Tailored hospital care helps elderly residents stay home

CHOICE team members with Max and Kaye

On a Tuesday evening in August, a quiet neighbourhood street welcomed an Emergency Department (ED) in the back of an ambulance.

Amidst local pets and kids running along, the neighbours wandered by as 76-year-old Kaye Tully was treated virtually in the back of the ambulance by the Fiona Stanley Hospital (FSH) Virtual Emergency Medicine (VEM) (external site) team.

“The ambulance provided emergency department care for me right at the front of my home,” Kaye said.

“This was a huge relief as I was very worried about leaving my 93-year-old husband Max at home as he is dependent on my care.”

After a virtual assessment, VEM supported Kaye and Max to avoid an ED admission to FSH by referring the couple to the Consider Home Over Inpatient Care Every time (CHOICE) team.

Kaye and Max were assessed by the CHOICE team the next morning and a decision was made to directly admit Kaye to the Fremantle Hospital (FH) Rapid Assessment and Treatment Unit (RATU) for medical care.

Head of Service for Geriatric Medicine at FSH, Doctor Bhaskar Mandal, said the RATU provides an acute geriatric service and helps support EDs by accepting referrals from VEM or CHOICE.

“By streamlining care to Fremantle Hospital, which is our specialised centre for aged care, we can minimise unnecessary bed movements for our elderly patients, shorten their length of stay and provide an enhanced patient experience,” Bhaskar said.

“The triple service collaboration is a brilliant example of how to provide person centred care at the right time and in the right place.”

Along with Kaye’s clinical care, Max’s needs were also reviewed by the CHOICE team with equipment, therapy and support services arranged so he could safely be supported at home whilst Kaye was admitted.

“I was grateful they sent me direct to the right place, minimising the length of time I was away from Max, but also for supporting him to stay at home with care while I was in hospital,” Kaye said.

“While in hospital, a member of the CHOICE team even gave me a picture of Max sitting in our kitchen as she knew I was missing him terribly – that was incredibly kind.”

Following a short three-day stay in hospital, Kaye was able to return home to Max.

CHOICE Senior Social Worker, Caron Denby, is now supporting the couple’s plan for future care needs.

“Most of the time our patients thrive at home, however, on occasions it becomes very clear that the residential care pathway is the best approach and CHOICE can support this from the community,” Caron said.

“Alternatively, we can support direct admissions back into hospital if required.”

CHOICE Coordinator Adam Horrocks said the collaboration between VEM, CHOICE and RATU helped Max avoid admission, helped Kaye admit to the right ward without entering ED, shortened Kaye’s inpatient length of stay, and continues to support the couple in planning for their long-term care needs whilst in the comfort of their home.

“This model of care is transforming the way we care for the elderly and will hopefully go from strength to strength in the future,” Adam said.

“By assessing our patients in their home environment, especially how they function, we can more accurately address concerns and reduce the many risks associated with hospitalisation.”

Importantly, Kaye and Max remain well together at home for as long as possible, with supports in place to ensure they have the care they need when they need it.

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