Geriatric MedicineTier 2Topic

Patient-centred care and multidisciplinary issues - services available to support older people and their carers in the community

Overview

A range of community-based services support older people to remain safely at home, spanning government-subsidised aged care programs, health services, and informal/voluntary supports
Community support is generally preferred over residential care where it can safely meet the person's needs, both from a patient-preference standpoint and given the system-level cost and capacity pressures of residential care

Domains of need

Needs typically span domains: personal care, domestic assistance, nursing care, allied health, social support/respite, home modification, and transport - rarely addressed by a single service

Assessment and services

Formal assessment (in Australia, via the aged care assessment system) determines eligibility for subsidised home care packages, matched to assessed need level
Services include: home care packages (personal care, domestic help, nursing), community nursing, allied health outreach, meal delivery, day respite programs, transport assistance, and home modification/equipment provision

Matching and review

Matching the level and type of support to actual assessed need (not simply the maximum available package) preserves patient autonomy while addressing genuine risk
Regular reassessment as needs change (typically increasing over time) prevents both under- and over-servicing, and anticipates the point at which community support may no longer be sufficient

Related concepts

Aged care assessment, residential care transition, carer support/respite, home modification for falls prevention

Key point

Awareness of and early engagement with community support services (rather than only considering them once a crisis forces the issue) allows a more gradual, better-planned increase in support as needs evolve, rather than a reactive scramble at a point of crisis

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