Feb 08, 2023

Thousands of older patients stuck in hospitals due to limited aged care places

Thousands of older patients stuck in hospitals due to limited aged care places

Thousands of older patients are getting caught up in a hospital ‘exit block’ that’s placing additional pressure on public hospitals due to the logjam of dischargeable patients who cannot access aged care services.

As a result, patients remain in the hospital for longer than necessary, elective surgery waiting lists grow, while ambulance ramping increases due to hospital beds sitting at capacity

The latest Australian Medical Association’s (AMA) report, Hospital exit block: A symptom of a sick health system, has revealed a record 19,631 people were stranded in hospitals during 2020-21 due to exit blocks. 

In total, 286,050 patient days were attributed to patients waiting for a place in residential aged care, and the AMA estimated this costs the healthcare system between $316.7 and $847.6 million annually.

Exit block is a term used by medical professionals to describe what happens when a hospital patient is medically cleared for discharge but they have no safe destination.

Examples include older people who are waiting for beds in aged care or a high-level home care package, and also people with disability who require National Disability Insurance Scheme (NDIS) funded accommodation or supports.

With one-in-ten older people or people with disability stuck in hospital for more than 35 days every year, AMA President, Professor Steve Robson, said there is a widespread impact on the healthcare system and the people who urgently need to access it.

“We have thousands of patients at any given time who are medically ready to be discharged from Australian hospitals but have nowhere to go,” said Professor Robson.

“[An] exit block means less beds for inpatient services, which results in increased waiting times for ambulance services, emergency department services, and essential elective surgeries. ​

“Public hospitals cannot afford to keep operating with this level of exit block. Our public hospitals already have limited capacity and are struggling.”

The number of people that could not be safely discharged from public hospitals has steadily increased by 7,000 people since 2011-12. 

Close to 8,000 people in 2020-21 were left waiting for aged care and home care services in New South Wales, while approximately 6,000 lived in Queensland.

Professor Robson said that while he is concerned by the number of patients waiting to be discharged, there are promising signs of change and he hoped State and Federal Governments can work together to reduce the impact of exit blocks.

“We want to see the Commonwealth and state and territory governments working together to expand on these programs so these patients ― many of whom are vulnerable members of our community ― can be discharged into more appropriate care,” said Professor Robson.

“The AMA is calling for a new hospital agreement, with 50–50 funding between the Commonwealth and States and Territories, removal of the arbitrary 6.5% cap on funding growth, and the reintroduction of funding for performance improvement.

“It is time for governments to step up and end this blame game. At the end of the day, these are people’s lives we are talking about, and they deserve more.”

The AMA’s report also proposed improving the interoperability of My Health Record and My Aged Care to improve care coordination and the collection of real-time data regarding the number of patients waiting for aged care and disability services.

Mr Robson said this would not only help the healthcare sector understand where the roadblocks are, but it would enable them to implement effective and targeted solutions that would free up beds and help clear the hospital logjam.

The AMA said reducing the impact of exit blocks and helping more people transition safely into aged care could save the sector an estimated $811.6 million to $2.17 billion per year.

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  1. As an aged care provider, operating at 70% occupancy, I am wondering how to access these residents who are waiting for care. If anyone would like a room in residential aged care, I would be happy to accept.

  2. This article fails to explain the reason for the lack of aged care places available to those ready for discharge from hospital. Many aged care facilities are operating with closed beds as they are unable to get staff to service those beds.

  3. The occupancy rate across aged care facilities is the lowest it has ever been. Some aged care providers are operating at less than 75 to 80%. The Industry is bleeding!
    The State and Federal govts need to sit down and agree to fund these people to take these beds whilst waiting for other services or to be assessed.
    It could be a separate program to transitional care.
    A little bit of innovation and cooperation could help alleviate these issues.

  4. As a NDIS provider and Aged care HCP provider we have first hand seen this occur for people wanting to exit the hospital only to be blocked due to funding arrangements not completed. TCP is available for patients to exit the hospital and receive care. However in our experience while we can assist and families also can provide the care, the allocation of TCP is selective and is holding up the process. Further to this, the use of alternative accommodation in motels and respite services other than aged care is available but not being utilized. There are aged care services with vacancies that would accept referrals. There are solutions that would be helpful if the right policies and procedures were implemented and services in the community were informed so they could assist.

  5. I am puzzled that the figures identified limited availability of places in residential aged care yet the national average occupancy rate is close to a 10% vacancy rate. However, given that the majority of the industry is operating at a loss there has been no financial incentive to rebuild the large number of former hostels that due to built environment constraints are not suitable for the frail aged we now see. Clearly there are multiple facets to solving the problems of the aged care industry and acute care that would require States and the Commonwealth working collaboratively.

  6. About 40 years ago I published a paper with Anna Howe on Nursing Home Type patients in public hospitals. Nothin has changed in 40 years. One solution is to have Aged Care Assessment Teams proactively going into hospitals, improved communication between hospitals and GPs and fast tracking high level aged care packages. This requires federal and state governments to cooperate and specialists managing patients to be proactive in developing community based solutions.

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