Lifting Your Horizons 2011 and BeyondLifting Your Horizons 2011 and Beyond

REDESIGN OF SERVICES FOR OLDER PEOPLE

Dr E Spellacy

HealthCare Providers New Zealand Inaugural Conference 8-10 August 2005

Bay Of Plenty DHB

BACKGROUND TO REDESIGNBACKGROUND TO REDESIGN

THE AGE OF AGEINGTHE AGE OF AGEING

Life ExpectancyLife Expectancy has doubled over the last 200 years has doubled over the last 200 years Previously not changed for thousands of years, so we Previously not changed for thousands of years, so we

have no cultural history to help us adjusthave no cultural history to help us adjust The increase in life expectancy is not slowing and The increase in life expectancy is not slowing and

progresses by 2 years every decade progresses by 2 years every decade

(due to environmental, nutritional, and medical changes)(due to environmental, nutritional, and medical changes)

LongevityLongevity has also shown an accelerating increase over has also shown an accelerating increase over the last 20 – 30 yearsthe last 20 – 30 years

Death rates in > 80 year-olds are fallingDeath rates in > 80 year-olds are falling

HEALTH IN OLDER PEOPLEHEALTH IN OLDER PEOPLE Ageing processes change the response and capacity ofAgeing processes change the response and capacity of physiological systems physiological systems

Presentation, investigation and treatment of disease is different from that in younger peoplePresentation, investigation and treatment of disease is different from that in younger people

Even minor loss of health may cause significant unstable disability and drive functional Even minor loss of health may cause significant unstable disability and drive functional support needssupport needs

Access to specialised rehabilitation is essentialAccess to specialised rehabilitation is essential

Extensive community and primary linkages are requiredExtensive community and primary linkages are required

This population is driving major changes in the health sectorThis population is driving major changes in the health sector

AGEING: IMPACT ISSUES (1)AGEING: IMPACT ISSUES (1)

Societal culture and attitude – impact of ageism increases

Social determinants become more relevant

Education, training and information needs change and increase for all

Change in disease patterns impact on health sector culture, staffing mix, and professional practice - not just costs

Capacity and partnerships become more critical

Workforce development, and the related role of the community and volunteers, assume a high priority

AGEING: IMPACT ISSUES AGEING: IMPACT ISSUES (2)(2)

Bi-directional influence on business, commercial services and local economy

Housing – issues include range, types, perceptions, stock, sole living, cognitive loss, ‘housing’ separated from ‘care’

Cognitive impairment more prevalent

‘Ageing in place’ induced residential sector changes

Palliative services for older people differentiated Purchasing framework mirrors ‘continuum of care’

NZ’s STRATEGIC JOURNEYNZ’s STRATEGIC JOURNEY1997 Facing the Future: A Strategic Plan (Prime Ministerial Task Force on Positive Ageing)2000 Report of the N.H.C. on Health Care for Older People

2001 The NZ Positive Ageing Strategy & Action Plan2001 The NZ Disability Strategy 2002 The NZ Health Strategy2002 Maori Health Strategy

2002 Health of Older People Strategy2003 Assessment Guidelines for Older People2004 Guideline for Specialist Health Services for Older People

BABY BOOMERS BABY BOOMERS 2011 2011 • • FirFirst wave reach 65 years; with cultural, financial and st wave reach 65 years; with cultural, financial and workforce impact workforce impact • • Window for redesign closing, but some leeway for needWindow for redesign closing, but some leeway for need• • Chronic conditions are top priority for DHBsChronic conditions are top priority for DHBs• • Community services are now first call on resourcesCommunity services are now first call on resources• • ‘Ageing in place’ strategy enacted, residential care mainly at ‘Ageing in place’ strategy enacted, residential care mainly at hospital level with av. age of entry to residential care 90+hospital level with av. age of entry to residential care 90+• • Rest home provision at population targeted levelsRest home provision at population targeted levels• • HOOPS implemented HOOPS implemented

20212021• Boomers • Boomers reaching 75 years. More people > 65 than < 15reaching 75 years. More people > 65 than < 15 • • Superannuation and Health/DSS first call on all govt. expend.Superannuation and Health/DSS first call on all govt. expend.

BABY BOOMER IMPACT BABY BOOMER IMPACT from 2011 – 2021 onwards from 2011 – 2021 onwards

We cannot afford to deliver, even to current best We cannot afford to deliver, even to current best

practice, unless radically new models of promotion, practice, unless radically new models of promotion,

prevention and intervention are in place prevention and intervention are in place

POPULATION GROWTH

PROPORTION OF OLDER PEOPLE

Plus heterogeneity of districts

Acknowledging: a) the health needs of other populations and communities e.g. children, Maori, those with chronic conditions, rural dwellers b) wider issues such as workforce, site improvement, and broader determinants of health

THE MAJOR CHALLENGES THE MAJOR CHALLENGES FOR BOP DHBFOR BOP DHB

BOP DEMOGRAPHY 2001-11BOP DEMOGRAPHY 2001-11

Population increase 14% v 7.3 % nationally over the decade (20% in the western BOP) Highest % growth in > 75 year group - 40% (5,000) 65 - 74 group - 30% (4,500) 45 - 64 group - 33% (14,000)

Very high relative percentage > 65y (18% in western BOP)

Sixth largest absolute DHB population > 65 in N.Z.

Discrepancy between specialised services and the older population is a major DHB challenge for quality, reputation and sustainability

HEALTH OF OLDER PEOPLE HEALTH OF OLDER PEOPLE STRATEGYSTRATEGY

THE VISION:

Older people participate to their fullest ability in decisions about their health and wellbeing and in family, whanau and community life.

They are supported in this by co-ordinated and responsive health and disability support programmes.

L I F E C O U R S E I N T E R V E N T I O N S T R A T E G I E S

I m p a c t s t r a t e g i e s f o r e f f e c t i n g f i t n e s s g a p c h a n g e s e n v i s i o n e d i n t h e c y c l i c a l l i f ec o u r s e p a t h w a y s o f O l d e r P e o p l e

Old

er

Pe

rso

n F

un

ctio

n f

or

Ind

ep

en

da

nce

Years

Lifestyle

Education ForHealth

Lifestyle RiskFactors &

Environment

Assessment &Rehabilitation

Review & Supportfor Resilience

Older PersonPalliative Care

Ageing In Place

LIFE COURSE INTERVENTION (diagrammatic)Individual health profiles may profoundly influence the course

PATHWAY DIRECTIONPATHWAY DIRECTIONOUTLINEOUTLINE

Which way into our future?

• What is this ageing?• Who are the old?• Why are they different?• What has it got to do with disability?• What has NZ been doing about this?• What are our time lines?• How are overseas countries approaching this?• What are other Districts doing?• What are we doing in BOP?• What else should we be thinking about?

WE NEED TO KNOWWE NEED TO KNOW

HEALTH FUTURES: 2020 HEALTH FUTURES: 2020 VISIONS VISIONS Institute of Policy Studies 1997Institute of Policy Studies 1997

Drivers: • Advance of medical technology• Need to ration resources• Impact of ageing • Growth in information technology• Greater consumer expectations of service

Questions:• Where do we want to be ?• What do we have to do to get there ?• When does it need to be done ?• Who has to do it ?

SOME KEY ISSUES SOME KEY ISSUES

IDENTIFIED IN OVERSEASIDENTIFIED IN OVERSEAS

STRATEGIES STRATEGIES

Australian directions in aged care: 2001

1. A constructive approach

2. Improve funding approaches

3. Regional development and delivery

4. Unbundling accommodation and care services

N.S.W. Framework for integrated support and management of older people in the NSW health care system

Standards: 1. Care & support of older people and their families/carers 2. Leadership and management structure

Key Issues: Dementia Systems approach Prevention, continuity and research for chronic and complex disease Admission as a sentinel event

NATIONAL SERVICE FRAMEWORK NATIONAL SERVICE FRAMEWORK FOR OLDER PEOPLE (U.K.)FOR OLDER PEOPLE (U.K.)

STANDARDS

One: Ageism; services provided on clinical need alone

Two: Person-centered; individuals treated by integrated services

Three: Intermediate care; transition support for independence

Four: General hospital care; right skill sets and specialist teams

Five: Stroke; reduce incidence and deliver an integrated service

Six: Falls; reduce incidence, treat and rehabilitate

Seven: Mental health; promotion, treat and manage dementia and depression

Eight: Promote healthy and active life; extend healthy life, councils

Medicines management

Local delivery of services

JOSEPH ROWNTREE FOUNDATION Older people shaping policy and practice (2004)

From welfare to wellbeing - planning for an ageing society (2004)

Key Issues:

Vision and culture; ageism and discrimination; poverty and

income; information and resources for choice; market needs

as consumers; quality and life; housing and support options;

strategy resourcing and commissioning at all levels

INTEGRATED CARE SYSTEMSINTEGRATED CARE SYSTEMS

Many examples from different countries, not an end in themselves, tend to focus on frail groups, generally not cheaper, may reduce hospital admissions, often preferred by patients, require established primary sector competencies, capacities and systems

e.g.

S.I.P.A. Montreal;

Metropolitan Jewish Health System N.Y.; P.A.C.E.; Minnesota Senior Health Options Programme; Texas Starplus; Wisconsin Partnership

Also U.K. examples

REDESIGN OF SERVICES FOR REDESIGN OF SERVICES FOR OLDER PEOPLE INITIATIVEOLDER PEOPLE INITIATIVE

Provides a design blueprint and path for the District’s implementation of the HOOP Strategy by 2010

• Utilises the DHB’s Programmes of Care Framework

• Incorporates other National Strategies & Guidelines

• Facilitates one of the Board’s principle health outcomes “Healthy, Independent and Dignified Ageing”

• Provides blueprint recommendations for management and funding consideration

Population with anearly condition and

few otherconditions

Population withadvanced condition

and multipleconditions

Population withend-stagecondition

General Population

Publicly Funded Provider Roles for Populations of Increasing NeedA

cti

vit

ies

alo

ng

th

e C

are

Co

nti

nu

um

Population at riskof a condition

BOPDHBPoC

Framework

Promotive/Preventive

Detective

Curative/Maintenance

Recovery/Rehabilitation

‘Continuity’Management

SupportiveCare

Support forDaily Living

Support forFamily/Whanau

Public HealthHealth PromotionHealth Protection

CommunityDevelopment

Primary Health CareCommunity Health

NGOSupportive Care

Primary CareGeneral Practitioner

Practice NurseNurse Practitioner

Allied HealthPharmacists

Expert / Specialist CareMultidisciplinary Teams

Secondary CareTertiary Care

Condition-Specific Care

Primary HealthOrganisations

F ig u re 2 : S pec ia lis t hea lth se rv ices fo r o lde r peop le as pa rt o f a con tinuum o f ca re(pub lic and p riva te p rov ide rs)

Community-based services

Hospital-based services/ residential care services

Community Health

Support Services

SHSOP Acute/ Medical/ Surgical

Adult Mental Health

Specialist Palliative

CarePsychiatry of old age

Geriatric services

Health promotion

Disease prevention

Injury prevention

Elder abuse prevention

P HO sO ther primary care

C ommunity therapy*

Nursing

P harmacy

Diagnostics

V ision

Hearing

Dental

P odiatry

S upported livingR espite care

R ehabilitation-focused home support

C arer support

E quipment

M odifications

Home visit

C ommunity/ marae-based

clinics

O utpatient clinics

Home visit

C ommunity/ marae-based

clinics

O utpatient clinics

Home visit

C ommunity/ marae-based

clinics

O utpatient clinics

Home care

R espite

Inpatient Inpatient HospiceR esidential care

Assessment and service co-ordinationAC C case management

Integrated referral/access

Accident & E mergency Department

R apid response – supported discharge

Inpatient

F r ie n d s

* Inc ludes phys io therapy, occupa tiona l the rapy, speech language , ch irop ractics, acupunctu re e tc .

CONTINUUM OF CARE

Why Does Frailty Matter ?Why Does Frailty Matter ?

Well-being declines Well-being declines

Complex needs increase Complex needs increase

Societal and financial costs escalate Societal and financial costs escalate (note year pre-death) (note year pre-death)

Health and social outcomes difficult to align with Health and social outcomes difficult to align with resource use resource use

Key feature in National and District Health strategies, Key feature in National and District Health strategies, frameworks and guidelines but few studies to assess frameworks and guidelines but few studies to assess need or effectiveness of interventionsneed or effectiveness of interventions

Frailty is more than thisFrailty is more than this ♥ ♥ Recent research is concerned with defining characteristics of frailtyRecent research is concerned with defining characteristics of frailty

♥ ♥ Diminished ability exists to perform practical Diminished ability exists to perform practical andand social ADLs social ADLs

♥ ♥ The importance of social and environmental factors especially for The importance of social and environmental factors especially for the old-old is now acknowledgedthe old-old is now acknowledged

♥ ♥ Like intrinsic and extrinsic risk factors for falls it has personal (physical, Like intrinsic and extrinsic risk factors for falls it has personal (physical, cognitive) and environmental factors (social, interpersonal, institutional, cognitive) and environmental factors (social, interpersonal, institutional, legal)legal)

♥ ♥ Often a transitional phase existsOften a transitional phase exists

♥ ♥ Both physical and social factors may have preventable Both physical and social factors may have preventable andand remediable remediable aspectsaspects

Reflected in current international criteriaReflected in current international criteria

OUTCOMES should:OUTCOMES should:

1.1. Improve systems and processes for Improve systems and processes for specialist health services for older peoplespecialist health services for older people

2.2. Contribute to an integrated continuum of Contribute to an integrated continuum of servicesservices

3.3. Support ongoing quality improvement Support ongoing quality improvement and sustainabilityand sustainability

Character of the InitiativeCharacter of the Initiative

The characterThe character IS IS to:to:

Align service development to the Health of Older People Align service development to the Health of Older People Strategy (HOOPS) Strategy (HOOPS)

Align service development with the BOP Programmes of CareAlign service development with the BOP Programmes of Care

Enhance co-operation, co-ordination and coherency Enhance co-operation, co-ordination and coherency

Understand existing services for maximizing what is currently Understand existing services for maximizing what is currently working well working well

To develop services that meet the needs of older people now To develop services that meet the needs of older people now and beyond 2011and beyond 2011

Character of the InitiativeCharacter of the Initiative

The character The character IS NOTIS NOT to: to:

Fit services into facilities or current constraintsFit services into facilities or current constraints

Endorse the Endorse the status quostatus quo

Have a “throw the baby out with the bath water” approachHave a “throw the baby out with the bath water” approach

Impede healthy outcomes in the longer term Impede healthy outcomes in the longer term

Disregard the service requirements of other population Disregard the service requirements of other population groupsgroups

Charter Format: rather than T.O.R.Charter Format: rather than T.O.R.

A Project profile: purpose, background, sponsor, advisor

B Steering group: purpose, membership, operational aspects, steering group competencies, functions, meetings, reporting, quorum

C Attributes and outcomes

D Risk management

E Key components: character, vision statement, guiding principles

F Project plan: structure, phases, existing services, domain approach, working parties, communication strategy, evaluation and review

G Appendices

Attributes & OutcomesAttributes & Outcomes

Summary for Practical Planning Recommendations

• be relevant for the district• work alongside Maori Health Services, with guidance • support the ‘continuum of care’ concept to reduce duplication and gaps• use local expertise and capability• meet real needs without shying away from innovation• improve communication and advocate for older people• not disregard the needs of other population groups• welcome the participation of communities and consumers• link with other agencies and authorities• be understandable and flexible, open to review and evaluation

• as far as possible withstand health system change !

DOMAIN AREASDOMAIN AREAS

Non-Government

Organisations &Voluntary Sector

Maori HealthServices

Psychiatry forOld Age

SteeringGroup

Long TermSupport

Disability

ConsumerHealth Service

User

Specialist HealthServices

Palliative Carefor Older People

Primary HealthSector including

PHO's

Intersectoral

Local Authorities

Project PlanProject PlanPhase One

July 2004 August Sept – Nov Dec – Jan

•Formation of steering group•Definition of pathway, issues and work-streams •Project outline•Project plan

•Scoping of project completed •Work-streams prioritised according to DHB decision matrix grid •Working parties established with defined objectives •Coherency

•Working parties in progress•Clarification of key issues, linkages, themes, with design landscape taking form•Foundation issues have resolution plans

•Interim time point, workshop•Report end January 05•Indication of timeframe for project consequences that are realistic, highlighting extensions if necessary•Pick up recommendations•Decision mandate

Identifying interim products Purchaser feedback on interim products, as needed

Project Plan Project Plan (cont.)(cont.)

Phase Two Phase Three

Feb – May 2005 June 2005 July 2005 September

•Re-scope as needed•Information correlated •Working parties re-clustered. •Major redesign optionsformulated

•Redesign recommendations aligned and presented,1–15 year solutions.

•Final report.

•Redesign recommendations reviewed by Funder.

•Organisation business cases prepared

•Business case implementation.

•On-going redesign and development

Interim projects identified.

Early pilot implementation as needed and feasible.

RSOP Initiative Activities (1)RSOP Initiative Activities (1)

Charter preparation and endorsement

Communication of Initiative, with initial gaps rectified

Education and awareness raising, ongoing core activity     Attitudes and age, profiling of leadership of change and marketing of “great ageing” 

   Steering Group evolution including transfer of knowledge

    Identification, scoping and development of seeding/germination and foundation products            

Early DirectionsEarly DirectionsSEEDING/GERMINATION PRODUCTS• Restorative rehabilitation ward pilot plan • ‘Elder abuse’ coordinated district prevention service (Rights Issue)• ‘Continuum of provider’ post-rehabilitation agreement• Orthogeriatric collaboration (osteoporosis, fractures and prevention)• Early recommendations re SHSOP core development• Resource directory → centre linked to access and community network• Professionally co-ordinated volunteer service

FOUNDATION PROGRAMMES• Alignment of priorities for these services: PHOs, DHB, HOOPS• Stocktake of basic to mid-level education & training availabilities• Assessment Guidelines for Older People preparation → InterRAI• End of life-course palliative care initial liaison • Mental health for older people co-development

RSOP Initiative Activities(2)RSOP Initiative Activities(2)Information gathering on district, national and international strategies, directions, services and research. Incorporation into education and information opportunities as above.

Focus Groups with NGO’s, community organisations, health service users and interested others to further inform about RSOP, gain advice on engagement with RSOP and gather views on service improvements.

Specific consultation and relationship meetings with key organisations, services and individuals

Minor involvement with other projects/groups e.g. site redevelopment

Strategies to keep abreast and be included in district directions, discussions and decisions.

“Morphing” of the above into a nascent district framework for specialised health services for older people.

Focus GroupsFocus GroupsPurpose

• To inform people about the Redesign Initiative and its objectives

• To ask for community contribution to the Redesign and how this contribution could continue in the future

• To glean ideas and suggestions about improvement in specialised services and to identify the most significant gaps in service provision

Focus Group QuestionsFocus Group Questions

• What are the most important areas for the BOP DHB to put resources into so that older people can stay fit, healthy and independent at home?

• What suggestions do you have for how all the people involved in services for older people could communicate and link more effectively?

• What could be done to improve health and support for older people in rural areas?

• How can we better support and develop Maori health services for older people?

• What are the changes we need to make in all our services to support older people with cognitive loss (dementia) and other mental health problems?

Focus Group QuestionsFocus Group Questions cont.cont.

• How can we effectively ensure that older people, their groups and organisations, are involved in the on-going planning and delivery of health and support services for older people?

• Please give us your three (3) most urgent gaps in service that need to be addressed.

• Please give us your five (5) greatest ideas for how health and support for older people could be improved.

Purpose of Mid-point Workshop:Purpose of Mid-point Workshop:

To allow a dedicated time for the To allow a dedicated time for the Steering Group to review the emerging Steering Group to review the emerging redesign framework and revealed redesign framework and revealed underlying issuesunderlying issues

To consolidate and endorse To consolidate and endorse components to be included in the components to be included in the indicative reportindicative report

To provide an opportune time for this To provide an opportune time for this as phase 1 transitioned to phase 2as phase 1 transitioned to phase 2

To allow the incorporation of other To allow the incorporation of other ‘brains’ and experiences before ‘brains’ and experiences before channeling of directionschanneling of directions

To achieve early consensus on the To achieve early consensus on the 2011 Design2011 Design

To report on the detail of the work of To report on the detail of the work of phase 1phase 1

To repeat, review, or reproduce the To repeat, review, or reproduce the background material already covered background material already covered or presented in phase 1or presented in phase 1

To ensure unanimity of thought To ensure unanimity of thought patternspatterns

To work out the operational detail of To work out the operational detail of changechange

To be constrained by the present or To be constrained by the present or our attitude to itour attitude to it

To know all the answersTo know all the answers

Was Was not

Overall: to have 2 days that positively influenced our redesign, our practice, and our district. Concept worked well

CONTENTS OF THE REDESIGNCONTENTS OF THE REDESIGN

Continuum of Care PathwayContinuum of Care Pathway

BOP emerging design and pathway is compatible with other NZ redesign models but has characteristics specific for this district

Overseas models of interest for some sub-groups of older people cannot be considered until significant local development work has occurred, but the design will not restrict these future options

Outline of the detailed redesign directions follows:

Key Redesign Components for B.O.P. Key Redesign Components for B.O.P.

1. Informed participating older people supported by their key individuals or groups

2. Populations are aggregations of people who live in communities; the neighbourhood community should be the core unit of the redesign, cross-linked by communities of interest

3. Communities have a need to participate for healthy ageing, whilst district agencies have a capacity need for them to participate

4. The range of participatory assessments and processes must be smoothly and promptly coordinated and translated into acceptable effective interventions for quality ‘ageing in place’

5. Cooperative interaction with primary health teams and agencies for all services is central to the continuum of care

6. Dynamic interchange of knowledge and health care plans between S.H.S.O.P., other specialist services and primary health teams will drive progress

7. The maturing implementation of the NZ PH&D Act 2000 ‘calls out’ for the DHB to ensure the ‘provider arm’ reflects the population focus and has a leverage function for improved population health outcomes. A coherent associated move away from the business format of unit outputs to an aligned ‘service-based’ delivery pattern has much to recommend it, including the potential for hospital culture change

8. The rapid development of S.H.S.O.P. across the district with a coordinated unified direction is an essential driver; and is not possible without changing from a facility-based to a service-based structure  

9. Ageism needs mitigation through leadership, competent understanding, societal role modeling, lifestyle and economy changes; thus producing the changed expectations of ageing which influence the reality

10.Positive change in the broader determinants of health has no age restriction in its influence and requires intersectoral resourcing

11.Practicalities of implementation must be recognised with regard to major areas of resource rationing

Key Redesign Components for B.O.P. Key Redesign Components for B.O.P. (cont.)(cont.)

‘ ‘WhānauWhānau Capacities’ Capacities’ Prof Mason DurieProf Mason Durie

Capacity Function Focus Manaakitia Whanau care Wellbeing of Whanau members Pupuri Taonga Guardianship Management of Whanau estate Whakamana Empowerment Whanau participation in society Whakatakato Tikanga Planning Future generations Whakapumau Tikanga Cultural endorsement Whanau members, Whanau protocols Whakawhanaungatanga Whanau consensus Whanau cohesiveness

“….It’s about building Maori Communities: Skills, Strategies, Structures, Systems…”

MaoriMaori

Highest relative growth rate of all populations for >65 years

Absolute numbers still low in the short to medium term

HOOPS and other national/mainstream directions for the health of older people are in line with many traditional Maori values - but are poorly known to many small Maori providers

Maori providers have often developed services in relative isolation from the mainstream, using innovation and knowledge of their people

MaoriMaori

Priority for next two years is - in keeping with the Treaty

Knowledge exchange

Relationship building

Integral in all aspects/domains of service development

Capability for future capacity building

Preparatory to enhanced Maori Health Services for Older People under the guidance of, and in partnership with, the Runanga

THE REDESIGN REPORTTHE REDESIGN REPORT

PART 1:PART 1: Specialist Health Services for Older People and Specialist Health Services for Older People and other secondary servicesother secondary services

PART 2:PART 2: Access and resources to support quality Access and resources to support quality ‘ageing in place’‘ageing in place’

PART 3:PART 3: Primary health Primary health PART 4:PART 4: Palliation and end of life services Palliation and end of life services PART 5:PART 5: Information, participation and inclusion Information, participation and inclusion PART 6:PART 6: Sectors laying the foundations for health Sectors laying the foundations for health PART 7:PART 7: Leadership – consequences for management Leadership – consequences for management

and governanceand governance

Part 1: Specialist Health Services for Older Part 1: Specialist Health Services for Older People and Other Secondary ServicesPeople and Other Secondary Services

Current organisational climateCurrent organisational climate S.H.S.O.P. – ‘Health in Ageing’S.H.S.O.P. – ‘Health in Ageing’ Musculo-skeletal servicesMusculo-skeletal services Organised stroke servicesOrganised stroke services S.M.H.S.O.P. – psychiatry of old age S.M.H.S.O.P. – psychiatry of old age Clinical linkages with other secondary Clinical linkages with other secondary

servicesservices

S.H.S.O.P. Recommendations S.H.S.O.P. Recommendations (High Level Summary(High Level Summary) )

Service structure established

Staff capacity and capability enhanced - all disciplines, especially nursing, with positive discrimination for catch-up

General wards liaison capacity, including leading role in 05/06 required ‘Organised Stroke Service’

Community teams formed, including supported discharge

Ambulatory prevention, including emergency presentation

Community and emergency admissions

Market leader and educator role recognised

Part 2: Access and Resources to Part 2: Access and Resources to Support Quality ‘Ageing in Place’Support Quality ‘Ageing in Place’

Integrated accessIntegrated access Home based support issuesHome based support issues Disability and the communityDisability and the community Local prioritiesLocal priorities Accountability for individualsAccountability for individuals Residences and the residential sectorResidences and the residential sector

Part 3: Primary HealthPart 3: Primary Health

Older people as a PHO populationOlder people as a PHO population

Scope of the PHO for this populationScope of the PHO for this population

Cohesive capabilitiesCohesive capabilities

Scope of primary servicesScope of primary services

Part 4: Palliation and End of Life Part 4: Palliation and End of Life ServicesServices

Relationship to life-courseRelationship to life-course Integrating curative and palliative therapies – Integrating curative and palliative therapies – a paradigm shifta paradigm shift Special needs of older people- a paradigm expansionSpecial needs of older people- a paradigm expansion Role of continuityRole of continuity Specialised services including hospice servicesSpecialised services including hospice services Fragmentation related to funding streamsFragmentation related to funding streams Generalist and specialist palliative servicesGeneralist and specialist palliative services

Redesigned framework for district palliative servicesRedesigned framework for district palliative services

Part 5: Information, Participation Part 5: Information, Participation and Inclusionand Inclusion

Informed peopleInformed people Communities caring through support netsCommunities caring through support nets Community mosaic influencing change in Community mosaic influencing change in

the districtthe district Utilising community capacity for service Utilising community capacity for service

deliverydelivery Combating ageism: inclusion and rightsCombating ageism: inclusion and rights

Part 6: Sectors Building the Part 6: Sectors Building the Foundations for HealthFoundations for Health

Education and training for qualityEducation and training for quality

Workforce development within the DistrictWorkforce development within the District

‘‘Positive Ageing’ within the Bay of Plenty, Positive Ageing’ within the Bay of Plenty, through intersectorial initiativesthrough intersectorial initiatives

Workforce development for an Workforce development for an older populationolder population

Relationship between demography, demand, Relationship between demography, demand, labour, services and culturelabour, services and culture

Workforce development implicationsWorkforce development implications Workforce planning considerationsWorkforce planning considerations Workforce development within the organisationWorkforce development within the organisation Training and developmentTraining and development Role boundaries, capabilities, competencies and Role boundaries, capabilities, competencies and

skillsskills

Part 7: Causes & ConsequencesPart 7: Causes & Consequences

LeadershipLeadership

ManagementManagement

GovernanceGovernance

Executive ManagementExecutive Management

Issues requiring specific knowledgeable leadership

e.g. Getting the ‘Age of Ageing’ on the executive and

management table

Leading ‘Positive Ageing’ across all sectors

Workforce planning - dual focus

Public health - shift in approach

Communication

Hospital culture

Backing leaders

GovernanceGovernance Personal Health v Disability v ‘Public’ Health

“Health, disability & environment are inextricably linked in older people”

Therefore, which Board Sub-committee leads the development of services for older people and

fosters the continuum of care ?

(notably the core ‘Specialist Health Services For Older People’)

“Healthy Thriving Communities”

Promotive/Preventive

Health Services

Primary Health CareServices

Specialist HealthCare Services

Hospital

Non-healthAgencies

IPA

NGO

Provider

Provider

Timeline

Start

Early Years

MiddleYears

FutureFruition

HealthyThrivingCommunities

FoundationsDisconnected, isolationist, fragmented, differentiated

Pt = Patient centredSC = Self-care skills

SocialDeterminantsinterventions

Specialist CareIntervenions

PrimaryHealth Care

InterventionsPt

SC

CoCCMgtCoC = Continuity of CareCMgt = Care Management

Legend

SocialDeterminantsinterventions

PrimaryHealth Care

Interventions

SpecialistCare

Intervenions

SC CMgt

Linked preventive, primary health and specialist care services

Formalised ‘Care Bridges’ to meet defined need

BOP District Health Sector ‘System of Care’

Service Development and Planning Team BO P DHB

Acknowledgements

Sponsor: Ron Dunham, CEO, BOP DHB

Advisor: Sharon Kletchko, Director Planning and Service Development, BOP DHB

Project Manager: Amanda Lacey