"Care managers" would help the elderly to remain in the community under proposals to be put to a Southern District Health Board committee today.
The disability support advisory committee will consider a plan for the future of community care for the elderly, commissioned from Auckland University.
Services would be organised around at least nine Otago and Southland "clusters" of GP practices to which care managers, pharmacists, nurses, housework providers, NGO groups and other health workers would be aligned.
Care managers would work with GPs and aligned services to co-ordinate the elderly person's care, keeping them out of hospital and rest-homes.
"People with complex needs will only need to tell their story once to their care manager and this person will work alongside their general practice to make sure they are getting the best response possible.
"People with less complex needs will be able to access prompt, efficient advice and support via the phone or face to face, when required."
Needs assessment processes would be shaken up with new assessing tools, leading to savings because care packages would be better tailored.
Acute response teams within the clusters would limit hospital admissions.
An overarching DHB "support unit" would provide monitoring, education, medical specialists, and professional development.
The approach was a "significant realignment" presenting "financial management" issues for the deficit-ridden Southern DHB.
"The change management exercise required to shift the service towards the model described in this document is also considerable and cannot be underestimated."
The DHB could not afford to keep the status quo because of the ageing population. Those aged 65 and over make up 15% of the South's population and would account for more than 20% by 2020, with the number aged 85 and over set to double.
The draft report was written after consultations with the South's aged care sector. Preliminary findings were presented to the sector last month in Balclutha. A DHB-appointed steering group will make recommendations to the July meeting, after which the public would be consulted if necessary.
