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In January, 90-year-old Joan Rodriquez fell off a chair and hit her head on her tiled kitchen floor.
The artist – who cut her elbow and bruised her left leg and hip – pressed the emergency alarm on her watch and was rushed to St Vincent’s Hospital by ambulance.
But instead of being admitted as a patient, she was assessed by an emergency doctor and a geriatrician and sent home with a comprehensive team of health professionals.
“For older people, the longer you stay in hospital the less function you maintain,” explained her daughter Miranda, who is a nurse. “They lose the ability to do things for themselves.”
Thousands of older Victorians are avoiding unnecessary hospital admissions through a new initiative that embeds geriatricians in emergency departments, diverting patients to more suitable care.
As Australian health ministers met on Friday to express concerns about the growing issue of hospital bed block, Victorian hospitals are stepping in with their own solution by fast-tracking out-of-hospital care for older, suitable patients to free up vital beds.
St Vincent’s Hospital Melbourne employs geriatricians who work alongside emergency department clinicians five days a week to assess older patients and safely divert them to their homes, aged care facilities or rehabilitation services.
This has freed up more than 1000 hospital bed days a year for patients needing more urgent hospital care, according to Dr Richard Kane, clinical director of geriatric medicine at St Vincent’s.
“We know that most people – not just older people – would prefer to receive their care at home, if the option is available and it’s clinically safe,” he said.
He said about 50 per cent of older patients who were planned for admission from the hospital’s emergency department were now diverted by geriatricians to other more suitable environments.
In Rodriquez’s case, this involved a fortnight at her supported accommodation in Fitzroy with visits from occupational therapists and nurses and a phone consultation with a pharmacist. Six weeks later, she underwent a comprehensive health check at one of St Vincent’s aged care services, where her cognitive decline, hearing loss and medication was assessed.
Her medication was tweaked, and a geriatrician at the service recommended that Rodriquez move from her supported accommodation and into aged care.
“She was failing at home and they could see it,” said Miranda.
“That early intervention in the ED was key. It put us on a pathway to receiving 24-hour support in aged care, which has been such a relief.”
Other health services that have embedded geriatricians in their emergency departments include the Austin, Eastern Health and Monash Health.
At Monash Health, the initiative has reduced the proportion of patients aged 65 and over being admitted from the emergency ward by 4 per cent. This equates to 1237 avoided admissions or 6186 hospital bed days per annum.
At the Austin, one-third of patients seen by the hospital’s Geriatric ED Innovation program avoid an inpatient stay and receive care and support outside the hospital.
“The innovation has driven a sustained 5 per cent reduction in admission rates for older persons and a 10 per cent reduction in inpatient length of stay,” a spokesman said.
Dr Jonathan Beavers, a geriatrician and clinical services director at Eastern Health, said since late 2024, its geriatrician in the emergency department initiative had safely diverted almost 2000 older adults to other pathways. It recently expanded the service to include an occupational therapist.
“This provides better care for our patients who can be safely treated at home, while also freeing-up vital beds for those patients who still need care inside our hospitals,” Beavers said.
Kane said that older patients presented more to hospital and were more likely to be admitted and experience complications.
These complications include delirium, infections and an increased risk of falls.
“Consumer surveys almost invariably tell us patients prefer to be cared for at home if it’s safe to do so,” he said.
“If we’re able to assess the person with a team in their own environment, with their own bed, chair, and equipment, it gives us a much more realistic impression of what we can do to support them to stay independent at home.”
While emergency department doctors do an incredible job of stabilising urgent medical issues and assessing whether people need to be admitted, Kane said geriatricians had incredible knowledge of older people and available support.
“Our lens is slightly different to theirs,” he said.
“Because of our knowledge of older people, their function, frailty, and the systems outside the hospital, we’re really well-positioned to help make those decisions and facilitate transfers to alternative care models.”
He said the model offered a solution to the issue of bed block by alleviating pressure on hospital beds.
“It’s good because it is effective from a reduction of hospital pressure perspective, but it’s also good because it aligns with what patients want.”
On Friday, state and territory health ministers raised their concerns about the growing problem of hospital bed block at a meeting in Sydney and called on the federal government to address the issue.
They released data showing that more than 3600 patients are stranded in public hospitals across Australia waiting for Commonwealth Government aged care placements. In Victoria, 302 patients are stuck in hospital and waiting for aged care placement. This rose by 29 per cent between March and June.
Victorian Health Minister Ingrid Stitt said she was concerned about a rise in older Victorians languishing in hospitals when they should be in an aged care facilities.
“These people deserve to get the care in the right settings,” she said.
She said these issues persisted despite Victoria having the benefit of having more than 5500 publicly funded aged care beds.
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Henrietta Cook is a senior reporter covering health for The Age. Henrietta joined The Age in 2012 and has previously covered state politics, education and consumer affairs. Email her via henrietta.cook@theage.com.au or henrietta.cook@protonmail.comConnect via X, Facebook or email.From our partners
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