Publications from ODSW Social Insights: Letters by DSW (Vol 2) | Página 59

Working with Various Client Groups
person. In many cases, older people can have their needs met through good
advice and good community support which is delivered by social agencies.
With the growing number of older people, the involvement of the
community is key to ensuring that whatever is put together is sustainable.
Most practitioners will advocate for focusing on reducing morbidity and
extending the healthy active life in old age, and therefore, a supportive
community that enables older people to remain in a familiar environment
and maintain their connections.

So what are alternatives to acute hospital care?
A relatively small proportion of older people will require acute hospital
care and it is good to keep it to appropriate and episodic acute care. The
challenge is enabling appropriate assessment, follow up and care in the
community which requires coordination and good communication among
the diffe rent parties involved in the lives of the old person. It requires a close
partnership with adult social care and primary care. It is understandable that
it is easier and faster to integrate acute and community services when these
are being run by a single provider. In the case of Singapore, this is largely
coordinated by the Agency for Integrated Care.
Nevertheless, the challenge still lies in helping families and the public to
appreciate that acute care should be timely and appropriate and that it
is often not the best, first port of call option for ailing and fragile older
people. There is a need to emphasize short stays at acute hospitals for those
who do not require the full diagnostic and treatment services of an acute
hospital. Where possible, it is useful that daily ward rounds bring together
key persons by “one practice” or “one team” however we compose it,
rather than several individuals on a not-joined-up list of contact points.
Discharge to intermediate and long term care facilities, e.g. day rehab /
day care centres / nursing homes or care at home, must be well supported.
Discharge can be better facilitated if there are regular inputs from a consultant
geriatrician in a multidisciplinary case conference. While there is recognition
for and supported investment in home-based community services, there still
remains a challenge to grow it as it relies significantly on trained manpower.
It is the community teams that provide support to prevent unnecessary
acute admissions especially in cases where intense, short term support is all
that is needed to keep the patient at home. However, putting together this
intense support requires providers to work in a more “boundary-less” way.
There is an increased emphasis on tapping on natural support systems and
step-up community-based support. This is made possible by more local GPs
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