Hospital Residential InReach Services

Helping people in residential care

Australia’s population is ageing, and with this comes greater rates of medical illness, disability, and social isolation. Older people are living in their own homes for longer with formal and informal support. However, this means that when they do eventually move to residential aged care facilities (RACFs), they tend to be more dependent on care and more likely to become acutely unwell.

General practitioner support at RACFs is often thinly stretched, and until recent years, the hospital emergency department was the only alternative for timely medical attention. Unfortunately, older people do badly with ambulance transfers and hospital stays, especially if they have a cognitive impairment or dementia. Levels of distress, discomfort, medical complications, and chances of dying are higher. Additionally, the range of treatment options that might be beneficial for a person narrows with the accumulation of frailty, disability, and chronic illness. Invasive treatments and surgeries may actually do more harm than good, so medications become the mainstay of treatment.

Public hospitals have responded by setting up Residential InReach services, which consist of doctors and/or trained senior nurses. In appropriate situations, they can respond quickly when residents become unwell, visit them at their RACFs, and deliver medical assessment and treatment for the person in the familiar surrounds of their RACF. This translates into better medical care for the older person, less strain on hospital emergency departments, and increased medical support and guidance for the care staff at RACFs.

One Residential InReach team at Austin Health in Melbourne, Australia engaged health professionals to find out more about the impact and quality of the service. Staff and GPs working in local RACFs, as well as their own InReach nurses, were interviewed. Responses were rich and varied, and came down to three key themes:

  1. When an older resident in a RACF becomes acutely unwell, deciding on the best course of action is quite complex and difficult for all concerned; the person, their family, their carers at the RACF, and their GPs.
  2. There is a lot of variability across RACFs in the numbers and skill level of staff, as well as availability of a general practitioner if residents become unwell.
  3. Austin Health’s Residential InReach service was widely seen as a useful and supportive adjunct in the medical care of residents in RACFs. Some interviewees requested greater availability of the service.

Residential InReach services seem to be a valuable addition to the medical care of older people living in RACFs.  Given that we are already seeing more and more people making the move to residential care, more needs to be done to improve the standards of care at RACFs, and access to timely medical support.

[Source: Dr Sanka Amadoru, Consultant Geriatrician, Austin Health (Residential InReach Service) and Aria Health]