vast networks with over 2,000 staff, such as Southern Cross Care.

The state’s metropolitan hospitals contain just under 3,000 beds.

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