Aged care

The CRE in Telehealth concluded in September 2019. Description of work below is not current.

Over 150,000 older Australians live in government subsidised residential aged care facilities (RACFs). This population has a high level of disability and unstable health status. Access to specialist service providers is constrained by the:

inability of the resident to travel,
high cost of providing an escort,
intermittent nature of demand for specialist services in aged care facilities

The MBS now includes item numbers to facilitate video-consultation into RACFs, yet to date very few working models have been developed. There are also no robust evaluations beyond single disease or syndrome consultations.

The CRE aims to improve the use of video-consultation into RACFs to:

Avoid the stress of travel for an older person
Reduce the costs by reducing the need for an escort
Offer specialist services as needed

With the limited resources, inevitable population ageing and minimal growth in the workforce, telehealth can be of benefit to people living in RACFs.

Our work

Telehealth for residential aged care: a pragmatic RCT

People in long term residential care have complex and chronic care issues. The staff may be able to provide more focused care if they have the support of specialists for advice on the care of residents. This project considers the value of a geriatric specialist assessment for all new residents via video conferencing, directly to the residential care facility. This will be supplemented by access to a wide range of other specialists coordinated through a telehealth service model on an "as needs" basis.

Operation, feasibility and cost minimisation studies of specialist geriatric medicine services in small rural hospitals

In 2004-2005, 35% of all hospital use in Australia was attributed to people 65 years and older. This proportion approaches 50% in small rural hospitals. In addition, associated with hospitalisation, it is common that older people experience a decline in functional ability, have higher rates of mortality and are prone to readmissions.

Telemedicine can be used to support the provision of services for older patients in a rural hospital setting. In 2013, The Centre for Online Health partnered with the Centre for Research in Geriatric Medicine to deliver geriatric services to three regional hospitals which lack access to geriatric medicine specialists. A series of studies to examine feasibility, acceptability, effectiveness and cost were developed.

Telemedicine represents a new way of delivering health care to older people. There is the potential for the service to be unattractive, ineffective and unacceptable. Research is required to ensure that this new approach endows benefits, and is not a significant compromise compared to conventional approaches. Telemedicine models may have a significant economic impact. Costs and benefits need to be considered from the viewpoint of a variety of stakeholders. A range of economic analyses are being undertaken, and additional work is being planned, which considers the cost-minimization analysis comparing the cost of delivering telemedicine services compared with travelling to receive or to provide a clinical service. Consideration needs to be extended to include cost shifting and increased costs incurred; and the implications from within the health system when a new service model enables increased efficiencies or improved equity. This body of work will consider the policy implications, including overall service demand, workforce requirements, funding models and wider impacts to ensure that older people in rural settings are offered the best available health care.