Would dedicated hospitals for over 65s ease the burden on emergency departments?

A growing number of older patients occupying hospital beds has resulted in a need for innovative ways to reduce pressure on emergency departments. One Australian doctor believes a designated hospital for older patients could be the answer.

David Green is the Director of Emergency Medicine at the Gold Coast University Hospital, one of countless Australian hospitals with overflowing emergency departments and frequent ramping.

“It’s very, very difficult when you’ve got patients sitting in beds in the emergency department, and you’re trying to offload ambulances and you’ve got no bed space,” Mr Green told ABC.

According to the Australian Institute of Health and Welfare (AIHW), the number of beds per 1,000 population in public hospitals has fallen by an average of 0.3% every year since 2018-19. This shift may be subtle, but with an ageing population, it shows that supply is not necessarily keeping up with demand.

“An elderly population has the biggest impact on the emergency department, particularly with ambulance ramping and all the difficulties associated with that,” Mr Green added.

“All those patients that didn’t die of their heart attacks and strokes from 20 years ago, due to the increase in successful therapies that we now use, come back with dementia and multiple illnesses later.”

Mr Green believes dedicated geriatric hospitals could provide specialised care for the over-65 population in the same way children’s hospitals support kids.

Unfortunately, this solution may not be a practical one. 

Griffith University’s Jennifer Kosiol believes that a hospital focused on older patients could still become bed-blocked due to the fact many people over 65 tend to have longer hospital stays. 

Others also end up waiting in hospital for an aged care bed to become available, with Queensland and South Australia just two states seeing a rise in the number of older patients who cannot be discharged without an aged care bed to go to. 

“We have around about 44% of our admissions to hospital are older than 65, and they tend to take up a large portion of hospital day beds, which means they tend to stay for longer than younger people,” Dr Kosiol told ABC

“If we don’t have people that have a next of kin, an enduring power of attorney and they’re not cognitively able to make decisions for themselves, we then have to rely on getting them a guardian through QCAT (Queensland Civil and Administrative Tribunal) and that process can take six months.

“Unless you fix the back end, or even the front end of admission, it’ll get blocked because we don’t have enough aged care beds.”

Queensland’s government will spend $200 million over two years to reduce long-stay patient numbers and free up hospital beds, while South Australia’s government is establishing sites for long-stay residents in less clinical settings for patients facing aged care delays. 

Bond University academic Kieran Le Plastrier is confident that preventative care is the solution, rather than creating another institutional setting to care for people. 

“If you focus on people being able to get timely access to preventative care before they’d get really unwell, you can actually prevent hospitalisations — so that’s got to be a key part of how we reframe healthcare in Australia,” Dr Le Plastrier said.

“We used to have specific psychiatric hospitals for persons with psychiatric illness and what we learned from that is that people going into those hospitals sometimes didn’t get the level of care they needed for their physical health even though they may have gotten good care for their mental health.

“As a result of fragmenting care in this way, we risk putting older people at risk because they don’t get the broad specialty input that sometimes people need.”