Jul 03, 2019

Assessing Older People’s Abilities From The Comfort Of Their Own Homes

No matter who you are, or where you’re from, one thing that the vast majority of people will agree with is the fact that there is simply no place like home.

The word ‘home’ often conjures images of a house filled with loved ones, but in reality, home is actually a feeling that comes with being in a place where you are truly comfortable and able to be yourself.

Home, can mean even more to an elderly person, as signs of significant physical and mental deterioration are often precursors to a life in an aged care environment, and remaining at home is often seen by elderly people as the final and most significant beacon of personal independence. 

Unsurprisingly, the majority of elderly Australians wish to remain in their own homes for as long as possible, and St Vincent’s Hospital has spent decades rehabilitating and assessing elderly people to ensure that it will be safe for them to do so.

 The Geriatric Evaluation and Management (GEM) program at St Vincent’s hospital is used to rehabilitate acute illness and deterioration in elderly patients while simultaneously assessing their future needs.

The average length of stay in GEM is roughly three weeks and the fact that this is the time period where staff decides whether the patient can go home or will need to be transitioned into residential care, make this an extremely pivotal moment in a patients life.

Giving patients the opportunity to prove that they are capable of living at home safely from the confines of a hospital is not without its difficulties, as the routine and familiarity of a home environment can play a massive role in how an elderly person is able to function – and it is with this in mind that St Vincent’s Hospital in now proud to offer the support and evaluation of GEM to people in their own homes.

Geriatrician’s, Dr. Richard Kane and Dr. Christine Mandrawa, have spent the last year setting up and implementing the GEM@Home model of care for St Vincent’s Hospital, and while the concept of bringing care into the family home is not new, the level of support and care being provided through GEM@Home is similar to that of an actual hospital.

“The idea is that we replicate what is provided in hospitals to people in their own homes, and that they have access to the usual collection of clinicians led by a geriatrician and nurse with expertise in the care of older people, and then the full suite of allied health practitioners with access to a little bit of pharmacy assistance and a capacity to broker in other service providers to compliment that,” said Richard.

“There has been some evidence around that Gem@Home model to suggest that it reduces the number of people that end up in residential care, the way it was designed initially was so that people would start off in GEM, and it would allow them to be discharged from hospital earlier and then for the GEM model to be implemented in their home,” said Christine.

“We do have a lot of patients that do that, and one of the advantages of that is that we get to see them in their home environments, we get to modify the home environment, we can see the layout ourselves and rehabilitate them in a setting that they are comfortable in.”

“The advantage of GEM at home is you can see the practical realities of their living situation.” It easy to say ‘do this’ or ‘do that’ in a hospital, but home is where it counts.” – but that was the initial model.”

While only in operation for close to a year, Dr. Christine Mandrawa already has a number of examples of GEM@Home yielding some amazingly positive results for elderly people who may not have been seen fit to return home without having this level of support in a home setting.

“We had a patient who was legally blind, he had been in his own home for more than 20 years and he came in with an acute medical illness and he was a little confused in the setting which created difficulties for him with taking his own medication,” said Christine.

“He went back home and continued having difficulties with managing his own medication from delirium and there was talk that he would probably need to go to residential care – but through GEM@Home, we managed to successfully transition him back to his own home by teaching how to use a dose-set-box to handle his medication needs.”

“We customized it with velcro because of his visual impairment and taught him how to use it.

“We got him a new microwave and we consulted with Vision Australia and got guidance around a few more aids that we eventually put in his house, and he was able to successfully become independent once again.”

Originally an offshoot of the GEM program, the growth and success of the GEM@Home model of care over the last year now, has St Vincent’s adapting the way in which they take patients and delivering better care outcomes for elderly people who may merely require a little bit of help to get back to independent living.

“Now we also take directly from the acute hospitals, so these are people who may have come in with something like pneumonia, and are now getting better, but are not quite able to do what they were doing before well enough to go home – but still needing a boost, or living at high risk of coming back to hospital,” said Christine.

“These people might only be in the hospital for 3-5 days and now when they go home they’ve got a doctor involved in their care and a multidisciplinary team around that.”

“Another cohort of people that we also see are those that are at risk of hospital admission. People who are slowly starting to decline and struggling at home, people who if you left them for another few months would probably end up in a hospital or residential aged care.”

“We get a long term program and supports in, with the aim to change the trajectory of their health and keep them healthier and in their own homes for longer.”


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