Geriatricians say they will not co-operate with HSE plan to discharge older patients from hospital more quickly

Geriatricians say they will not co-operate with new Health Service Executive plans to medically assess older patients before transfer from hospital to a nursing home.

From this week, the HSE’s enhanced community care programme is being extended to include an interface with nursing homes. The move aims to ensure older patients are discharged more quickly and given supports after their transfer to a nursing home.

As part of the new approach, all older patients transferring from hospital to nursing homes – about 3,000 a year – will be assessed and cared for by community-based medical teams.

The Irish Society of Physicians in Geriatric Medicine (ISPGM), representing over 130 consultant geriatricians, says it has “grave concerns” that the pathways proposed will “undermine the appropriate care and treatment of older people presenting for acute care and/or rehabilitation”.

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It has told members not to co-operate with the new arrangements until “proper” consultation has taken place.

According to the HSE, the deployment of the Integrated Care Programme for Older People (ICPOP) teams and wider primary care teams will improve the care of older people and reduce admissions to hospital, as well as supporting early discharge from hospital and reducing readmissions.

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ICPOP teams are led by a consultant geriatrician and include nurses, physiotherapy, occupational therapy, speech and language therapy, social work and dietetics.

The HSE plan, seen by The Irish Times, aims to “minimise conveyances” from nursing homes to hospitals, reduce the time older patients spend in hospital and achieve “zero tolerance” of long wait times to enter hospital.

To achieve this, new pathways for overseeing the transfer of patients are proposed, including a greater role for geriatricians in reviewing and providing advanced care planning for patients. In the first year of implementation, it is proposed that 12.5 per cent of older people in nursing homes will be reviewed by specialist geriatric teams.

ISPGM says it is “beyond disappointing” that such a “seismic change” in the paradigm of care has been launched without any consultation.

“There is no cognisance or acknowledgment within the paper of the needs of frail older people requiring rehabilitation in the course of recovery from acute illness, the supports required to deliver this, or the risks posed to the lives of older people who are inappropriately disenfranchised of acute care when these pathways are implemented.”

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Older people in transitional care are already at risk from a lack of a coherent governance model, the group says: “The document appears to prioritise the needs of the acute system over what we understand to be the needs of older people at the transition to nursing home care.”

Rejecting the claim of no consultation, the HSE says its plans were presented at a community care conference in September, attended by over 1,000 people. “Around the country there are already many examples of exceptional care to older people being delivered in collaboration with acute hospitals, community services and nursing homes,” according to a spokesman.

HSE chief clinical officer Dr Colm Henry has agreed to meet ISPGM to discuss their concerns.