Waikato District Health Board’s Supported Transfer and Accelerated Rehabilitation Teams (START) for older persons, is in place in Hamilton, Thames and Tokoroa and there are already reductions in long-term home care use.
Registered nurses oversee the teams with input from occupational therapists, physiotherapists and clinicians. Health care assistants, trained in rehabilitation principles, visit the clients up to four times a day.
START is a collaborative programme that provides rehabilitation of older patients within their home environment enabling early seamless discharged and improved function in line with daily living.
Professor Matthew Parsons, Waikato DHB’s newly-established chair in gerontology nursing, a joint appointment between Auckland University and Waikato DHB, said the programme was already resulting in reductions in long-term home care use. The service improves participants’ functional reserves and it is anticipated that it reduces their likelihood of going into residential care.
We anticipate working with primary care to make it available for GPs to access directly, he said.
“This is a sensible alternative where we’ve got well-developed primary care services, are comfortable that the patient is medically stable and their GP knows they don’t need to be in hospital.
“There has been a significant increase in function as older people pass through the service and they appear to be less likely to require ongoing home care on discharge.
“All patients participate in an individualised goal focussed rehabilitation plan and there are discussions about clients, at a minimum weekly, in an interdisciplinary environment. To date, 178 patients have accessed START and remain with the team for an average of three weeks.”
Health Workforce Hauora Maori Training Fund funds health care assistants for START and they were the first to start the Careerforce level three training.
Health Workforce NZ (HWNZ) is actively involved in reviewing this role given the opportunities it presents for rehabilitation.
“They are also engaged in developing a programme to support the development of generic competencies in assessment and rehabilitation for nurses and see START as an ideal mechanism for this,” said Prof Parsons.
Older Persons and Rehabilitation Services group manager Barbara Garbutt said the development of the new role was critical.
“We altered the model in Tokoroa to adapt to the unique requirements of this rural setting with a smaller population. A Request for Quote process was undertaken, and the successful provider was Access Homehealth, who provide the health care assistants for this region.”
Their staff were all trained to be part of START.
Following the Christchurch earthquake, Canterbury DHB adopted the START model, and will work towards full roll out by July.
This month the Waikato OP&RS / University of Auckland partnership secured Health Research Council funding to evaluate the START model through a randomised controlled trial design.
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