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Older People Mission Statement To improve the health and quality of life of older people in counties Laois, Offaly, Longford and Westmeath. Introduction Services are provided in the home, the community, acute hospitals and in care centres for older people. The interventions offered include health promotion, disease prevention, diagnosis and treatment, care and rehabilitation. The overall provision of long-term beds is in line with the national target that 90% of people over the age of 75 years should be maintained in their own homes. In relation to beds there is an inequity in the availability of beds within the Midland area. This issue will be addressed over the next few years by the provision of extra beds in those areas that are under provided. Services provided in the community include; public health nurses, special twilight nursing service, home help services, therapy services, community rehabilitation units, support services for carers, boarding out and special housing aid scheme for older people. Services in community units include assessment and rehabilitation, palliative care, respite care, day care, long-term care. Support Services include health promotion, GP Service, chiropody, dental, audiology and ophthalmology, pharmacy, community welfare, community development, environmental health, continence advisory service and psychiatry of later life. Day care services are provided in 10 locations with a total of 326 day care places. The Board promotes and supports voluntary / community activity by grant aiding appropriate services and initiatives by way of Section 65 grants. 76
Table: Older People population profile by County County Over 65 Years Over 75 years Westmeath 7,898 3,498 Longford 4,264 2,029 Offaly 7,392 3,218 Laois 6,647 2,874 TOTAL 26,201 11,619 Achievements in 2004 The Community Nursing Unit in Birr was opened A multi-disciplinary education / awareness programme on Dementia care was launched for staff. In line with the recommendations of Protecting Our Future, a Steering Committee on Elder Abuse was established, and a policy and procedure for the investigation of allegations of abuse of older people was developed. Training commenced for staff in the implementation of the Board s policy and procedures for the investigation of allegations of abuse of older people. Public Health Nursing Care Management project for older people commenced Work commenced in the Midland Regional Hospital at Tullamore on a pilot project for Case management integrated care one network project (ICON). An Equality working group was established to develop a strategy /action plan in addressing equality issues New development of student placements for physiotherapy commenced. A regional Manual Handling Co-ordinator was appointed Additional capital funding was secured to provide up-grading of facilities, in St Mary s Mullingar, St Joseph s Care, Longford and the Dementia Unit in Mountmellick, St Brigid s Hospital Shaen, and Abbeyleix District Hospital. 77
Emerging Issues The demographic and heath profile of older people in the midlands, societal changes and illness patterns are placing greater demands on all services and existing staffing resources across the Board s area. Additional Consultants with speciality in geriatric medicine are required, development of a Social Work / Psychology services are required to meet the growing numbers of an ageing population. Upgrading and replacement of some care centres to comply with health and safety regulations. Appropriate placements are required for people with significant disabilities inappropriately placed in long-stay units Scope of current Rehabilitation Units need to be expanded to include response to acute episodes for older people in their homes avoiding admissions to acute hospital care. Community rehabilitation units are required in Offaly and extend to Edenderry. Community Rehabilitation Team activity in Athlone will place increasing demands on therapy services. With the increasing numbers of acute orthopaedic patients referred to Community Rehabilitation Units, a need has been identified for some specialised equipment for therapy services. Cardiac and pulmonary rehabilitation programmes need to be expanded to local sectors to ensure a more accessible service. Creation of a shared Colo-rectal nurse specialist post between acute hospital and community to provide a Colo-rectal service to inpatients and continue to provide a follow up service to patients at home following discharge A designated specialist nursing tissue viability post is required, to provide a service for long stay units, nursing homes and community nursing service. The need for additional day care places, in partnership with other agencies. The development of appropriate day care packages of care /interventions in these settings is essential in consultation with relevant professional disciplines. 78
Appointment of Care /Case managers to manage and administer Home Care Packages to meet the individual needs of older people both in the community and residential care. Equipment such as CCTV cameras and additional profiling beds and mattresses required for some Care Centres Increase in chiropody sessions are required to meet the needs of older people. The development of regional guidelines for the provision of therapy services and adaptive aids and appliances to clients in Private Nursing Homes Escorts on buses are required for dependent persons attending day centres. Additional funding is required for training /materials /equipment which would facilitate in-house training, also funding to support the development of Activities programmes in care centres. Continuous Quality Improvement Initiatives Many initiatives and projects were undertaken at different locations in the pursuit of quality through the guidance of the Quality Facilitator, Clinical Audit, Risk Management and Health Promoting Hospitals, and ICON (Integrated Care One Network) Project Management Team: Based on best practice, a quality, integrated approach to addressing malnutrition risk was developed. Smoke free initiatives in place in care centres and day centres Health Promoting Hospital bronze and silver awards achieved. Smoking cessation programmes delivered. Consumer Panel for Older People established in January 2004, there are plans to develop additional panels during 2005 Activity programmes developed in care centres in partnership with local Libraries, Arts Centres, schools and other agencies. 79
Go for Life programme delivered in the community. Community Rehabilitation Team established in Athlone, reduction in bed waiting times for long stay care achieved due to the increased activity of the seven community rehabilitation teams Arts in Care Programme continued in all care centres, Further training in Module 1of the Arts in Care course for staff commenced in October. Awareness workshops were organised for staff to raise awareness of the importance of the arts in ensuring an improved quality of life or social gain for their clients. Eight awareness workshops were completed, with twenty participants per workshops. Music Network One module of activity was delivered by Music Network. Six weekly workshops were provided, in eight Care Centres. St. Brigids Hospital, Shaen participated for the first time. Activity in Care Training programme Programmes have been implemented in ten locations and in 2005 it is planned to train an additional 20 staff. This course is accredited through Waterford Institute of Technology. Activity Co-ordinator group A Regional Activity Co-ordinator group was established to share experiences, facilitate the inclusion of health promotion in documentation and to standardise documentation for activities. This work was carried out in consultation with the Regional Documentation Group. Health Promoting Residential Care Initiative, 10 steps to Healthy Ageing Implementation plan developed to enable all residential care centres to adopt Initiative Falls Prevention and Management Programme Literature research was completed on falls with a further piece of research conducted in the Accident & Emergency Department Tullamore, to determine barriers / reasons for failing to uptake health promotion information on falls prevention. A Falls Assessment Screening Tool was developed, with pilot and validation sites identified.. 80
Information and Listening Day for Older People An Information and Listening Day for Older People was held in October to create a forum for a sharing of information on services available and to identify the needs of Older People. National Hospital Challenge Day All residential care centres participated in the National Hospital Challenge Day in May. Ofalia House, Edenderry, received the overall award in the Community Unit category. Slí na Slainte project launched in all residential care centres, to coincide with National Hospital Challenge Day. Slí na Slainte signage erected in all care centres. Eight centres were involved in Physical Activity participatory workshops organised for staff. Health & Safety Awards Events and vaious initiatives were undertaken in all Care Centres for National Health and Safety week. St. Mary s Care Centre, Mullingar, and Riada House, Tullamore were award winners. Intergenerational Projects Intergenerational projects continued in care centres. Centres of Excellence The Community Nursing Unit in Birr, and St. Mary s Care Centre, Mullingar commenced work on the Centre of Excellence project which is being led out by the Nursing Midwifery Planning and Development Unit in partnership with the University of Ulster. Work commenced on the implementation of multi-disciplinary care plans with the assistance of the Nursing /Midwifery Planning and Development Unit Capital Projects There are a number of projects where work is currently being carried out.. These include the Athlone Hospital Project, Riada House, Tullamore and St Mary s Care Centre, Mullingar. Support for Carers The Board continued to support the Carers Association through provision of Section 65 funding. Training and information was provided to support carers in their roles. 81
Carer exhibitions and on-going carer clinics were provided in partnership with the Carer s association. Alzheimer Society Continued to work in Partnership with the Alzheimer Society in the provision of home support and day services. Workshops on Age Awareness Age Awareness / Equality workshops provided for staff and community groups in partnership with Age and Opportunity in an effort to reduce ageism and combat negative stereotypes of older people. National Performance Indicators OP1 Efficiency: The number of re-admissions of those aged over 65 years for the same complaint /condition to acute hospitals within, one week of discharge, one month of discharge Orthopaedics Medicine Surgery Gynae Ophthalmology ENT One 2002 = 1 88 18 0 N/A 15 week 2003 =0 55 30 1 10 2004 =0 12 6 1 9 One 2002 =10 248 113 1 N/A 35 month 2003 =9 180 118 1 46 2004 =1 67 25 3 25 The above figures are based on those coded at reporting periods. OP2 Equity /Access: The number of patients over 65 years on the waiting list for- Cataract / ENT /Orthopaedic surgery End of year Cataract Surgery ENT Surgery Orthopaedic Surgery 2003 2004 286 National collection of statistics 14 12 71 80 The selection criteria for surgery is based on need not on the length of time on the waiting list. In keeping with the recommendations of the National Health Strategy, all persons on the waiting list will be seen within one year. 82
OP3 Efficiency: Percentage uptake of influenza vaccine among the GMS population aged over 65 years: The GMS are unable to provide figures for reporting periods as specified. OP4 Efficiency: Number of people aged over 75 years in residential continuing care settings, i.e. health board and other residential continuing care settings, including private and voluntary, as a percentage of the total population over 75 years End of year 2003 2004 QRT 1 QRT 2 QRT 3 QRT 4 10.07% 10% 9.7% 10% 10.5% 11.1% 10.01% 11% OP5 Efficiency: Percentage of people over 65 years of age who were in receipt of the following services during the reporting period. Home Help services, Hours of Home Help service provided, Day Care, Respite care. Home Help Total Home Day Care Respite care (Ave per QRT) Help Hours for (Ave per QRT) (Ave per QRT) year 2002 8% 474,366 3.04% 0.96% 2003 9% 491,507 4% 1.1% 2004 8% 445,169 5% 2% 83