Geriatric Evaluation and Management (GEM) Beyond Hospital Walls
Amy Parker1, Stephanie Garratt1, Frances Batchelor1, Andre Catrice21National Ageing Research Institute, Parkville, Victoria, Australia2Victorian Department of Health, Melbourne, Victoria, Australia
Abstract
Background: Victoria’s Geriatric Evaluation and Management (GEM) program has historically been provided within inpatient hospital settings that promote independence and facilitate rehabilitation of older people with multidimensional health needs. However recent focus on the development of hospital avoidance and bed substitution strategies to address organisational priorities and reflect patient preferences has seen the expansion of GEM into the patient’s home environment. The aim of this project was to explore the current models of care being used in Victorian health services to support home-based GEM.
Methods: Mixed methods survey of 29 health services across metropolitan, regional and rural Victoria. A total of 23 responses were received, signifying a 79% response rate. Of these, 52.2% (n=12) of health services indicated that they provide home-based GEM with 66.7% (n=8) located in metropolitan Melbourne.
Results: There is currently no ‘agreed’ model of care across Victoria for home-based GEM, with health services establishing their own service profiles based on individual need and organisational contexts. Despite this, a minimum clinical workforce profile consisting of nursing, physiotherapy, occupational therapy, allied health assistants and specialist geriatric medical services (mostly a geriatrician or registrar) was identified as a core requirement for care provision. Limited access to allied health outside business hours, however, was reported as a significant challenge to service efficiency and effectiveness.
Conclusion: Home-based GEM is an emerging service model in Victoria. While there are some consistencies in profile, processes and practice, the program is continuing to evolve in response to policy directions, local innovation and demand.
Biography
Amy is a Senior Research Policy and Practice Fellow within the Clinical Gerontology Division at NARI. With a clinical background in physiotherapy, and significant project management experience in the public healthcare system, she leads NARI’s program of work for the Victorian Department of Health (DH) regarding older people policy development and evaluation.
Amy is committed to supporting the implementation of evidence-based practice into hospital care and is a member of NARI’s Knowledge and Research Translation-Impact Committee. Her particular areas of interest include: clinical governance, quality and safety systems, workforce development, innovative models of service delivery, health literacy and environmental design.