Topic: Older person health

A new face-to-face service which connects vulnerable older people with a variety of aged care and other services, provides guidance in navigating the My Aged Care system and does regular check-ins with clients, is now operating in South Western Sydney.

South Western Sydney Primary Health Network (SWSPHN) has funded six “care finder” services across the region, which will focus on the specific needs of their communities.

Care finder service providers in South Western Sydney include:

• CatholicCare Sydney which covers all of South Western Sydney with a particular focus on older people at risk of homelessness (131 819)
• Catholic Healthcare which covers Campbelltown Local Government Area (LGA) (1800 225 474)
• Multicultural Care Limited which covers all South Western Sydney LGAs with a particular focus on Hindi and Vietnamese communities (9718 6199)
• Western Sydney Migrant Resource Centre which covers all South Western Sydney LGAs with a particular focus on Arabic and Assyrian communities (8778 1200)
• EACH social and community health which covers Camden, Wollondilly and Wingecarribee LGAs (1300 003 224)
• Benevolent Society which covers Bankstown, Fairfield, Liverpool and Campbelltown LGAs (1800 236 726)

The care finder services are a Commonwealth-funded aged care initiative, and part of the government’s response to the Royal Commission into Aged Care’s recommendation for more localised and face-to-face support to help people navigate access to aged care services.

Through the program, older people are assisted to find services and support which is right for them and considers their individual needs. The care finder organisations complement the existing My Aged Care single entry portal.

Care finder services are intended for senior Australians who need intensive support.

This includes non-Aboriginal and Torres Strait Islander people aged 65 and over, and Aboriginal and Torres Strait Islander people aged 50 and over. Those eligible for the service may be isolated, have communication barriers or trouble processing information.

According to SWSPHN’s 2022-2025 Needs Assessment, in 2021 there were 148,072 older adults living in South Western Sydney.

It is expected the number of people aged 65 years and older will reach up to 220,620 by 2031, an increase of 49 per cent. The growth in the next 15 years is expected to be particularly significant amongst those over 85 years of age (an increase of 92 per cent) with an additional 14,660 people.

The most significant increase in the older population in the next 15 years will be in the Macarthur region: Camden (181.5 per cent), Campbelltown (83.1 per cent) and Wollondilly (81.9 per cent) LGAs; followed by Liverpool LGA (94.9 per cent).

SWSPHN Chief Executive Officer, Dr Keith McDonald PhD, said the care finder services were vital to ensuring members of our growing ageing population were able to access aged care services and other relevant community support.

“We’ve worked with our community – including consumers, carers and aged care providers – to design services which support the specific needs of older adults in our region, and we’re thankful to all those who shared their valuable knowledge and input during forums and via surveys,” he said.

“Care finder services will have a particular focus on those who are vulnerable, and are at greatest risk of falling through the cracks. This includes people who are not yet receiving aged care services, as well as those who are.

“The program aims to improve the health of our older people by improving participants’ understanding of aged care services and how to access them, and improving coordination of and connection to aged care and other services they may need.”

There are four ways for South Western Sydney residents to apply for care finder services.

• Call and speak to any of the commissioned care finder service providers
• GP referral: A GP may decide care finder services are needed and submit a referral on behalf of the patient
• My Aged Care: A My Aged Care assessor may decide whether care finder intensive support is needed and apply on the person’s behalf
• Call Triple I centralised intake to discuss a referral to a care finder service in your area (1800 455 511)

Visit our website to find out more about how care finder services can help and how to access those services.

Working with aged care providers and people living in aged care homes has always been a labour of love for nurse and owner of The Practice Bundanoon, Jessie Beresford.

Jessie tells us about her passion project in this edition of Spotlight on General Practice.

 

Why did the team at The Practice begin working with the local aged care facility to assist the community to access better healthcare?

As a manager at a local aged care facility, current practice nurse and practice owner, Jessie (pictured right) found her passion and drive for improving health outcomes for residents of residential aged care homes in the region.

Still working in Wingecarribee, but moving into primary care, continuing this care was a no brainer for Jessie and her practice staff.

As well as going into aged care facilities, The Practice has taken on more than 20 new patients who are residents in aged care homes locally, to provide a deeper level of care. This trust and ongoing commitment to continuity of care has allowed for a number of changes to take place in this area.

What does this involve?

One day a week, on a Tuesday afternoon, Jessie will visit the local aged care home to chat with residents about their health. These sessions can include anything from discussing patient care plans, blood pressure checks, mental health checks or simply chatting with residents to let them know what options they have during this time of their lives in regard to ongoing care and support.

This support helps to take the burden off registered nurses working at aged care homes who are often overworked and simply don’t have the resources available to take the extra time to chat with residents.

Why is the work to support this community important? And what has this achieved?

An advocate for aged care, Jessie believes it is important to let older people know what they are entitled to and what their options for care are as they age. Families, carers and patients should have all the necessary tools to guide the older person through their later stages.

Information is available online and sometimes at general practices or libraries, but it’s about knowing what is useful and what can help the patient to make informed decisions about their own health and the care they wish to receive is vital. Visiting the aged care home allows for this transfer of information and having patients cared for at The Practice allows for continuity of care.

Further supporting her work at the aged care home, Jessie’s role as a practice nurse is to ask the important questions during her over 75s health checks for all patients around this age: Do you have a Will? Do you have a Power of Attorney? Have you got a next of kin? And so on. It is important to make sure these documents are up-to-date and easily accessible prior to the patient being placed in an aged care home.

Through this care, residents living in Wingecarribee are given the autonomy to make their own decisions about their care and what they would like to happen as they age. Carers and families are given peace of mind and the tools to ensure the best outcome.

What is the biggest challenge of the role and how can it be overcome?   

A lack of funding. The role is essentially being a liaison for the person, or the conduit between them and the right care plan for now and in the future. The work is time consuming and not everyone in the region can be cared for due to these constraints.

The care doesn’t end after the information session ends at the aged care home – there is a lot of follow-up with phone calls, emails and check-ins taking place for each individual.

What is the most rewarding aspect of being a practice nurse and facilitating care for such a diverse population?  

Knowing older people are safe, this includes the reassurance and increased knowledge for the older people, their families and their carers.

What is the best way to educate people living and working in aged care facilities about the importance of maintaining good health?

Communication and education for families, working with the deputy managers at aged care homes to assess the needs of people living in the area each week.

Education typically consists of assisting with the next stages, including where to refer the patient, wound management, palliative care management and behaviour management.