Dr Nicky Baker, Research Fellow, ARIIA
Over the last decade there has been a 32% increase in people aged 65 years and older in Australia. With the increase in ageing population, there has been an associated 5.9% increase in residential aged care admissions nationally, so that, today more than 200,000 Australians live in residential aged care (RAC)1. Of all the states and territories, Tasmania has the highest proportion (20%) of the population aged 65 years and older, and of these, 36.5% live in residential aged care2. People aged 65 years and older are more likely than younger age groups to be hospitalised, experience a longer length of stay (LOS), and have higher rate of readmission. Longer stays in hospital for older people leads to increased likelihood of hospital acquired conditions, cognitive and physical deconditioning, and functional decline3. Further, the financial and system cost of managing unnecessary or avoidable presentations creates additional burden to an already overstretched health system4. Residents in RAC homes are often frail with multiple comorbidities. The priority for medical management of these comorbidities is a regular maintenance control rather than cure5. However, this group can also be frequent users of emergency ambulance and hospital services. The ambulance travel and hospital admissions are stressful for residents and families, and are costly to the health system, yet are often avoidable6.
The Aged Care Reform Unit (ACRU) of the Tasmania Health Service (THS) was launched in January 2023. They deliver programs to improve access and flow between RACs and hospitals for better resident outcomes and health system benefits. ACRU also facilitates the Tasmanian Aged Care Collaborative (TACC) whose overarching purpose is to support delivery of person-centred care for residents in their movement between RAC and hospitals.
'To call or not to call' for residential aged care nursing staff is a proof-of-concept initiative that involves face-to-face workshops, provision of evidence-based resources, and follow up support via peer support and mentoring to address these issues. The collaboration is supported by THS’ ACRU, the Aged Care Quality and Safety Commission (ACQSC), Ambulance Tasmania, Primary Health Tasmania and Aged care Research and Industry Innovation Australia (ARIIA).
The aims of the evidence-based practice workshops to be held across Tasmania in the week of the 24 March 2025 are: to increase capacity of residential aged care ENs and RNs with early identification and response to deterioration in the older person; to engage the right clinical support in place; to strengthen clinical reasoning, decision making and communication skills; and to make direct referrals to supporting Tasmanian Health Services (THS).
Evidence-based resources include the Aged Care Learning Information Solution (Alis) learning platform, the after-hours tool-kit for aged care, information on shared transfer of care. These will be used by workshop facilitators to support experiential learning through case studies developed by ACQSC on scenarios depicting an older person who has fallen, an older person experiencing clinical deterioration and multiple hospital presentations, and an older person requiring end-of-life care.
Evaluation of this collaboration and the initiative aims to provide the evidence to support other regional areas to address these national issues in a context- and state-specific way; to support the aged care workforce to provide care in place wherever possible; and to meet the preferences and needs of older people living in residential aged care.
1. Source: (Australian Government 2025) Aged Care Research and Reporting
2. Source: (Australian Institute of Health and Welfare 2024) AIHW
3. Palmer (2018) The Acute Care for Elders Unit Model of Care. Geriatrics
4. Chen et al. (2024) Preventing functional decline in hospitalized older adults in medical ward: a best practice implementation project JBI
5. Hillen et al. (2017) Disease burden, comorbidity and geriatric syndromes in the Australian aged care population Australasian J Ageing
6. Gullick & Islam (2023) Exploring avoidable presentations from residential aged care facilities to the emergency department of a large regional Australian hospital Australian J Rural Health
*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.