Older Persons and Rehabilitation

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Older Persons and Rehabilitation is entering an exciting period of expansion and service re-development. With the challenge of significant growth in demand for services to the ageing population, the facility and service developments signal the organisation’s comprehensive response to improving access to the right care at the right time. Looking to the future – expansion into the new facility We are expanding our service. To achieve this building has commenced on a major new assessment, treatment and rehabilitation facility, the Older Persons and Rehabilitation Building, right across the road from the main Waiora Waikato Hospital campus This will be a purpose-built space for assessment and rehabilitation teams to work in the most efficient way possible. It will allow for seamless provision of: services for older adults: inpatients, assessment-treatment-rehabilitation, and outpatients mental health services for older people organised stroke services including acute stroke service rehabilitation services for <65 year olds. The new facility will have 113 beds. Significant outdoor areas and courtyard space are also part of the plans. Construction also includes a bridge over Pembroke Street to link the building with Waikato Hospital. Visit the photo gallery to see construction progress images.

OP and RS Strategic PlanOP and RS Operational PlanOP and RS organisation chartPrinciples of best practice Disability Support Link Older Persons and Rehabilitation Service Facility Design Report Referral to OP and RS Public notice Packages of Care (high and complex) for older people in the Taumarunui area

Construction began in December 2012, and is due for completion June 2013. The building will allow more cooperation among the contributing specialties of psychiatry, orthopaedics, adult medicine/neurology (stroke), and surgery. While these are separate and distinct specialties, there are clear points of shared interest and service interface. The ‘rubbing of shoulders’ in the workplace and the culture of rehabilitation is associated with better outcomes and shorter lengths of stay. Photo: Architect's impression of the new Older Persons and Rehabilitation Building.

Looking to the future - service redevelopment

The new facility will be fantastic, but service development is just as important as the bricks and mortar. Service redevelopment will be very important for improving patient outcomes, enhancing throughput and gaining efficiencies across the organisation.  Both services are excited about and committed to:

• service collaboration, ensuring service delivery is seamless and appropriate across the care continuum
• integrated service delivery, achieving a value that the constituent services cannot achieve in isolation
• greater efficiency and efficacy of services
• collocation, improving communication in the interests of patients and staff development.

We will endorse seamless care through staff engagement, clinical and service integration, and working together with our patients, their families and whanau.

Redesigned service delivery models will be mindful of the need to provide a greater range of convenient services closer to our patients’ home to promote and protect good health, self management and independence in the community.  Our admission avoidance scheme (START) will help us ease the pressure on the hospital. 

Implementation of the InterRAI tools will ensure needs assessment and care planning focuses on how to best meet our patient’s needs and optimise individual function and potential.  The various components of a patient’s care plan will be well integrated to ensure better, sooner more convenient service delivery.
 
We are also working hard on building a flexible, sustainable, fit for purpose workforce who will be well positioned to deliver healthcare services for older people.

Service developments already happening include:

• Comprehensive Stroke Unit
• Orthogeriatrics Rehabilitation Service
• Supported transfer and accelerated rehabilitation teams for Hamilton, Tokoroa, Thames and Hauraki areas

New services are planned, such as

• further roll out of supported transfer and accelerated rehabilitation teams  and home-based therapies
• improved collaboration for outpatient services, such as falls and ‘funny turns’ clinics
• and making the most of the existing outpatient facilities such as the Memory Service.

There are exciting new opportunities to research and develop, such as community-based support teams (clusters) of staff nestled in primary practice.

Research and training options for all members of staff will be encouraged, including unique training opportunities focussing on, for example, adult rehabilitation and comprehensive stroke services.

START (Supported Transfer and Accelerated Rehabilitation Team)

Waikato DHB’s Older Persons and Rehabilitation has introduced a new service called Supported Transfer and Accelerated Rehabilitation Team (START), which provides intensive rehabilitation in patients’ homes, enabling early seamless discharge and improved function in line with daily living.

The aim of START is to:

• provide and promote rehabilitation of patients in their home environment in collaboration with community therapy services and specialist geriatric medical care 
• provide and coordinate continuing clinical assessment to recognise deterioration and need for change in nursing or medical treatment or hospital admission 
• work collaboratively with long term care providers by supplying education and training to carers as appropriate and developing a care plan for long term use in the home 
• provide and improve education to patients, carers and family 
• undertake a collaborative and individualised programme of health promotion for each client.  Particular emphasis is placed on the role of fitness and prevention of de-conditioning.

Read more on START.

Feedback from a grateful client

• A story of the START family

The Stroke Rehabilitation Clinic

More than 650 patients are admitted to Waikato Hospital every year with strokes or transient ischaemic attacks and another 250 in the Midland region. Best practice, evidence and expertise in stroke management and rehabilitation guide the development and direction of the Waikato stroke service.

Rehabilitation is an essential part of stroke recovery for the majority of patients, however in those cases where recovery is no longer possible the rehabilitation team aims to facilitate adjustment by providing support to individuals and families in managing to live with stroke related problems.

The establishment of the Stroke Rehabilitation Clinic brings together the interdisciplinary team philosophy, which offers a comprehensive, holistic, patient-centred approach to care.  The Stroke Foundation field officer plays an integral part in the team offering support to patients and families.
Primary and community health care providers activate referrals to the Stroke Rehabilitation Clinic by a single point of entry referral.

Media releases

• New Older Persons build starts at Waikato Hospital
  
• Dedicated stroke units to save lives
  
• Stroke Awareness Week 5-11 September 2011
  
• Clinical leadership group paints a bright future for stroke services
• $40m rehab hub for Waikato DHB approved
  
• Good start for new older persons service
  
• DHB and University linked in aged care leadership role
  
• Launch brings two services together
• Team approach to helping patients at home
• Waikato Hospital Stroke Unit on the move
• Service comes at a good time for Peter
  

Overview of current services and facilities

Older Person and Rehabilitation provides interdisciplinary assessment, treatment and rehabilitation (AT&R) services for adults. Physicians lead interdisciplinary teams consisting of medical, nursing and allied health staff, in both geriatric medicine and rehabilitation.  Our inpatient, outpatient and community-based services, include: Waikato Hospital - Inpatient AT&R including Ward 54 (Orthopaedic Rehabilitation Service), Ward 55 (Comprehensive Stroke Unit and Neuro Rehabilitation), Ward 58 (general AT&R) - see details below Thames Hospital – 10 AT&R beds Matariki and Rhoda Read – 10-12 convalescent care beds in each facility Disability Support Link (DSL) – community-based service coordination for people with disabilities and a need for long term supports.

Inpatient AT&R (Assessment, Treatment and Rehabilitation)

Our teams

Our purpose is to provide assessment, treatment and rehabilitation for people over the aged of 65.  Specialised rehabilitation is also provided for younger people over the age of 16.

We aim to restore, maintain and promote their cognitive and functional ability.

Assessment, treatment and rehabilitation consists of a cluster of areas providing specialist intensive assessment, treatment and rehabilitation.

Excellence in patient care and outcome is paramount and this is achieved by providing effective and evidence based care.

All units have been refurbished and new equipment provided. Each area features comfortable lounge areas specific to patients and their families/whanau. Therapy areas are available with opportunities for group work, education and recreation.

Meet Older Persons and Rehabilitation leadership team

Back row (left to right): Katie Holloway Sanjeev Nand Paul Fitzpatrick Deryl Penjueli Luke Wilson Beverley Carney Kim Holt Front row (left to right): Veronica Cherrett Barbara Garbutt Phil Wood Annie Bradley-Ingle

Opportunities for resident medical officers (RMOs)

Resident medical officers gain experience in dealing with a broad range of conditions and are important members of interdisciplinary team.

We provide excellent opportunity for resident medical officers to practise medicine in the Older Persons and Rehabilitation Services’ community-based and home-based settings.

Resident medical officers also have the opportunity of seeing new GP referred patients to outpatient clinics and do this work under the supervision of consultant physicians.

Resident medical officers work in the Older Persons and Rehabilitaton Services for a period of three months and rotate with other sub-specialities of medicine.  For those who are interested, longer periods of appointment will be available. This area of medicine is as an excellent training ground for those wishing to pursue GP training.

Teaching programmes include weekly rehabilitation education meetings, grand rounds, medical unit case presentations, trainee lectures and radiology sessions.

Clinical leadership partnership

Phil Wood Clinical Services Leader

Barbara Garbutt Group Manager OPandRS

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