Second National Transition Care Forum 2009 National Convention Centre Canberra 24th November 2009

Second National Second National Transition Care Transition Care

ForumForum20092009

National Convention Centre Canberra

24th November 2009

A component of :A component of :Transition Care: Innovation Transition Care: Innovation and Evidence (TIE) Research and Evidence (TIE) Research ProgramProgramFunded by a NHMRC Program Funded by a NHMRC Program GrantGrant

University of University of SydneySydney

Flinders UniversityFlinders University

University of University of QueenslandQueensland

Transition Care ForumTransition Care Forum24 November 200924 November 2009

Objectives of Forum:Objectives of Forum: To explore the Australian Transition Care To explore the Australian Transition Care

Program – current status and future directionsProgram – current status and future directions To explore developments related to TC in To explore developments related to TC in

AustraliaAustralia To understand international developments To understand international developments

relevant to transition carerelevant to transition care To examine other aspects of ‘transition’ for To examine other aspects of ‘transition’ for

older people older people

Supported by a Strategic Grant awarded by the National Health and Medical Research Council

TimeTime TopicTopic SpeakerSpeaker

9:009:00 Introduction and Introduction and WelcomeWelcome

Transition Care – Transition Care – Innovation & Evidence Innovation & Evidence (TIE)(TIE)

Ian CameronIan CameronTIE – University of SydneyTIE – University of Sydney

9:209:20 Keynote SpeakerKeynote Speaker

Transition Care from Transition Care from an International an International PerspectivePerspective

Stuart ParkerStuart ParkerUniversity of Sheffield UKUniversity of Sheffield UK

9:509:50 The future of Subacute The future of Subacute Care in View of the Care in View of the National Health & National Health & Hospitals Reform Hospitals Reform Commission ReportCommission Report

Gail YappGail YappDepartment of Health & AgeingDepartment of Health & Ageing

10:210:200

MORNING TEAMORNING TEA

10:410:400

Does Transition Care Does Transition Care have a future?have a future?

Leon FlickerLeon FlickerUniversity of Western AustraliaUniversity of Western Australia

11:111:100

Keynote SpeakerKeynote Speaker

Transition Care into Transition Care into the Futurethe Future

Lesley PodestaLesley PodestaDepartment of Health & AgeingDepartment of Health & Ageing

11:411:400

DebateDebate: Transition : Transition Care, Rehabilitation, Care, Rehabilitation, GEM?GEM?

Is Time the Real Is Time the Real Healer?Healer?

Lesley Podesta Lesley Podesta (Department (Department of Health & Ageing)of Health & Ageing)

Stuart Parker (Stuart Parker (University of University of Sheffield UK)Sheffield UK)

Nicole Doran Nicole Doran (Department (Department of Health Victoria)of Health Victoria)

Leon Flicker Leon Flicker (University of (University of Western Australia)Western Australia)

Craig Whitehead Craig Whitehead (TIE – (TIE – Flinders University)Flinders University)

ModeratorModerator: : Sue Kurrle Sue Kurrle (TIE – Hornsby Ku-ring-gai (TIE – Hornsby Ku-ring-gai health Service)health Service)

12:312:300

LUNCH & POSTERSLUNCH & POSTERS

TimeTime TopicTopic SpeakerSpeaker

13:313:300

PanelPanel: Transition : Transition Care – State Care – State Commonwealth and Commonwealth and Service Perspectives Service Perspectives of a Maturing Service of a Maturing Service and Current and Current InitiativesInitiatives

Trudy SuttonTrudy Sutton (ACH Group) (ACH Group)

Graham KraakGraham Kraak (Queensland (Queensland Health)Health)

Nicole GoranNicole Goran (Department of (Department of Health Victoria)Health Victoria)

Melinda LongMelinda Long (Northern Sydney (Northern Sydney & Central Coast Area Health & Central Coast Area Health Service)Service)

14:314:300

Frailty – It’s Frailty – It’s Relevance to Relevance to Transition CareTransition Care

Sue KurrleSue Kurrle (TIE – Hornsby Ku- (TIE – Hornsby Ku-ring-gai Health Service)ring-gai Health Service)

14:414:455

Consumer Choice Consumer Choice and Transition Careand Transition Care

Julie RatcliffeJulie Ratcliffe (TIE – Flinders (TIE – Flinders University)University)

15:015:000

Variability of Variability of Implementation & Implementation & Utilisation of the Utilisation of the Transition Care Transition Care Program across Program across AustraliaAustralia

Craig Whitehead Craig Whitehead (TIE – Flinders (TIE – Flinders University)University)

15:115:155

Transitional Care Transitional Care Quality IndicatorsQuality Indicators

Nancye PeelNancye Peel (TIE – University of (TIE – University of QueenslandQueensland

15:315:300

AFTERNOON TEAAFTERNOON TEA

15:515:500

Transition Care in Transition Care in Action – Assessing, Action – Assessing, Planning & Planning & EvaluationEvaluation

Free PapersFree PapersBetty Tzouvelis Betty Tzouvelis (Department of (Department of Health Victoria)Health Victoria)

Trudy Sutton Trudy Sutton (ACH Group)(ACH Group)

Shanandoah Schaffers Shanandoah Schaffers (Peninsula Health Transition Care)(Peninsula Health Transition Care)

Mandy Beylacq Mandy Beylacq (Transition Care (Transition Care Program, Qld)Program, Qld)

16:316:300

Health Economics of Health Economics of Transition CareTransition Care

Paul Scuffham Paul Scuffham (TIE – Griffith (TIE – Griffith University)University)

16:416:455

Questions on Questions on afternoon sessionsafternoon sessions

Ian Cameron Ian Cameron (TIE – University of (TIE – University of Sydney)Sydney)

17:017:000

Overview and Overview and Synthesis of ForumSynthesis of Forum

Len Gray Len Gray (TIE – University of (TIE – University of Queensland)Queensland)

17:317:300

Close of ForumClose of Forum

Transition Care Program - Transition Care Program - BackgroundBackground

DefinitionDefinition “Transition Care provides short-term support and

active management for older people at the interface of the acute/subacute and residential aged care sectors.”

“It is goal oriented, time limited and targets older people at the conclusion of a hospital episode who require more time and support in a non hospital environment to complete their restorative process, optimise their functional capacity and finalise and access their longer term care arrangements.”

Australian Government Department of Health and Ageing. The transition care program guidelines. Canberra: DHA, 2005. http://www.health.gov.au/internet/main/publishing.nsf/content/EBBB0E83C736F2AACA2571E70008AA40/$File/tcpg.pdf


http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-policy-transition.htm


Australian Government Program, in Australian Government Program, in collaboration with state governments, collaboration with state governments, announced in 2004announced in 2004

2,000 places with operational budget 2,000 places with operational budget of $150 million in initial Programof $150 million in initial Program

Current Australian Government has Current Australian Government has committed to funding an additional committed to funding an additional 2,000 places2,000 places


Total allocated & operational transition care placesState/Territory as Dec 4, 2008

State Allocated Transition Care Places

Operational Transition Care Places

NSW 772 768

VIC 570 570

QLD 389 383

SA 193 193

WA 178 178

TAS 67 57

NT 22 16

ACT 37 37

NATIONAL 2,228* 2,202

* 228 of these 2,228 transition care places are part of the first stage of the Rudd Labor Government election commitment – bringing the total to 4,000 by 2011-12.http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-je-je232.htm

Transition Care Program - Transition Care Program - EvaluationEvaluation

Evaluation released by Minister Elliot on 8 September 2008

Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-transition-national-evaluation.htm

The Transition Care Program provided additional treatment and care options following hospitalization that were highly valued by patients and their families.


Transition Care Program - Transition Care Program - EvaluationEvaluation

Functional improvements occurred … those who received Transition Care had fewer readmissions to hospital and were less likely to move into permanent residential aged care.

The Transition Care program is relatively expensive when incremental cost effectiveness is considered.


Transition Care in the Transition Care in the context of other services for context of other services for

older peopleolder people

Giles et al. Aust Health Rev 2009; 33 (4): 572-582. http://www.aushealthreview.com.au/publications/articles/issues/ahr_33_4_1109/ahr_33_4_572.html

Transition Care and other Transition Care and other services for older peopleservices for older people

Giles et al. Aust Health Rev 2009; 33 (4): 572-582. http://www.aushealthreview.com.au/publications/articles/issues/ahr_33_4_1109/ahr_33_4_572.html

Transition Care – related Transition Care – related developmentsdevelopments

National Partnerships – Health, Health National Partnerships – Health, Health and Health Workforce Reform: Subacute and Health Workforce Reform: Subacute carecare State plans are available at: State plans are available at:

http://www.federalfinancialrelations.gov.au/cohttp://www.federalfinancialrelations.gov.au/content/national_partnership_agreements/health.ntent/national_partnership_agreements/health.aspxaspx

Plans vary from general statements, eg “Plans vary from general statements, eg “NSW Health is committed to achieving a 20% growth in subacute activity over the four years 2009/10 - 2012/13”, to statements about developments at specific sites.

State based initiativesState based initiativesSupported by a Strategic Grant awarded by the National Health and Medical Research Council

Transition Care –Transition Care – International Issues International Issues

Ageing populationsAgeing populations United KingdomUnited Kingdom CanadaCanada United States of AmericaUnited States of America New ZealandNew Zealand Other countriesOther countries


Other aspects of Other aspects of ‘transitions’‘transitions’

Transition issues in health and Transition issues in health and support servicessupport services ConsumersConsumers Service providersService providers Quality indicatorsQuality indicators Economic aspectsEconomic aspects

Frailty and disability Frailty and disability


National Transition Care National Transition Care Forum 2009Forum 2009

Packed program – keep to timePacked program – keep to time Note poster session during the lunch Note poster session during the lunch

breakbreak Where possible, opportunity for Where possible, opportunity for

questions during the dayquestions during the day Note question session at 4.45pm. Note question session at 4.45pm.

Preferably submit written questionsPreferably submit written questions Enjoy the day! Enjoy the day!

Transition Care Program - Transition Care Program - BackgroundBackground Transition care is provided at the conclusion

of an inpatient hospital episode and involves short-term (up to 12 weeks) support and active management for older people

Assessment and approval from an Aged Care Assessment Team is required for entry

Services are designed to improve patients’ physical, cognitive and psychosocial functioning

Services may include medical and nursing support, rehabilitative services, personal care and case management (including identification of longer term care options).

The program is offered predominantly in the community, but also in selected subacute or residential aged care facilities.Supported by a Strategic Grant awarded by the National Health and

Medical Research Council


“An average transition care episode is expensive (about $11 000). Therefore, careful consideration of the relative cost-effectiveness compared with other interface programs such as inpatient subacute services is essential”

“Transition care services should be established within the context of overall regional plans for aged care, incorporating hospital acute and subacute inpatient services, and long-term”

Gray L, Travers C, Bartlett H, Crotty M, Cameron I.

Transition Care: Will It Deliver? Medical Journal of Australia 2008; 188: 251–253


Documents

Second National Transition Care Forum 2009 National Convention Centre Canberra 24th November 2009