Taskforce Introduction
Here is an update for Community Industry Group members, friends, and strategic partners interested in the collaborative work being undertaken across this region in response to the hospital bed block crisis affecting older people and people with disability. Bed block is a significant social justice issue. It impacts people who are unable to leave hospital after discharge due to the lack of safe and appropriate residential care options.
Background - Reasons behind these initiatives
Late last year, Community Industry Group examined the complex and persistent ‘wicked problem’ of older people and people with disability being unable to leave local hospitals after their conditions had been treated. In the Illawarra Shoalhaven Health District (ISLHD), there are, on average, over 100 people unable to return home or secure accommodation in a local aged care home with 24/7 support.
After reviewing similar work being conducted across the country, Community Industry Group submitted a proposal to federal and state government departments responsible for the welfare of older people, outlining several interrelated projects to be implemented over a number of years. Although we have not secured all the funding required for full implementation, the NSW Ministry of Health provided our local health district with one year of funding for three key initiatives:
Coordinate a collaborative Task Force involving all relevant stakeholders,
Conduct baseline research into patients awaiting discharge and the capacity of aged care providers in this region.
Develop a volunteer aged care transition support scheme (STARS) to assist older people unable to leave hospital, and their families/carers.
The first Task Force meeting, held on 6 September, included representatives from 14 strategic partners. Participants shared insights and discussed the outcomes of the interim research report, which analysed the last 1,000 people approved for aged care who experienced prolonged stays in ISLHD hospitals over the past year. It also assessed the capacity of the 19 providers operating 46 aged care homes across the region. See a brief video from Task Force participants here.
With this information in hand, several significant initiatives are underway as part of the projects. Below is a brief update on each:
1. Local Government
Local governments are key stakeholders, both through their responsibility to local communities and their role in planning and development approvals. Several meetings were held this year with Wollongong City Council to discuss aged care expansion needs and stalled development projects.
Council has outlined strategies to assist providers, including pre-planning advice and access to senior staff expertise. Proposed strategies also include potential planning allowances to enable better yields and returns for providers’ developments. Meetings were also held with Kiama and Shellharbour Councils, both of which are proactively addressing the aged care bed shortage in their areas.
2. ARCTS Dementia Webinar by DOHAC
Community Industry Group invited the Australian Government Department of Health and Aged Care (DOHAC) to host a Dementia Services Australia presentation on the Acute to Residential Care Transition Service (ARCTS) trial conducted in the Illawarra, Tasmania, and Adelaide in 2022.
The 29 October workshop was well attended by local aged care providers, who gained valuable insights into the study’s findings. We are optimistic about securing future funding to continue ARCTS’s best-practice dementia transition assistance services in the Illawarra.
3. Residential Aged Care Providers Taskforce Update
The three largest providers of residential aged care in the region (Warrigal, IRT, and Uniting) are all members of the Taskforce, alongside Keyton, which plans to build 140 beds at the University of Wollongong (UOW). Community Industry Group recognises that all providers play a crucial role in addressing the supply challenges across the region.
A Taskforce update meeting was held on 7 November for all residential providers in the region. The meeting offered an opportunity to hear from ISLHD CEO Margot Mains about the current bed block situation and to receive a briefing from our researchers on the findings of their interim report.
We will continue to keep all providers informed about ongoing initiatives and aim to expand the project shortly to include providers of in-home care services. Every provider has the potential to contribute to alleviating this crisis. Big issues require collective action.
4. Evaluation of Empty Homes
The interim report revealed a current shortage of 1,023 aged care beds in the region. Given the significant projected growth in the population of older people, it is essential to explore all strategies to address this shortfall. Several vacant aged care homes were reviewed to assess their suitability for emergency, short-term, or transitional accommodation. Of these, only one has been identified as both available and suitable.
Uniting at Gerringong has agreed to allow ISLHD to conduct an exploratory study on the premises to determine whether it could be repurposed for regional health service accommodation to assist people experiencing bed block.
5. Special Commission into NSW Health
The NSW Government has been conducting a Special Commission into the funding of its health services, including efforts to "integrate the health and aged care sectors to ensure care is delivered in the right place at the right time for older people." Commissioner Richard Beasley held hearings in Wollongong in late August, during which Community Industry Group presented an overview of the aged care shortages and the resulting bed block crisis. The Special Commission is ongoing, with further submissions being prepared by CI Group researchers.
6. STARS Transition Volunteers
The Supported Transition Assistance Response Scheme (STARS) program trains volunteers experienced in aged care services to assist with the transition of older people from hospital to aged care homes or back to their own homes. STARS volunteers provide trusted and experienced guidance to older people and their families during this challenging process.
Since May 2024, we have recruited and inducted 19 STARS volunteers from diverse backgrounds, including aged care, home care, residential services, management, and lived experience. These volunteers bring compassion, patience, and time to help older persons and their families navigate this emotional journey.
STARS is now established in Bulli, Shellharbour, and Coledale Hospitals, with Figtree and Milton Ulladulla Hospitals to follow, and Wollongong Hospital joining in the new year. The program has already facilitated 14 referrals, with 57% of older persons transitioning to an aged care residential service within a few weeks. This success is a testament to the collaboration between ISLHD professionals, social workers, NUMs, placement team members, nurses, aged care providers, and STARS volunteers.
We were honoured to hear ISLHD CEO Margot Mains commend the contributions of STARS volunteers during a recent network meeting.
7. ACCPA National Conference Panel Discussion
At the October ACCPA national conference in Adelaide, Community Industry Group participated in a panel discussion alongside a Tasmanian project addressing similar challenges. Representatives, including Nicky Sloan, Mark Sewell, and Paul Sadler, shared initiatives being implemented in the Illawarra with an audience eager to explore collaborative solutions.
8. Providers’ Internal Assessments
Our aged care supply researcher, Paul Sadler, has been mapping the Illawarra-Shoalhaven service system, revealing no growth in total bed numbers over nine years and a steady increase in non-operational places due to room conversions. Workforce constraints and development costs have also hindered planned projects.
9. Patient Flow Analysis
Professor Kathy Eagar's analysis of 1,000 older people's hospital experiences highlighted an average stay of 66 days, with delays posing risks to patients’ health and the healthcare system. Streamlining patient flow is essential to improving outcomes.
10. ISLHD Aged Care Considerations
The ISLHD management team is forming an internal taskforce to enhance health and aged care services, with CI Group serving on the advisory panel to provide recommendations.
11. Solutions for People with Disability
A significant cohort of people with disability is also affected by bed block. CI Group is working with the Illawarra Disability Alliance (IDA) to include disability providers in these initiatives.
12. Provider Feedback
The items above were reviewed on 27 November at the Regional Quarterly Aged Care Provider Meeting. During the meeting, the highest priorities for improving the system, as identified by the majority, were:
Resolve local council planning hurdles.
Support patient transitions, especially those with dementia.
Encourage hospitals to engage in aged care partnerships.
Increase early intervention through home modifications and high-care home support.
Advocacy
After two years of immersion in this most wicked of problems, CI Group has identified a number of levers that could make a difference, and which we are advocating for. These include:
Incentivising investment in residential aged care through capital funding (e.g., targeted market viability funding to this area).
Reducing vacant bed days at aged care homes wherever possible.
Funding a team of Aged Care Project Officers to assist providers through the planning and development system and expedite increases in bed numbers.
Increasing home care packages in the region and implementing a trial of higher-level packages across a range of existing providers.
Breaking down barriers at the health/aged care interface, where the systems work together for the same people but are very confusing for each other.
Expanding Hospital in the Home so patients can recover in a safer place.
To address aged care workforce challenges, we recommend:
A local workforce project for the promotion of aged care careers and streamlined application processes.
Easing 24/7 Registered Nurse minute requirements when a service is in expansion mode.
Exploring opportunities for Nurse Practitioners in aged care when GPs can’t be found.
Extending student visa workplace extra hours caps to allow them to work more hours in the care sector.
Increasing the recent allowance for 10% capacity for Enrolled Nurses for Nursing Care Minutes.
Pausing the increase in the idealised Care Minutes during the bed block crisis.
Waiving HECS/HELP debt for Registered Nurses who work in aged care for three years post-graduation.
Next Steps: Have your say for the Taskforce and Final Report
Early in 2025, CI Group will hold another Taskforce meeting to ensure all the main stakeholders understand what is to be proposed in the final report to the NSW Health Ministry. All providers and stakeholders have an opportunity to have their say about what they need to expand their residential care, home care, home modifications, or other essential services.
Please write to Project Lead Mark Sewell at ask.markw@gmail.com to have your say for the sake of older people approved for aged care and people with disability who are unable to leave hospital, some remaining there until the end of their lives.