Specialist care replaces hospital trips for aged care residents

Specialist care replaces hospital trips for Illawarra aged care residents In short: More than 95 per cent of residents referred to an Illawarra-Shoalhaven aged care outreach service last financial year were able to avoid a trip to emergency. The service brings specialist treatment into homes, allowing frail residents to receive care in familiar surroundings. What's next? Dr John McKenzie wants the outreach model eventually expanded to allow specialist teams to treat more frail elderly people in their own homes. For one aged care resident with cellulitis the prospect of being taken to hospital was distressing. Instead, a specialist health team in the Illawarra came to her. Over four days, she was given antibiotics and reviewed by clinicians while remaining in her residential facility on the NSW South Coast, surrounded by people and surroundings she knew. "What we knew about this resident … is they got very distressed at the thought of going to hospital, an unfamiliar environment," Warrigal chief executive Jenni Hutchins said. "This [solution] meant that the resident stayed at home in a familiar environment and was able to have the same treatment as they would have received in hospital." For Dr John McKenzie the case illustrates why treating frail older people outside hospital can be so important. "As a geriatrician I spend a lot of my time explaining to people that a hospital isn't a safe place for a frail, older adult," he said. "I don't mean that in a truly negative sense. Just we recognise it's a strange environment with bright lights and lots of noise. "If you exist with a vulnerable brain it's not the safest place if we can provide care in a quieter, homely, familiar environment." Dr McKenzie is co-director of the Illawarra Shoalhaven Local Health District's Division of Aged Care and Rehabilitation Medicine and works with its Aged Care Outreach Service (ACOS). The service brings geriatricians, nurses and other clinicians into residential aged care facilities to provide treatment such as intravenous antibiotics, fluids and medication reviews that might otherwise require a trip to hospital. ACOS began in the Illawarra in July 2023 and expanded across the entire Illawarra Shoalhaven Local Health District in September 2025. New figures show the team accepted 2,502 referrals during the 2025–26 financial year. Of those, 2,393 or 95.6 per cent of residents were able to be managed in their home, avoiding a move to an emergency department (ED). Since June the team has also picked up another 124 cases in emergency departments and supported those residents back to aged care rather than admitting them to hospital. Hoping to ease pressure on ED The service is reducing avoidable demand at a time when emergency departments across the Illawarra-Shoalhaven are handling tens of thousands of patients. The latest Bureau of Health Information figures show Wollongong, Shellharbour, Shoalhaven and Milton Ulladulla hospitals recorded a combined 42,687 ED attendances between January and March. Wollongong had the highest number, with 18,200 presentations and a median stay of four hours and 48 minutes, while Shoalhaven recorded 10,459 presentations. Fewer than half of patients started treatment on time. The pressure extends beyond emergency, with the number of older patients stranded in Illawarra-Shoalhaven hospitals while waiting for an aged care placement rising from 101 to 129 in the year to March. Dr McKenzie said the outreach service could help to ease the pressure on the local heath system. "I think the exit block from hospital, the bed block as it were, is more complicated than simple demand and presentations, but I definitely think we are having an impact," he said. Dr McKenzie said the aim was not to prevent people going to hospital when they needed or wanted to. "Seeing us is not a barrier to hospitalisation, it's an alternative," he said. "We're just another arm reaching out into the communities to try and support older adults where they live." Lessons from older patients Dr McKenzie said the value of treating people where they lived went beyond avoiding an emergency department. After 30 years working in geriatric medicine in Australia and the UK, he has found listening to older people and respecting their choices is fundamental to good geriatric care. "I will never be as old as them while I'm working. So I'm all ears for what they would like, what they have lived and experienced," Dr McKenzie said. "You have to listen and you have to understand and you have to take on board what they have to say because they have the lived experience that you simply do not." Dr McKenzie believes the next major step is to extend the model beyond residential aged care to frail older people still living in their own homes. "I think that would be the huge game changer for our population," he said.