Draft
Urana
Multipurpose Service
Clinical Services Plan
Version 2.3
April 2021
Draft Urana MPS Service Plan 2020
Document Administration
The Draft Urana Service Plan has been developed in close consultation with the Urana community, the Health Service Manager (HSM) and Cluster Manager. Their input and feedback has been incorporated into Version 1.0 of the Draft Plan.
Revision History
Date Issued Version Feedback from Changes Incorporated Date range 7/4/2021 V2.1 Executive 7/5/2021 Board Community Ministry of Health
Urana MPS Service Plan December 2020 Murrumbidgee Local Health District Planning Unit Contact: Melanie Mann Ph: 0475 958 858
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TABLE OF CONTENTS
DOCUMENT ADMINISTRATION ...... 2 REVISION HISTORY ...... 2 1. EXECUTIVE SUMMARY ...... 5 2. INTRODUCTION ...... 8 2.1 FACILITY OVERVIEW ...... 8 3. CONTEXT ...... 11 3.2 OVERVIEW OF MURRUMBIDGEE LHD ...... 11 3.2.1 Location of Urana Health Service ...... 13 3.3 SERVICE ACCESS ...... 14 3.4 TRANSPORT ...... 15 3.4.1 Road...... 15 3.4.2 Bus and Bus/Train Services ...... 15 3.4.3 Commercial Air Transport ...... 16 3.4.4 Taxi ...... 16 3.4.5 Community Transport Services...... 16 3.4.6 Community Concerns Regarding Transport ...... 16 4. DEMOGRAPHICS ...... 16 3.5.1 Population Breakdown of Catchment Populations ...... 17 4.2.2 Culturally and linguistically diverse populations ...... 18 4.2.3 Aboriginal Population ...... 18 4.2.4 Population Change ...... 18 4.2.5 Social Determinants of Health...... 20 4.2.6 Pension Support ...... 21 4.2.7 Local Industries and Employment ...... 22 4.3 HEALTH OF THE POPULATION ...... 22 4.3.1 Mortality ...... 23 4.3.2 Morbidity (Hospitalisation) ...... 24 4.4 HEALTH RELATED BEHAVIOURS ...... 30 4.4.1 Smoking ...... 30 4.4.2 Alcohol ...... 31 4.4.3 Obesity/ high BMI related illness ...... 32 5. EXISTING FACILITIES ...... 34 6. EXISTING NETWORK OF HEALTH AND RELATED SERVICES ...... 35 6.2 GP SERVICES ...... 37 6.3 ACUTE AND INPATIENT CARE SERVICES ...... 37 6.3.1 Emergency Department Activity ...... 38 6.3.2 Inpatient Activity ...... 39 6.4 SUPPORT SERVICES...... 43 6.4.1 Medical Imaging ...... 43 6.4.2 Pharmacy ...... 43 6.4.3 Pathology ...... 43 6.4.4 Body Holding Facility ...... 43 6.4.5 Sterilisation Services ...... 43 6.4.6 Stores Management ...... 44 6.4.7 Maintenance Services ...... 44 6.4.8 Waste management ...... 44 6.4.9 Catering, Cleaning and Laundry Services ...... 44 6.4.10 Patient transport ...... 44 6.5 COMMUNITY HEALTH SERVICES ...... 44 6.5.1 Non Admitted Patient Occasions of Service ...... 46 6.6 AGED CARE SERVICES ...... 48 6.6.1 Residential Aged Care Beds ...... 49 6.6.2 Community Units - Billabidgee ...... 50
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6.6.3 Other nearby NSW Aged Care Services ...... 50 6.6.4 Community Aged Care Packages ...... 51 6.6.5 Aged and Dementia Care, Aged Care Assessment Team ...... 51 6.7 HEALTH RELATED TRANSPORT ...... 52 6.8 REMOTE HEALTH CARE (VIRTUAL CARE) ...... 52 6.9 OTHER PRIVATE SERVICES ...... 53 6.9.1 Visiting Specialists ...... 53 6.9.2 Private Pharmacy Services ...... 53 6.9.3 Private Pathology Services ...... 53 6.9.4 Blood Bank ...... 53 6.9.5 Private Allied Health ...... 53 6.10 OTHER COMMUNITY SERVICES ...... 53 6.10.1 NSW Home Care Services- Family and Community Services, Aging, Disability & Home Care .... 53 6.10.2 Local Health Advisory Committee ...... 54 6.10.3 Hospital Auxiliary ...... 54 7. PROPOSED SERVICES ...... 55 7.2 PLANNING PRINCIPLES ...... 57 7.3 FACTORS IMPACTING ON THE PLANNING OF HEALTH SERVICES IN URANA ...... 57 7.4 ACUTE CARE SERVICES ...... 58 7.4.1 Emergency Services ...... 58 7.4.2 Inpatient Services ...... 58 7.5 SUPPORT SERVICES...... 60 7.5.1 Medical Imaging ...... 60 7.5.2 Pharmacy Services ...... 60 7.5.3 Pathology Services ...... 61 7.5.4 Mortuary Services ...... 61 7.5.5 Sterilisation Services ...... 61 7.5.6 Stores Management ...... 61 7.5.7 Maintenance Services ...... 61 7.5.8 Waste Management ...... 61 7.5.9 Catering, Cleaning and Laundry Services ...... 61 7.6 PRIMARY AND COMMUNITY HEALTH SERVICES ...... 62 7.7 AGED CARE SERVICES ...... 62 7.8 HEALTH RELATED TRANSPORT ...... 68 7.9 INFORMATION TECHNOLOGY...... 68 7.10 STAFF ACCOMMODATION...... 68 8. PROFILE OF PROPOSED SERVICES ...... 70 8.1 MPS SERVICES ...... 70 8.2 ROLE DELINEATION ...... 71 8.3 CURRENT AND PROPOSED STAFFING LEVELS ...... 71 8.4 PROPOSED OPERATING BUDGET ...... 72 9. BENEFITS OF THE PROPOSAL ...... 73 10. COMMUNITY CONSULTATION ...... 75 10. EVALUATION AND MONITORING ...... 76 11. SUMMARY ...... 77 APPENDIX 1: ABBREVIATIONS ...... 78 APPENDIX 2: ACTIVITY DATA...... 79 APPENDIX 3: ROLE DELINEATION LEVELS URANA MPS ...... 82
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1. EXECUTIVE SUMMARY
The Urana Multi-Purpose Service (MPS) is the first line health service provider for the people of the Urana community. The Urana MPS is situated in Urana Township within the Federation Council Local Government Area (LGA), which forms part of the Murrumbidgee Local Health District (MLHD).
Not all the Federation Council LGA population flows to Urana Health Service. Federation LGA has two health services; Urana MPS and Corowa Health Service. The post code 2645 or Urana Urban State Suburb is the closest alignment for the Urana MPS catchment. The data set that most accurately reflects the past activity and therefore will best suit projections of future growth and needs has been based on the former Urana Shire LGA, this is used for making planning assumptions. This is the most accurate data set to review activity for the MPS, it is current data, despite boundary changes. Future planning should not reflect only current occupancy, but needs to consider local use patterns and trends in population for relevant age groups. This is especially true for isolated facilities and in communities where there is a single provider. Population health data offers insights into the region and broader trends locally, so the current Federation Shire and MLHD wide data is used as a baseline. There is no 2019/2020 data currently in the state-wide inpatient planning tools, as a result of Covid-19 the data cleansing and upload were delayed. It should also be noted that due to the dramatic impacts of the Covid-19 pandemic the 2019/2020 data will largely be considered an anomaly and whilst reviewed is a data outlier.
The Urana Shire LGA in 2016 had a population of 1,121 with 17% aged 70 years and over (208). Projections for this population (based on the assumption that it will change similarly to the former Urana Shire LGA) indicate that by 2036, 21% will be aged 70 years or over (225 people). Urana is a geographically remote community and the majority of stays at the Urana MPS (85%) are from Urana and Oaklands townships.
Urana MPS currently provides a range of services. The hospital is a 22-bed Multi- Purpose Service. Three beds are classed as acute beds and 19 as High Care Residential Aged Care Type. Activity levels for both bed types have been increasing in recent years. The facility has a 24 hour emergency department and is supported by visiting services.
A range of primary care services are provided through the Urana MPS. The local GP provides Visiting Medical Officer services for the Health Service.
There is no other aged care provider in the town with the nearest facilities being located in Lockhart (47km) or Jerilderie (57km). Both nearby communities are largely self- sufficient in aged care places and as such there is generally not opportunities for Urana residents to access these places, as well as a reluctance to move Urana residents out of their home community.
Urana MPS is one of the top priorities for the MLHD to improve and upgrade. It is listed on the MLHD Asset Strategic Plan and has a number of items listed in the Asset Opportunities documentation. The site has recently been successful in a grant for funding to improve palliative care services and infrastructure at the hospital. These upgrades to the palliative care space to the bedroom, bathroom, a family room and kitchenette.
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This Service Plan is a requirement for the Ministry of Health and to assess the Urana MPS for future renewal and redevelopment. Should Urana be supported in principle, more detailed planning will be required prior to any capital investment. There are no set time frames for this to occur.
Community consultations took place on a number of occasions between 2018-2020. The Service Planner met with the Local Health Advisory Committee (LHAC), the manager and staff of the MPS, and large groups of community representatives, representatives of the council and the Auxiliary. Those consulted were satisfied that the services to be provided in the proposed MPS model will meet their current and future health needs.
The Urana Multipurpose Service (MPS) model is planned to continue to meet the health and aged care needs of the Urana community. The Urana MPS will continue to be an integrated health service offering a ‘one stop shop’ including inpatient beds, palliative care, respite care, flexible aged care, slow stream rehabilitation transitional care, community health and aged care services. The model will be guided by the State Government Residential Aged Care Facilities and Multipurpose Services: Operational Guidelines, March 2020 and also by the Living Well in MPS principles. Living Well in MPS looks to support staff to improve the quality of life for residents living in MPS aged care facilities creating a more home like environment.
It is proposed that the MPS’s day to day operations be managed by the Health Service Manager and who in turn will report to the Deniliquin Cluster Manager. Urana MPS Advisory Committee will continue to provide advice on the health, aged care and community support needs of their local community.
It is proposed that the Urana MPS will provide:
Level 1 emergency department with Telehealth capacity and close observation/quiet room with flexible use; 4 inpatient beds that are used flexibly to include respite and palliative care; 24 residential aged high care beds suitable for those with lived experience of dementia (at commissioning); Lifestyle activities spaces, including kitchenette for residents; Community and allied health services; Consultation rooms for both private and visiting health services; and Staff Accommodation.
The MPS will provide inpatient services (including respite and palliative care), high care residential aged care, community health, outpatient and emergency care. Partnerships with other providers will ensure a seamless transition between the various services for the community.
Continuing to operate as a Multipurpose Service (MPS) will provide the following benefits:
Improved access to health and aged care services that meet community needs; More innovative, flexible and integrated service delivery; Viable acute, residential high care, community health and community services for the future; A greater focus on prevention and community outreach programs;
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High care respite and transition programs for the Urana community; National Standard Accreditation incorporating the Aged Care Module to support alignment with the Aged Care Standards and Living Well in MPS Principles of Care The continued strong support of the MPS LHAC to ensure active community participation in service planning and consumer participation in care.
The Urana Health Service will require and benefit from capital investment to meet future service requirements discussed in this Plan including improved emergency and inpatient areas, flow, modern residential aged care rooms, ability to fully implement living well in MPS models, staff accommodation and staff spaces.
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2. INTRODUCTION
Local Health Districts and Specialty Health Networks (LHDs/SHNs) undertake a range of planning as part of usual business processes, examples of these include clinical services, workforce, asset, financial, business and broader strategic planning.
A clinical services plan (CSP) provides sufficient information to describe a service or services and how these will need to be delivered into the future to reflect changing health needs of the community and ways of providing care. A CSP is a robust document and is essential in supporting the scope of potential investment priorities identified in the LHD/SHN Asset Strategic Plan. It is important to understand that a CSP does not indicate any commitment to a specific capital investment.
A CSP will prioritise the services and strategies for implementation to respond to communities’ heath needs. Where there is a need for supporting capital investment to deliver these service outcomes, the subsequent capital planning process will translate these service developments into infrastructure responses.
A CSP should outline how services will develop or evolve over a 5 and 10 year period to meet community health needs. As models of care and service delivery, technology and workforce change over time, the detail of the strategies in the plan will evolve, and plans should be reviewed and updated accordingly at appropriate intervals. Usually the CSP is formally requested by the NSW Ministry of Health, as a CSP is required prior to commencing facility planning including Business Case developmentIf a CSP is used as the basis for infrastructure investment, it is to be submitted to the Ministry of Health for endorsement after being approved by the LHD/SHN and prior to commencing infrastructure/investment planning.
The NSW Health Process of Facility Planning (POFP) details and directs the processes for the procurement of capital infrastructure across the public health system (including buildings, major equipment, information management systems etc.). The POFP requires an endorsed service plan that sets out the demonstrable need to procure the particular capital infrastructure before it can be commenced1.
2.1 Facility Overview The Urana Multi-Purpose Service is the first-line health service provider for the people of the Urana community as well as a number of small hamlets nearby. The hospital has been classified under the NSW Hospital Peer Grouping classification as a Multi- Purpose Service. These facilities offer a combination of hospital emergency and inpatient services, residential aged care and community health services. It was the first MPS classified in the Murrumbidgee LHD in 2008.
The National Health and Hospitals Reform Commission’s (NHHRC 2009) Interim Report recognises the value of the MPS model. The key objectives of the MPS program include:
Improved access to a mix of health and aged care services that meet community needs; More innovative, flexible and integrated service delivery;
1 NSW Heath Services Planning Guide
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Flexible use of funding and/or resource infrastructure within integrated service planning; Improved quality of care for clients; Improved cost-effectiveness and long-term viability of services.
The MPS program contributes in several ways to the achievements of priorities identified in the NSW State Plan and the NSW State Health Plan. In the State Health Plan:
Direction 1: Keeping People Healthy – through community health programs and services in partnership with primary health service providers; Direction 3: Delivering Truly Integrated Care; including partnering people in their care, working with other health service providers and community services and integrating care in the MPS setting to meet the needs of emergency, acute, community and aged care needs; and Strategy 4: Designing and Building Future-Focused Infrastructure – which meets the needs of small rural communities to maintain a vibrant and viable health service.
The Urana Multi-Purpose Service in situated on the corner of Church and Princess Street in Urana Township in the Federation LGA. Not all the Federation LGA population flows to Urana Health Service for health care. Federation LGA has two health services; Corowa Hospital, and Urana Multi-Purpose Service. The previous Urana Shire population region will be used throughout this plan as the best descriptor for the hospitals catchment, encompassing the majority of patients flowing to the facility.
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Figure 1: Former Urana Shire Council Map
This Service Plan provides an analysis of the former Urana LGA and Urana Health Service catchment area and health service needs including: Demographic information; Health status; Existing health and health related services; Use of health and health related services; Key issues impacting on health services; and Proposed services.
Consultations with key stakeholders conducted in June 2018 and again in February 2019 have informed the Plan. Two community and stakeholder public meetings were held in 2018, followed by meetings with Federation Shire delegates, local community health teams, the town General Practitioner as well as ongoing communication with the Urana LHAC Chairperson. The planning process was commenced in 2018, and has been ongoing with some delays experienced due to workforce availability and COVID-19. The Chief Executive and board has since attended a site visit. The LHAC has been fully supportive of the Urana Multi-Purpose Service being renovated or
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3. CONTEXT
The Urana MPS is located within the Deniliquin Cluster of MLHD, which also contains the hub site of Narrandera Health Service, and Lockhart MPS.
3.2 Overview of Murrumbidgee LHD The Murrumbidgee Local Heath District (MLHD) was formed on 1 January 2011. It is one of seven Rural LHDs in NSW (Figure 1). The MLHD covers 21 Local Government Areas spread across 125,000 square kilometres (Figure 1A and 1B). MLHD is comprised of 47 geographically spread health facilities and community health centres. Most of the LHD is considered inner regional or outer regional in terms of remoteness. The largest towns are Wagga Wagga, Griffith and Deniliquin. Albury is considered to be part of Albury/Wodonga Health; however some MLHD health services continue to be provided in this community.
Figure 1A: NSW Rural Local Health Districts (LHDs)
Source: MLHD Website
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Figure 1B: Murrumbidgee Local Health District
Source: MLHD website
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3.2.1 Location of Urana Health Service
The Urana health service is situated in the township of Urana in the Riverina area of NSW between Lockhart and Jerilderie. It was formerly the centre of the Urana local government area which has now amalgamated with the former Corowa Shire to form Federation LGA. Urana is located 566 km south-west of Sydney and 379 km north of Melbourne. The Urana area, for the purposes of this report, incorporates the population within the boundaries of the former Urana LGA. (Figure 1C and Table 1).
Note: Estimated Resident Populations (ERPs) and Population Projections are not officially calculated for the Urana Health Service catchment area – as it is now part of the Federation LGA. The ERPs and projections have been calculated locally using the age/sex proportions that the State Suburbs of Urana, Oaklands, Morundah, Boree Creek and Rand made up of the Federation LGA in the 2016 Census. Projections and estimates are therefore subject to the assumptions made for the Federation LGA as a whole, not specifically the Urana area and should be regarded as an indication of the possible population dynamics only.
Figure 1C: MLHD showing Urana area (former Urana LGA) in relation to capital cities.
Source: Public Health, MLHD, created using Esri ArcGIS software.
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Table 1: Distance from Urana Township to nearest cities and towns (by car) Town Distance from Urana (Kilometres) Approx. travelling time (hours) Lockhart 47 0:35 Jerilderie 57 0:40 Berrigan 73 0:50 Narrandera 82 1:00 Corowa 82 1:00 Wagga Wagga 111 1:15 Albury 126 1:30 Canberra 352 4:00 Sydney 568 6:00 Melbourne 400 4:50 Source: Google maps
3.3 Service Access The MLHD model of care is based on the NSW model for rural health services2 which has a core of community hospitals, Multi-purpose Services (MPS’s) and primary health care including general practice, community services, public health and health promotion. Supporting these are District and Base hospitals within MLHD and tertiary referral hospitals in Sydney, Melbourne and the ACT.
This model supports people obtaining the best possible service for their health needs. It highlights the integrated nature of health services and the important role of information technology, virtual care and transport in the delivery of a comprehensive range of services across the District.
In the last 12 months there have been significant increases in the availability of virtual services across the state and MLHD, especially since the outbreak of Covid-19. The technology to support this service access has improved and expanded. These services can be delivered directly to patients in their homes or hospital clinics in Urana, but also supporting local nursing and medical staff to provide care in Urana reducing the need to transport patients to other hospitals.
Local public health services and service networks include: Community Hospital and Community Health – Urana Health Service including Primary & Community Care outreach from Albury, Lockhart, Corowa, Finley and Wagga; Rural referral health service – Albury Base Hospital as part of Albury/Wodonga Health and Wagga Wagga; and Tertiary referral health services – Melbourne or Sydney.
There are multiple community services available locally including:
Community Aged Care Packages provided by Interreach and Valmar; Interreach provide a range of services including youth, aged and disability and NDIS; Community Home Support Program; Podiatrist; Physiotherapist; Hairdresser is located in the community health building; Community transport via Valmar at Lockhart; and
2 Report of the Rural Health Implementation Coordination Group. The NSW Rural Health Report, 2002
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Home Care.
There are number of Government and business services in Urana. The council offices host a My Gov agency consisting of a largely self-service access computer and minor identification checks. The council offices also offer Bendigo Banking facilities. The nearest Medicare offices are in Wagga Wagga or Albury; the Road and Traffic Authority office by appointment one day a month in Oaklands or is open 5 days a week in Finley and Albury; while the closest Centrelink offices are in Albury, and Wagga Wagga.
The Urana Post office offers banking and bill pay for most of the large banks.
3.4 Transport The reliance on public transport is an issue in most rural communities, particularly for the elderly. Transport options are limited and public transport is lacking. Elderly residents often do not have family locally due to the shift of younger people to larger centres for work, education and social opportunities. Urana also attracts retirees for its lower costs of living and close knit community. Social isolation for the elderly becomes an issue when the ability to drive ceases. Access to health services becomes problematic, and partners of aged care residents face ongoing challenges to visit their partner regularly, even within short distances.
3.4.1 Road Urana is located between Lockhart and Jerilderie and is serviced by a network of narrow rural roads linking to the Riverina Highway in the south, and to the major arterials of the Newell and Kidman Highway to the north west. The network of roads immediately into town provide the only transport link for large trucks and rural farm equipment transporters between these towns, highlighting a major risk for the elderly travelling these roads, even for short distances. Access for ambulance and patient transport is also via the same rural roads.
Table 2: Distance from Urana to nearest cities and towns Town Distance from Urana Approx. travelling time (Kilometres) (hours) Lockhart 47 0.35 Jerilderie 57 0.41 Berrigan 73 0.50 Corowa 82 0.57 Wagga Wagga 111 1.16 Albury 126 1.27 Narrandera 82 0.55 Canberra, ACT 361 3.55 Sydney 568 5.53 Melbourne, Victoria 380 4.00 Source: Google Maps
3.4.2 Bus and Bus/Train Services There is a weekly bus service running on various days between Urana and; Lockhart Wagga Wagga Albury
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Narrandera Corowa Jerilderie These services are through NSW TrainLink Coach, and offer connections to XPT train services from Wagga and Albury to the capital cities. This service is the 733 Wagga Wagga to Moama route. The coach stop is in Anna Street in the centre of town. The post office is the agent for NSW Transport.
3.4.3 Commercial Air Transport There is no commercial airport at Urana. There is a council maintained landing strip used for private aircraft, training and agriculture. The closest airports for commercial passenger services are at:
Albury; Wagga Wagga; Narrandera; Griffith; and Melbourne.
The air ambulance provides fixed wing and helicopter retrievals from Urana airport. This service is very infrequently used.
3.4.4 Taxi There is no taxi service in Urana, making access to other aged care providers out of town challenging for family and carers to visit. Community transport options are available to some nearby towns.
3.4.5 Community Transport Services Community transport services are available through Valmar. Valmar offers a community transport bus weekly to a variety of locations. Pick-ups are offered in Lockhart, Oaklands and Urana and destinations vary for shopping, medical appointments and fun activities/days out to nearby tourist attractions. There is the option of booking a Valmar car service to take mobile clients to appointments also. This is booked via patient flow unit used to take well residents to appointments.
There is also a community transport vehicle pool available, coordinated by volunteers with fuel subsidised.
3.4.6 Community Concerns Regarding Transport Transport to other communities is an ongoing issue, particularly for the elderly who no longer have a drivers licence. The lack of taxi services and minimal public transport limits access to other communities. There is therefore a high reliance and need for public services to be provided locally. 4. DEMOGRAPHICS The population of the former local government area of Urana is the major catchment for the Urana health service (Figure 2). The estimated resident population (ERP) as
Draft Urana MPS Plan-2020 page 16 of 82 Draft Urana MPS Service Plan 2020 of June 30, 2019 was 1,129, the population has been declining since 2011 with an average annual decrease of 13 people per year 2012 to 2016, a 5 per cent decrease over 5 years (ABS Regional Estimated Resident Populations).
Figure 2: Urana (former LGA)
Source: Public Health, MLHD, created using Esri ArcGIS software, May 2018.
3.5.1 Population Breakdown of Catchment Populations
The median age of the Urana population in 2016 was 50 years, older than the median age for NSW at 37.6 years and Australia at 37.2 years. The proportion of the population aged 65 years or older was 24.6% in Urana compared to 15.9% in Australia and 16.3% in NSW (Table 2).
Table 3: Summary demographic characteristics Urana and NSW 2019 ERP Aboriginal population (2016 Median 65 years 70 years Area Males Females Total Census) age 0–14 years and over and over N N N N % N % N % N %
Urana 643 586 1229 37 3.3 50 242 19.7 302 24.6 208 16.9
NSW 2.9 37.6 18.5 16.3 11.5 Australia 2.8 37.2 18.7 15.9 11.1 Source: #ABS Estimated Resident Population June 30, 2017 for NSW and Australia (Aug 2018), *Aboriginal data from 2016 ABS Census, Quikstats.
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Urana LGA has slightly more children and less 15-64 year olds, proportionally than NSW and Australian averages (Figure 3). The proportion of older people is significantly larger in Urana than NSW and national averages. Figure 3: Age distribution comparison Urana area, NSW, Australia, 2019
15.9 Australia 65.4 18.7
16.3 NSW 65.2 65 + 18.5 15-64 0-14 24.6 Urana 55.7 19.7
-5.0 5.0 15.0 25.0 35.0 45.0 55.0 65.0 75.0 % of total population
Source: ABS Estimated Resident Population June 30, 2017, August 2018.
4.2.2 Culturally and linguistically diverse populations
Eighty-two per cent of Urana residents were born in Australia, and 2% spoke a language other than English at home (20 people). Due to a small population number further information is not available.
4.2.3 Aboriginal Population
The 2016 ABS Census reports that 3.3% of Urana’s residents identified as Aboriginal or Torres Strait Islander (37 people).
The Usual Resident Population of Aboriginal people in Urana area for 2016 was approximately 40 which was 3.3% of the total population compared to 2.9% in NSW and 2.8% in Australia. Due to a small population number further information is not available.
4.2.4 Population Change
The estimated resident population Urana area (June 2019) 1,229
Population growth from 2012 to 2016 for Urana area has indicated an average annual decrease of around 13 people with a net decrease of 59 from 2012 to 2016, a 5 per cent decrease over 5 years (based on ABS Estimated Resident populations).
The population of Urana is ageing, the median age of the population had increased from 47 years in 2011 to approximately 50 in 2016. Population projections (estimated from the Federation LGA projections 2019) forecast a decrease in total population of
Draft Urana MPS Plan-2020 page 18 of 82 Draft Urana MPS Service Plan 2020 around 45 to 50 people per 5 year period from 2021 to 2036. The forecast also indicates an increase in aged populations (65+ years) to 2026 then a plateau from 2031. From 2021 to 2031 there could be an increase in the population aged 70+ years of around 20 people with majority of this increase in the 80+ year age group (Table 3). The proportion of older people is projected to increase over time with those aged 70 years or over making up 17 per cent of the population in 2021 rising to 20.4 per cent in 2031 (Figure 4).
Table 4: Urana area population projections, 2016 to 2036 Age group Proj_2016 Proj_2021 Proj_2026 Proj_2031 Proj_2036 Urana 00-04 69 63 59 54 50 approx. 05-09 110 100 93 88 82 10-14 72 74 68 63 60 15-19 71 64 65 60 55 20-24 40 34 30 30 27 25-29 35 34 30 26 26 30-34 43 46 45 39 36 35-39 62 61 64 62 55 40-44 64 57 57 60 57 45-49 92 84 75 77 79 50-54 93 83 76 69 71 55-59 114 102 93 86 78 60-64 87 89 81 74 70 65-69 99 87 90 83 78 70-74 57 68 62 64 59 75-79 57 61 73 68 70 80-84 38 42 45 55 52 85+ 30 30 33 36 44 Total 1234 1179 1139 1093 1048 Change in pop’n from previous -55 -40 -46 -45 65+ years 282 288 303 306 303 22.8% 24.4% 26.6% 28.0% 28.9% Change in 65+yr from previous +6 +15 +3 -3 70+ years 183 201 213 223 225 14.8% 17.0% 18.7% 20.4% 21.5% Change in 70+yr from previous +18 +12 +10 +2 80+ years 68 72 78 91 96 5.5% 6.1% 6.8% 8.3% 9.1% Change in 80+yrs from previous +4 +6 +13 +5
Source: 2019 Department of Planning and Environment Population Projections, 2019 ERP base.
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Figure 4: Population projections for Urana area, all ages and 70+ years 2021 to 2031.
Source: NSW Department of Planning Population projections (2019).
These changing population demographics will have an impact on the future demand for services related to ageing including chronic disease management, primary health/ health education services, acute/ sub-acute care and aged care services. The demand for child and family health services is likely to decline.
4.2.5 Social Determinants of Health The health and wellbeing of individuals and communities is strongly linked to socio- economic factors where it is well documented that those who are socio-economically disadvantaged have poorer health. The Australian Bureau of Statistics Index of Relative Socio-economic Disadvantage is a score calculated on the percentage of the population in a particular area (such as LGA) with certain characteristics related to disadvantage (e.g. low income, high unemployment, low skilled jobs, and fewer qualifications). The scores for all areas across Australia are then put in order, given a ranking and divided into 10 groups (deciles), with Decile 1 being the 10% most disadvantaged areas, and Decile 10 the 10% least disadvantaged areas. Urana area is made up of 4 SA1 geographic units (118110, 118111, 118112, 125915) three of which are in the top 20% most disadvantaged SA1s in Australia and the 4th is decile 5 (Figure 5), such that 65% of the Urana population live in “relative disadvantage”. The Australian Standard Geographic Classification category based on Accessibility/Remoteness Index of Australia (ARIA+ 2011) indicates that the former Urana LGA is classified as “moderately accessible” (University of Adelaide www.spatialonline.com.au/ARIA_2011).
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Figure 5: Socioeconomic Disadvantage by SA1, MLHD, 2016
Source: Public Health, MLHD, created using Esri ArcGIS software and ABS SEIFA data 2016, May 2018.
4.2.6 Pension Support In June 2016, 7.6% of the 0 to 64 year old population of Federation LGA were Health Care Card holders (706 people); 33.5% of people aged over 15 years were Pension Concession Card holders (3,527) and 6.7% of those aged 65 years or over were Seniors Health Card holders (224). The proportion of the population receiving many pension categories was higher than NSW (Table 5) indicating that a large proportion of the Federation LGA is welfare dependent.
Table 5: Income Support Recipients June 2016, Federation LGA and NSW Federation LGA NSW Pension type Number % of eligible % of eligible population population Age 2512 75.1 67.6 Disability support 470 6.7 5.2 Female sole parent 146 5.6 3.7 Unemployment 456 6.5 4.8 Unemployment long term 388 5.5 4.0 Young people 15 to 24 yrs on unemployment 45 3.8 3.0 benefit Welfare dependent and other low income 284 8.4 9.9 families Health Care Card holders 706 7.6 6.4 (less than 65 years) Pension Concession Card holders (15 years 3527 33.5 21.9 and over) Seniors Health Card holders 224 6.7 8.3 (65 + persons) Total concession card holders (PCC + HCC) 4233 34.5 23.6 Source: Social Health Atlas of Australia, Data by Local Government Area from Centrelink, PHIDU, June 2016, accessed November 2020.
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On Census night August 2016, 6% of people in Federation LGA were classified as having profound or severe disabilities with over one thousand people providing unpaid assistance to persons with a disability. There were approximately 255 people under 65 years of age living in the community with a profound or severe disability and 400 aged 65 years or over (Table 6).
Table 6: Profound or Severe Disability 2016 number and percentage, Federation LGA and all NSW. Disability status 2016 Federation NSW Number % % Unpaid assistance to persons with a disability (aged 15+ yrs) 1187 11.7 11.6 People with a profound or severe disability (includes people in long- 649 5.8 5.6 term accommodation), All ages People with a profound or severe disability and living in the community, 614 5.5 4.9 All ages People with a profound or severe disability (includes people in long- 255 3.1 3.0 term accommodation), 0 to 64 years People with a profound or severe disability and living in the community, 252 3.1 3.0 0 to 64 years People with a profound or severe disability (includes people in long- 398 13.2 19.1 term accommodation), 65 years and over People with a profound or severe disability and living in the community, 364 21.1 14.9 65 years and over Source: Compiled by PHIDU based on the ABS Census 2016 (unpublished) data.
4.2.7 Local Industries and Employment The September 2020 small area unemployment figures reports the Corowa Region (SA2) unemployment rate as 3.7% (Australia 6.9%, NSW 47.2%) with an estimated labour force of 5,000 (September Quarter 2020). The most common industry of employment for persons aged 15 years and over usually resident in Federation LGA (ABS 2016 Census) were Pig Farming (4.2%), Supermarket and Groceries (3.7%), other grain growing (3.1%), Hospitals (3.0%) and Aged Care Residential Services (3.0%). This profile is heavily influenced by the population of Corowa with a large pig farming/processing industry. The former Urana LGA industries were dominated by sheep, beef and grain farming (ABS 2011 Census).
4.3 Health of the Population People living in rural and remote areas generally have worse health than people living in metropolitan areas. This is a result of several factors including socio-economic disadvantage, access to health care services, shortage of health care providers, unhealthy lifestyle behaviours, greater exposure to injury/risks and geographic isolation.
As the Urana area population is relatively small, it is difficult to look at specific indicators of health at this level; therefore health status will be discussed at the LHD level unless NSW Ministry of Health data is available by LGA.
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4.3.1 Mortality
The age-adjusted “all cause” death rate for 2018 in MLHD is significantly higher than expected based on NSW rates (573.7 per 100,000 population compared to 506.4 per 100,000 in NSW). There were 2,201 deaths in MLHD 2018 and the death rate has overall been decreasing steadily for both males and females since the early 2000’s, the rate for males has decreased significantly from 2016 to 2018 however it is significantly higher than the rate for females and both males and females in MLHD have significantly higher death rates than NSW overall. The major causes of death for males and females is cancer followed by circulatory diseases (Figure 6). Figure 6: Causes of Death in MLHD 2017/18
Source: Health Statistics NSW, Nov 2020
There was an average of 152.0 deaths per year (2014-15) for residents in Federation LGA at a rate of 665.2 per 100,000 population which was significantly higher than the NSW rate. The rate of death due to potentially avoidable causes for people aged under 75 years in Federation has been declining, from 156.8 per 100,000 per year (around 18 deaths) in 2001-2002 to 118.7 per 100,000 in 2014-15 (around 13 deaths). Due to small numbers the rates can vary dramatically from year to year although there is a definite downward trend to 2001-2002 to 2014-2015 (Figure 7).
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Figure 7: Potentially avoidable deaths, Federation, NSW, 2001-2002 to 2017-2018
Source: Health Statistics NSW, November 2020
4.3.2 Morbidity (Hospitalisation) The most significant cause of hospitalisation in MLHD (2016-17) was “other factors influencing health care” (ICD10 Z-codes*) (15,383 episodes, 12.1%); followed by digestive system diseases (13,327, 10.5%), and then dialysis (12,630 episodes, 9.9%). The pattern for most causes was similar for males and females however the highest rate of hospitalisation for females was maternal and neonatal related diagnoses.
Since the early 2000’s rates of separations for most major categories of cause have been increasing slightly, however the major contributor to increased separation rates overall for the MLHD is the increasing rate of dialysis admissions which have doubled in 15 years. Dialysis has increased from around 3% of admissions in 2001-02 to around 10% in 2016-17. For MLHD residents the age-adjusted rates of hospitalisation by cause were significantly higher than the NSW rates for a large number of causes (Figure 8). *In 2016 in MLHD there were around 13,500 episodes with Z-codes although specific reasons for hospital contact are varied, some of the major reasons for these encounters were for chemotherapy (~4,000), newborns (~2,000), surgical care follow up (~1000) and endoscopic examinations (~500).
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Figure 8: Hospitalisation by cause and sex. MLHD 2018-19Source: Health Statistics NSW, 2018
Source: Health Statistics NSW, November 2020
Hospitalisations for Federation LGA residents specifically: The average number of hospitalisations per year for residents of Federation LGA ranged from to 5,657 to 6,226 from 2012-13 to 2016-17. Rates of hospitalisation for Federation LGA residents have been increasing since the mid 2000’s but have generally been similar to NSW rates (Figure 9). In 2012-13 the separation rate for Federation was 35,062 per 100,000 population (5657 separations) this has risen to 37,005 per 100,000 in 2016-17 (6,226 separations) (Table 7).
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Figure 9: Hospitalisations trend Federation LGA 2001-02 to 2016-17
Source: Health Statistics NSW, May 2018.
Table 7: Hospitalisations for all causes, Federation LGA, 2012-13 to 2016-17 Rate per 100,000 LL 95% UL 95% Year State comparison Number population CI CI 2012-13 Federation LGA 5,657 35061.8 34051.1 36092.5 Rest of NSW 2,692,044 34219.9 34178.6 34261.3 Total NSW 2,697,701 34220.3 34179.1 34261.6 2013-14 Federation LGA 5,961 36779.8 35739.3 37840.4 Rest of NSW 2,765,655 34472.7 34431.6 34513.9 Total NSW 2,771,616 34476.5 34435.5 34517.6 2014-15 Federation LGA 5,588 34258.8 33252.4 35285.4 Rest of NSW 2,841,113 34741.2 34700.2 34782.1 Total NSW 2,846,701 34739.8 34698.9 34780.7 2015-16 Federation LGA 5,600 34015.8 33010.3 35041.4 Rest of NSW 2,932,202 35145.3 35104.5 35186.1 Total NSW 2,937,802 35251.4 35210.5 35292.3 2016-17 Federation LGA 6,226 37004.6 35938.6 38090.8 Rest of NSW 3,018,535 35297 35256.6 35337.5 Total NSW 3,024,761 35968.8 35927.6 36009.9 Source: HealthStats NSW, November 2020.
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Potentially preventable hospitalisations Potentially preventable hospitalisations (PPH) are those that could potentially have been avoided through preventive care and early disease management, usually delivered in an ambulatory setting such as general practitioners or community health services (Figure 10).
In relation to PPH rates by condition type (2018-19) the most common in terms of total bed days per year in MLHD were: • Chronic obstructive pulmonary disease (5,100 total bed days); • Cellulitis (3,728 total bed days); • Congestive cardiac failure (3,615 total bed days); • Urinary Tract Infections (2,701 total bed days); • Diabetes complications (2,867 total bed days).
The most frequent in terms of admission numbers in 2018-19 were: • COPD (1,165); • Urinary tract infections (995) • Cellulitis (952); • Dental conditions (768); • Ear nose and throat infections (719) • Congestive cardiac failure (718) • Iron deficiency anaemia (623).
The causes with significant increasing trend in admission rates since 2001-02 were: • Pneumonia and influenza (vaccine preventable) • Other vaccine preventable conditions • Bronchiectasis • Nutritional deficiency • Urinary tract infections • Cellulitis • Iron deficiency anaemia • Ear, nose and throat infections
Those with significant decreases in admission rates since 2001-02 were: • Congestive cardiac failure • Angina • Perforated bleeding ulcer • Pelvic Inflammatory Disease.
The age-adjusted rates of PPH by condition in MLHD were significantly higher than the rates for NSW for the following: • COPD • Urinary tract infections, including pyelonephritis • Cellulitis • Dental conditions • Ear, nose and throat infections • Congestive cardiac failure • Iron deficiency anaemia • Diabetes complications • Convulsions and epilepsy • Asthma
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• Bronchiectasis • Gangrene • Other vaccine-preventable conditions • Total preventable hospitalisations
Figure 10: Potentially Preventable Hospitalisation by cause MLHD 2018-19
Source: Health Statistics NSW, current as of November 2020.
PPH rates for Federation LGA residents have been decreasing since 2001-03 when they were significantly higher than NSW rates in 2015-17 the rates were no longer considered high compared to NSW (Figure 10). This can indicate less residents requiring hospital treatment for preventable causes and/or the same patients requiring less admissions (i.e. the data is based on counting admissions not individual patients).
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Figure 11: Potentially Preventable Hospitalisations trend Federation LGA 2001-03 to 2018-19
Source: Health Statistics NSW, November 2020.
The average number of hospitalisations per year for residents of Federation LGA was around 5,500 in 2014-15 increasing to 6,500 to 2018-19. The age standardised rate was 37990 per 100,000 population in 2017-18, which was significantly higher than the rate for the rest of NSW for that year and all of NSW (Table 8) and rates have been steadily increasing since the early 2000’s (Figure 11).
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Table 8: Hospitalisation Indicators for Federation LGA residents NSW rate per Higher or Trend in Average Standardised 100,00 lower than LGA Year per year Rate /100,000 0 NSW* Since 2005 All hospitalisations 2018-19 6494 37990 34818 High Increasing Potentially Preventable 2017-19 307 2454 2161 Not higher Decreasing Smoking attributable 2017-19 166 1326 659 High Increasing
Alcohol attributable 2017-19 65 518 514 Not higher Increasing High Body Mass attributable 2017-19 126 1007 752 High Increasing
Fall-related injury 2017-19 90 718 706 Not higher Increasing COPD 2017-19 48 385 230 High Increasing Coronary Heart Disease 2017-19 65 520 493 Not higher Decreasing Dementia as principal diagnosis or co-morbidity (65+ yrs) 2017-19 47 1307 1625 Not higher Decreasing Asthma 2017-19 21 166 142 Not higher Decreasing Self-harm hospitalisation Not higher Persons 2017-19 15 119 93 Increasing Self-harm hospitalisation Not higher Female 2017-19 11 169 118 Increasing Self-harm hospitalisation Male 2017-19 6 100 69 Not higher Increasing Diabetes as principal diagnosis 2017-19 - 244 156 High Increasing Diabetes Type 1 as principal diagnosis 2018-19 11 89 50 Not higher Decreasing Diabetes Type 2 as principal diagnosis 2018-19 12 144 101 Not higher Decreasing Source: Health Statistics NSW, accessed November 2020 *Based on 95% Confidence intervals around age- standardised rates per 100,000.
4.4 Health Related Behaviours
4.4.1 Smoking Tobacco smoking is the single most preventable cause of ill health and death in Australia, contributing to more drug-related hospitalisations and deaths than alcohol and illicit drug use combined. It is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, cancer and a variety of other diseases and conditions.
The per cent of the MLHD adult population reporting to be current smokers has been declining since 2002 and has remained below 20 per cent since 2013, however in 2017 the adult smoking prevalence was 22 per cent, which was higher (not significantly) than the NSW rate. The smoking rate is again below 20 percent and in 2019 was 17 per cent in MLHD which closer to NSW rate of 15.5 percent. The prevalence of daily smoking in MLHD has hovered around 15 per cent since 2005 but has shown a declining trend to 11 per cent in 2019 which is similar to the overall trend for NSW. For school students in MLHD/Albury/Southern NSW LHD (combined) aged 12-17 years in 2017 the per cent of students who reported to be heavy, light or occasional smokers was 6.7 per cent which was similar to NSW at 6.4 per cent of students.
Smoking was believed to have contributed to 3,926 hospitalisations in the MLHD in 2018-19 at an age-adjusted rate of 1157.7 per 100,000 population this rate was significantly higher than NSW at 663.0 per 100,000. MLHD had the highest rate of smoking attributable hospitalisations among NSW LHDs for males and females. MLHD had seen a decrease in smoking attributable hospitalisations since the early 2000s (in
Draft Urana MPS Plan-2020 page 30 of 82 Draft Urana MPS Service Plan 2020 males) to around 2013-14 but has plateaued for males and females with a slight increase 2016-17 to 2018-19.
The number of deaths which could be attributed to smoking in 2018 in MLHD was 278 at a rate of 73.2 per 100,000 population which was similar to the NSW rate of 65.7 per 100,000. The death rate in MLHD has halved for males from early 2000’s to 2018 however it is still significantly higher than the female death rate which has remained fairly steady over time.
Smoking attributable hospitalisation rates by local government area show that all LGAs in MLHD had significantly higher rates than NSW. However rates of death attributed to smoking were relatively low for most MLHD LGAs, but not significantly lower than NSW (2017 to 2018).
4.4.2 Alcohol Excessive alcohol consumption is one of the main preventable public health problems in Australia, with alcohol being second only to tobacco as a preventable cause of drug- related death and hospitalisation.
Long-term adverse effects of high consumption of alcohol on health include contribution to cardiovascular disease, some cancers, nutrition-related conditions, risks to unborn babies, cirrhosis of the liver, mental health conditions, tolerance and dependence, long-term cognitive impairment, and self-harm. Some research suggests that at low levels of consumption, alcohol may reduce the risk of some cardiovascular and cerebrovascular disorders, while other research suggests that there may be no protective effect from drinking. 3
In the 2019 NSW Health Survey risk consumption of alcohol was defined as: consuming more than 2 standard drinks on a day when drinking alcohol. Adults in MLHD had a slightly higher rate of risk consumption than NSW in 2019 at 41.5 per cent compared to 32.8 per cent. The prevalence in MLHD had remained fairly steady from 2002 to 2013 when the rate was significantly higher than NSW, the rate is no longer significantly higher as the rate in NSW and MLHD have both increased from a low in 2014. Another category of risk consumption is the “immediate risk to health” defined as consuming more than 4 standard drinks on a single occasion in the last 4 weeks. In the 2019 survey 36.1 per cent of adults in MLHD drank at this level compared to 26.7 per cent in NSW. The frequency of consuming alcohol is another measure of risk with 15.2 per cent of adult males in MLHD (2018-2019) reporting drinking alcohol on a daily basis compared to 5.5 per cent of females; weekly consumption was reported by 37.0 per cent of the adult population (at least one alcohol free day per week); less than weekly consumption by 33.0 per cent of adults and 19.7 per cent reported never drinking alcohol (15.3% of males compared to 24.0% of females). For school students aged 12 to 17 years 37.1 per cent reported to have consumed alcohol in the past 7 days, and 23.5 per cent in the month prior to survey in the MLHD/Albury/Southern NSW LHDs (combined) compared to 24.9 per cent and 13.7 per cent in NSW (2017 School Students Survey), the rates for MLHD/Albury/Southern NSW LHD had dropped from 2008 to 2014 but increased in 2017 rates for all NSW have continued to slowly decline.
3 Health Statistics NSW website, NSW Ministry of Health, Feb 2019
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Alcohol attributable hospitalisations are those where the consumption of alcohol is believed to make up a percentage of hospitalisations for certain causes, such as injury and cardiovascular disease as well as liver disease and mental health conditions. Alcohol consumption in MLHD contributed to 1,469 hospital admissions in 2018-19 at an age-adjusted rate of 636 per 100,000 males and 357 per 100,000 females, which was similar to NSW rates for males and significantly lower for females (NSW: 651 per 100,000 males and 404 per 100,000). The age-adjusted rate of alcohol attributable hospitalisations in MLHD has been increasing since the early 2000s for both males and females as is the same for NSW. There were 80 deaths per year in the 2017 to 2018 period which could have been attributed to alcohol in MLHD at rate of 24 deaths per 100,000 population this was slightly higher than the NSW rate of 20 per 100,000.
Alcohol attributable hospitalisation rates by local government area show that no LGAs in MLHD had significantly higher rates than NSW, but Griffith LGA was significantly lower. No LGAs had significantly higher or lower death rates than NSW for alcohol attributable causes (2017 to 2018).
For Urana LGA the rate of alcohol attributable hospitalisation was within expected range (2013-15) with around 11 hospitalisations annually, rates have been increasing since the early 2005-07.
4.4.3 Obesity/ high BMI related illness
Excess weight, especially obesity, is a risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers. Being overweight can hamper the ability to control or manage chronic disorders.4
The NSW Health Survey 2019 reported that in MLHD significantly more adults were overweight or obese (as measured by self-reported height and weight used to calculate Body Mass Index) when compared to NSW (MLHD: 69.4%, NSW 55.2%). In MLHD 35.2% of adults were classified as obese (significantly higher than NSW at 22.4%) and 34.2% as overweight (not significantly higher than NSW at 32.8%). In MLHD the proportion of adults who are obese has been gradually increasing from 2002 to 2019, however the percentage of overweight adults has dropped from 2013 to 2017, but increased to 2019. Of concern is that the prevalence of obesity in MLHD is now higher than that of overweight. NSW rates of adult obesity have been rising gradually, but rates in the overweight category have plateaued. For adults in MLHD (and all NSW) being overweight was more prevalent in males (44%) than females (24%), but levels of obesity were slightly higher in females in 2019 (38%) than males (33%).
Overweight and obesity attributable hospitalisations are those where high body mass (BM) is considered to have contributed to the underlying illness, for example a proportion of diabetes and cardiovascular disease admissions. The MLHD had the highest age-adjusted rate of high BM attributable admissions among all LHDs in NSW for males and females separately and for the population as a whole. In 2018-19 in MLHD, 3,518 admissions were attributed to high BM at an age-adjusted rate of 1056 per 100,000 population. The MLHD rate was significantly higher than NSW rate of 753
4 AIHW Cat. no. AUS 122 2010
Draft Urana MPS Plan-2020 page 32 of 82 Draft Urana MPS Service Plan 2020 per 100,000 population. In NSW, BM attributable admissions have increased slightly since 2010-11 where the rates in MLHD have increased significantly in MLHD.
Relatively higher weight related mortality rates by LGA were centred around Wagga Wagga, Albury and Griffith LGAs in MLHD and Parkes, Western Plains and Mid Coast LGAs, however these were not significantly higher than NSW rates (2017 to 2018). Hospitalisations attributable to overweight were significantly high in all MLHD LGAs except Murray River, Carrathool, Coolamon, Temora and Junee.
High body mass attributable hospitalisations as reported by the NSW Ministry of Health on the Health Statistics NSW website were higher than expected (based on NSW rates) for Urana LGA with around 14 hospitalisations per year (2013-15). Urana LGA had 83 people registered as having Type 2 Diabetes by the National Diabetes Services Scheme (NDSS) in March 2018, approximately 7% of the population was registered with the NDSS which was significantly higher than the national rate of 5.3%.
“Stand out” issues for Urana area in particular: Relatively low socioeconomic status Small and decreasing population which is relatively remote Ageing population both in proportion in older age groups and actual increases in numbers of older people; COPD Lifestyle diseases related to smoking and obesity/overweight Diabetes
Figure 12: Urana area Residents Separations by hospital of service 2016/17 (excluding ED only, chemotherapy, renal dialysis, and unqualified neonates)
Source: FlowInfov.19
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5. EXISTING FACILITIES
The Urana Multi-Purpose Service is a 22 bed health facility is compliant to current standards and Australasian Health Facility Guidelines with respect to fire, security, access and electrical safety. However the site is no longer fit for purpose, no longer enabling the most current models of care to be employed. The layout of the site is no longer efficient.
Urana Health Service has received funding for minor works and upgrades over the last 5 years. Funds were used for upgrades including the following:
Solar panel upgrade Upgrade to palliative care room and lounge facilities is in planning stages Significant upgrade to ED to meet security standards Installation of “air lock” at front entrance Increased “swipe card access” to the site Duress alarm system updated Security doors fitted between main entrance / RAC and Acute beds in order to allow for “lock down processes” Upgrading and re-fitting of store room Upgrade of mortuary Extending width of doors in some aged care rooms completed New Air Conditioning System New “self-starting” generator installed New storage area in “shed” at rear of acute beds Improvements to meeting space and tea room is ongoing Improvements to the education space Carpark lighting upgrades
The detached community health building has a separate entrance to the main health service building. There is no reception area, clients arrive into a meeting and training space. There is no separation between the waiting area and clinical/staff spaces. The building consists of 5 consultation rooms and large activities/meeting room. These are well utilised by a variety of health service staff as well as community and service providers. Space for additional visiting services exists and the activities room provides opportunities for additional group and exercise activities. The group room is used regularly by the fitness classes, ladies auxiliary, community and staff meetings.
The existing staff accommodation consists of three single bed rooms. It does have shared shower/bath and kitchen/dining facilities. It is aged, lacks privacy and will not meet future staff accommodation requirements. It is attached at the rear of the community health building with entry gained externally or through the community health building.
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6. EXISTING NETWORK OF HEALTH AND RELATED SERVICES The Urana Health Service, a 22 bed facility, is classified as Multi-Purpose Service providing a mix of inpatient and Residential Aged Care (RAC) services. All residential aged care is Commonwealth funded. The Health Service consists of:
24 hour emergency services (1 Bed); Inpatient services (3 beds); Aged care services (19 High Care Residential Aged Care Type Beds); Primary/ Community Health services; and Support services.
The Urana Multi-Purpose Service mainly provides a range of level 1 and 2 role delineated services. This means that the complexity of the service is one of low acuity, with emergency department facilities for stabilisation and transfer of clients. It primarily provides services to the people of Urana and surrounds.
The layout of the MPS has some existing high care rooms collocated with acute beds and the remainder of high care beds in a separate wing which impacts on staffing efficiencies. This layout doesn’t allow the full implementation of the “Living well in MPS” principles, as it limits access to social areas. It also presents challenges for residents aging in place as the rooms are not best equip for wandering dementia.
At the beginning of 2019 the remaining four low care aged care beds were reclassified to high care. These rooms have narrow doors are difficult to get lifters in and out of and so are not best suited for the provision of high care aged care services. This may require residents in these rooms to be moved as their needs change.
Community Health service areas are in a standalone building on the MPS campus. There is a large group activity/meeting room and a number of offices that double as consult/treatment spaces. There are also some staff accommodation bedrooms within this building.
The Health Service is the only facility in town for residential aged care and has service relationships with other health facilities, most importantly Lockhart, Wagga Wagga Base Hospital, and Albury Base Hospital.
Services at Urana Multi-Purpose Service are based on the Rural Health Service Model, with a focus on providing services locally which are safe and sustainable. The interrelationship between primary care services and other rural health services is outlined in figure 13.
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Figure 13: Model for Rural Health Service
Source: Report of the Rural Health Implementation Coordination Group. The NSW Rural Health Report, 2002
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Service networks for residents of Urana include: Primary & Community Care – Urana staff with occasional outreach from Wagga Wagga and Lockhart Community Health; MPS/Community Hospitals – Corowa Hospital and Lockhart MPS; Maternity services at Wagga Wagga Base and Albury/Wodonga Health; Mental health services – Albury/Wodonga Health, Wagga Wagga Community Mental health, Emergency review via telehealth from Wagga Wagga; Pathology services from point of care testing and NSW Health Pathology; Rural referral health service –Albury/Wodonga Health, and Wagga Wagga Base Hospital; and Tertiary referral health services – Sydney or Melbourne.
Retrieval services determine the best option for transfer to ensure timely access to the right level of service for the patient’s condition, including interstate. Mental Health inpatient referrals are primarily to Wagga Wagga Base Hospital but also utilise Albury/Wodonga Health.
6.2 GP Services There is one GP in Urana at present who has Visiting Medical Officer credentials, making them professionally responsible for the proper clinical management and treatment of patients and residents in Urana. The GP practice is located in the centre of town a few minutes’ drive from the Urana MPS. The GP provides an on call service for the hospital 7 days a week, including emergency department attendance as required. There are intermittent periods of unavailability e.g. leave. The GP has opened a new surgery in the nearby hamlet of Oaklands (36km away) and is building up the clientele with a view to recruiting another GP to support that practice and assist at the Urana MPS.
The local council provides the GP clinic and doctor housing, and has purchased and renovated the additional clinic in Oakland’s. The GP has the full support of the community and local government.
The GP has a list of over 1000 active clients in the local region. He is very dedicated to the town and the community and has the full support of the community behind him also.
6.3 Acute and Inpatient Care Services
Inpatient care services include:
24 hour emergency care, stabilisation and transfer as required; Medical Admissions; Palliative Care; and Respite.
A number of Registered Nurses are First Line Emergency Care Course (FLECC) accredited and the majority of Enrolled Nurses are medication endorsed. Urana has recently commenced participation in the Nurse Delegated Emergency Care program which enhances the scope of practice for Registered Nurses within certain guidelines. The hospital underwent accreditation to National Standards 1 to 10 in November 2017.
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The Hospital emergency department (ED) operates 24 hours per day seven days a week. The Visiting Medical Officer (VMO) and hospital nurses staff this area. The staff working in the ED can access the Critical Care Advisory telehealth service with specialist medical advice and video support from Wagga Wagga Base also.
Mental health presentations are reviewed by Mental Health Emergency Consultation Service (MHECS) in Wagga Wagga, this service is used for consultation, advice and an interim management planning. MHECS assessments are conducted via videoconferencing which uses the current critical care cameras in the ED. The Remote Area Medical Service offers medical support to facilities without a doctor (due to vacancy or to cover leave). This service consists of remotely located GPs who are available on phone or video call to assess, review and manage non-critical ED clients, inpatients and aged care residents in daily care planning.
Urana MPS currently has access to AMRS (Aeromedical and Medical Retrieval Service, NWS) which is a 24 hour phone line for the adult emergency retrieval service and access to critical care beds. Assistance is available for VMO’s and nursing staff, this is very seldom used, and the facility manager has only used this service once in the last 3 years.
The hospital contract a private physiotherapist from Albury when required. This is a long standing relationship, with weekly visits. This provider also offers the Vitality Program including exercise, nutrition and cognition consultations and is a valuable part of the social interactions of many attendees. There is an occupational therapist available to consult at the hospital also from Lockhart.
The NSW Ambulance Service based in Lockhart works closely with Urana Health Service and the NSW Fire Service in Lockhart. There is a Volunteer First Responder program provided through the NSW Fire Service in Lockhart. There is also an Ambulance service in Jerilderie.
6.3.1 Emergency Department Activity The Emergency Department (ED) has a one bay resuscitation area for acute management, treatment, admission or transfer. A designated mental health assessment room is located adjacent to the ED, however this room is used flexibly for paediatric assessment and by visiting services at times. The mental health room is used less for remote assessments that are now completed in the ED using the remote assessment cameras.
The average ED presentations from 2015/16 to 2018/19 shown in the table below (table 8) equates to an average 1.5 presentations per day. This has stayed quite stable over this time, trending slightly upwards. There are very few triage 1 presentations, none in the last four years. Most of these critically ill patients would likely be retrieved by Ambulance NSW and taken to a larger centre for diagnostics and treatment. Triage 5 activity, which include minor illnesses, constitute between 42-67% of activity (Table 9).
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Table 9: Summary Urana Hospital ED activity by Triage Category Triage Category 2015/2016 2016/2017 2017/2018 2018/2019 1 0 0 0 0 2 23 9 25 20 3 49 57 72 53 4 116 114 101 145 5 374 299 358 310 N\A 3 1 2 Grand Total 562 482 557 530 Data source: ED presentations – EDAA v19.0
A significant proportion of the activity of the ED is from outpatient clinic and planned return visits 46.4%, as shown in the table below. There are no triage one presentations in the last 4 years, and very small numbers of triage 2 presentations. The majority of ED activity is non urgent triage 5 visits (63%). Given the high percentage of triage 4 and 5 and return/outpatient clinic visits (table 10) this activity may be better suited to provision in a community health setting. There are a significant number of dressings that are attended to by ED staff rather than community health due to the lack of a Community based Registered Nurse. There may be an opportunity to look into alternate models of care being trialled into the future for the ED and community health, especially noting that 81% of presentations to the ED are between 9am and 6pm. Opportunities for collaboration could be explored.
Table 10: Summary Urana MPS ED activity by Visit Type Visit Type Name 2014/ 2015/ 2016/ 2017/ 2018/ 2015 2016 2017 2018 2019 Emergency Presentation 199 270 279 286 254 Return visit – Planned 122 198 99 101 116 Outpatient Clinic 118 86 80 153 131 Pre-arranged Admission: With ED 26 2 13 Workup 7 9 Other presentation types 1 6 11 10 20 Grand Total 466 562 482 557 530 Data source: ED presentations – EDAA v19.0
6.3.2 Inpatient Activity The following inpatient activity (excluding ED activity) reflects the role delineation levels for Urana MPS and therefore excludes renal dialysis, chemotherapy and unqualified neonates.
Table 11 indicates an increase of 39% in inpatient separations between 2014 and 2018/19. Acute bed days have fluctuated with an overall 84% increase over the period. Separations for sub and non-acute services have not fluctuated vastly for the same period. Bed days for sub and non-acute have initially remained stable and they fluctuated significantly over the 2016/17 year. This indicates longer lengths of stay. The increases look as though they fluctuate and show significant increases, however in small facilities this can depend on the mix of cases and issues presenting year on year. A handful of long term clients in the ward can skew activity levels. Increases in activity for 2016/17 are attributable to changes in policy in emergency department admissions criteria, resulting in more admissions into inpatient wards.
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Table 11: Urana Hospital Activity by Patient Type (excludes ED activity)
2014/ 2015 2015/ 2016 2016/ 2017 2017/ 2018 2018/ 2019 Total Separations 59 61 69 78 82 Total Bed Days 265 321 586 318 488 Source: FlowInfo V19.0 NSW MoH (excludes renal dialysis, chemotherapy and unqualified neonatal services)
Table 12 provides a summary of the sub and non-acute activity at Urana. Sub-acute care categories include maintenance care, palliative care, rehabilitation, and geriatric evaluation and management.
Maintenance care (Nursing Home Type Patients) makes up a large proportion of separations and bed days for this category of care. Due to the small numbers in this activity type, break downs of different types are not shown. Whilst there aren’t large numbers of visits (separations) the length of stay is longer.
Palliative care separations are generally low, but will fluctuate based on community need. Bed days for this category have fluctuated greatly during this time, which reflects the nature of palliative care management.
Table 12: Urana MPS Sub and Non-acute Activity 2014/15 to 2018/19 Values 2014/ 2015/ 2016/ 2017/ 2018/ 2015 2016 2017 2018 2019 Total Separations 4 5 7 2 10 Total Bed Days 68 123 359 43 231 Source: FlowInfo V19.0 NSW MoH (excludes renal dialysis, chemotherapy and unqualified neonatal services)
The top five service related groups for separations at Urana MPS in 2018/19 were for: Maintenance Non Subspecialty Medicine Palliative Care Respiratory Medicine Cardiology
See Appendix 2 for further details.
Table 13 provides occupancy detail for Urana MPS. Overall occupancy for the facility (acute/sub-acute and aged care type beds) has been increasing over the last three years.
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Table 13: Summary Urana Hospital Inpatient Occupancy M213 Urana Acute 2014/15 2015/16 2016/17 2017/ 2018 2018/ 2019 Total separations (excluding Emergency Care) 58 61 69 78 82 Total occupied bed days (excluding Emergency Care) 264 321 587 319 488 Total Available Bed Days 1095 1096 1097 1095 1095 Total Average Beds Occupied (Daily Average) 0.7 0.9 1.6 0.9 1.3 Total Average facility occupancy 24.1% 29.3% 53.5% 29.1% 44.6% Total Number of Acute Beds - G 3.0 3.0 3.0 3.0 3.0 Data Source: Admitted Patient HIE DOHRS Universe August 2020
People aged 45 years and over made up 92% of separations and 97.3% of bed days in 2014/19 for total acute/ sub-acute separations, reflecting the older demographic in Urana. See Appendix 2 for further details.
Aboriginal people made up less than 2% of acute/sub-acute separations in between 2015-201 which is less than the 3.3% of the community that identify as Aboriginal. Details are not shown in appendices as the numbers are too small and may be identifiable.
Of the inpatient separations 98% were for people from MLHD LGAs, while people from Southern LHD and Victoria made up the remaining 2% of separations in 2015-2019 (table 14).
Table 14: Urana MPS Separations by LHD/State of Residence 2018/19 Residence LHD 2015-2019 Name Total Separations Murrumbidgee 284 Southern 2 Victoria 2 Total Bed Days Murrumbidgee 1705 Southern 3 Victoria 3 Source: FlowInfo Version 19.0, NSW MoH (excludes renal dialysis, chemotherapy and unqualified neonatal services)
Murrumbidgee LHD met 63% of health service demand (bed days) required by residents of Urana followed by private facilities accounting for 18% of bed days. There was also some utilisation of Victorian services including Albury Wodonga Health (14%). See table 15 and 16 below.
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Table 15: LHD of Hospital of Treatment for Urana Residents 2018/19 (Excluding ED only, Chemotherapy, Renal Dialysis and Unqualified Neonates) LHD Of Hospital Name Total Separations Total Bed Days Murrumbidgee 308 1022 Other Private 179 294 Albury Wodonga Health-Victoria 74 220 Private Day Procedure Centres 49 49 St. Vincent's Health Network 5 15 Western Sydney 2 6 Other 3 5 Grand Total 620 1611 Source: FlowInfo Version 19.0, NSW MoH
Table 16: MLHD Hospital of Treatment for Urana Residents 2018/19 (Excluding ED only, Chemotherapy, Renal Dialysis, and Unqualified Neonates)
Hospital Name Total Separations Total Bed Days Wagga Wagga (excl. Coll. Care) 85 279 Urana McCaughey 70 333 Private Hospitals 25 95 Albury 42 120 Corowa 25 91 Narrandera 15 46 Other 32 74 Grand Total 294 1038 Source: FlowInfo Version 19.0, NSW MoH
Psychiatric separations for Urana residents at any facility accounted for less than for 2% of separations and 3% of bed day demand by former Urana Shire residents in 2018/19 in any facility. Detailed data isn’t shown as it may identify individuals.
The main services by service related group (SRG) used by former Urana Shire residents in any location in 2018/19 were for: Non Subspecialty Medicine Respiratory Medicine Palliative Care Neurology Gastroenterology Cardiology Rehabilitation Haematology Non Subspecialty Surgery
More detail is available in Appendix 2.
Urana hospital is not role delineated to provide renal dialysis, chemotherapy and services for well newborn babies. The following table (17) provides detail of where former Urana LGA residents go for these services. The majority of chemotherapy bed days are provided by private services and a very small amount of renal dialysis demand is met by Victorian services. Private services also met 48.8% of unqualified neonate
Draft Urana MPS Plan-2020 page 42 of 82 Draft Urana MPS Service Plan 2020 services (well newborns), while Victorian facilities provided 39.5% of bed days with MLHD facilities providing the remaining 11.6%.
Table 17: Former Urana Shire LGA residents demand for Renal Dialysis, Chemotherapy and Unqualified Neonate Services 2018/19 SR Gv50 Name LHD Of Hospital Name Total Separations Total Bed Days Chemotherapy Other Private 54 54 Private Day Procedure 6 6 Centres Chemotherapy Total 60 60 Unqualified Neonate Victoria 5 17 Other Private 4 21 Murrumbidgee 2 5 Unqualified Neonate Total 11 43 Renal Dialysis Victoria 5 5 Renal Dialysis Total 5 5 Grand Total 76 108 Source: FlowInfo Version 19.0, NSW MoH
6.4 Support Services
6.4.1 Medical Imaging Outpatient X-ray services are available nearby at Lockhart which has a one day per fortnight service. Corowa Hospital has x-ray services Monday to Friday. Urgent imaging services are available at Wagga Wagga or Albury including ultrasounds and CT Scans. Ambulance or patient transport transfers are available.
6.4.2 Pharmacy Pharmacy supplies for inpatients care are provided from MLHD Pharmacy Unit on a weekly basis. A Clinical pharmacist from Wagga visits the hospital frequently (at least monthly). There is a private Pharmacy in Urana that provides accredited pharmacy services including dispensing and medication reviews in the residential aged care area.
6.4.3 Pathology Pathology is provided by NSW Health Pathology in Wagga Wagga. Urana Health Service Staff collect the specimens. There is one courier pick up a day from Monday to Friday at 11am. If the patient is being transferred to another facility they may take pathology with them to be checked.
Point of care testing is available after hours, weekends and in emergency cases. This is well utilised, often preventing patients needing to travel out of town.
6.4.4 Body Holding Facility Funeral Directors generally collect the deceased directly from residential aged care rooms or the cool room. The cool room has capacity for two trolleys.
6.4.5 Sterilisation Services Sterilisation services are provided through Wagga Wagga Base Hospital. Service frequency is dependent on need, is rarely used as most items are disposable.
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6.4.6 Stores Management Stores are ordered through a centralised MLHD stores ordering system. Stock levels are maintained at a level where shortages and expiry are avoided.
6.4.7 Maintenance Services A maintenance supervisor position is shared between Urana and Lockhart facilities and is assisted by the Wagga Asset Management work centre. This position provides general maintenance. Trade and engineering services are provided through Wagga maintenance staff and contractors. Gardening and watering are provided by local contractors.
6.4.8 Waste management
Waste is separated on site. General waste is collected by the Council, while Sterihealth collect clinical waste approximately every eight weeks.
6.4.9 Catering, Cleaning and Laundry Services Catering, Cleaning and Laundry services are provided through an MLHD contract with HealthShare. HealthShare have one office within the facility. Linen is taken to Wagga Wagga once per week. The kitchen provides fresh cooked meals and can provide light meals for residents as required.
There is no resident accessible kitchen for preparing and sharing food amongst aged care residents, family and community members. There are rules around foods being brought into the HealthShare kitchen from the community that are restrictive. The current layout of the facility doesn’t allow “cooking smells” to waft through the facility to stimulate appetite, this limits residents engagement with food preparation which is part of the implementation of living well in MPS program at Urana.
6.4.10 Patient transport MLHD Patient transport service offers transfers between facilities for patients who are currently admitted to a public hospital within MLHD. Transport is offered between facilities and for speciality care appointments. Most transfers from Urana are to Wagga Wagga for specialist care.
2017/18 15 transfers (3 for medical imaging) 2018/19 10 transfers (3 for medical imaging) 2019/20 14 transfers (4 for medical imaging)
Community transport (provided by Valmar) mostly takes inpatients and residents well enough to travel unaided in a car.
6.5 Community Health Services Community Health Services in Urana are provided by one community enrolled nurse (3 days per week) and one child youth and family nurse (1 day per week). Other services are able to be requested as the need arises in the community, these include visits from a Diabetes Nurse Practitioner, a generalist councillor, care coordinator, palliative care specialist and OT. Local promotion of these services needs to be increased as some health providers and community members were not aware they are available.
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There is a central intake call centre which coordinates access to community health services. Community members or health staff are able to call the number with a referral for a service. Their eligibility for the service is assessed and coordinated from Wagga Wagga with clients referred to local services. When the service was first established there were some minor teething challenges, which have since been resolved. Visiting service providers travel in teams for safety and efficiency. This requires adequate clinical space to accommodate multiple services delivered at any one time. Additionally some clinical space is periodically utilised by private service providers.
Collaborative models of care are always evolving to better deliver community health services. These models rely on a team approach between private and public health providers to ensure the best management plans for local people.
Locally based community health staff include a community nurse and a child and family health nurse. Visiting community health services are outlined in table 18 below.
Table 18: Visiting Community Health Services Visiting Service Outreach from: Frequency Community Nurse Based locally 3 days/week Child and Family Health Nurse Based locally 1 day per week General Counsellor Corowa As needed Palliative care nurse Wagga Wagga As needed Diabetes Nurse Practitioner Wagga Wagga As needed Palliative Care Specialist Tocumwal or Corowa As needed Occupational Therapist Lockhart As needed Care Coordinator Marathon Health Wagga As needed Wagga Mental Health - general Wagga As needs Mental Health Older Persons Wagga As needs Mental Health – Child and Family Wagga As needs D&A Albury As needs Diabetes Educator Wagga Wagga 1 day per month Women’s health Albury Monthly Dietitian Wagga wagga As needs Podiatrist Private As needed Palliative Care CNC Wagga Wagga As required Sexual Assault Worker Wagga Wagga As needs Physiotherapist Private Albury Weekly Aboriginal Health Wagga Wagga As needs Child Protection Counselling Wagga Wagga As needs Joint Investigative Response Wagga As needs Team (JIRT) Source: HSM Urana Health Service and Manager Central Intake Service
Occupational therapists (OT) from Lockhart MPS can provide adult services based on referrals. This service is primarily for those over 65 looking to return home or maintain living independently at home.
Diabetes services are offered by the Diabetes Nurse Practitioner enabling advanced interventions to improve symptoms and allow clients to self-manage their condition better.
The generalist councillor offered services in Urana to priority groups over 16 years of age. These groups include clients experiencing domestic violence, vulnerable families and those with chronic and complex health conditions.
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The Wagga Wagga community MHDA team provide outreach services to the Urana community, however the frequency of visits can and is often increased due to consumer needs within the community. Outreach services are provided by the Adult, Child & Adolescent and Older person’s mental health clinicians. The Drug and Alcohol worker also attends as required. The Consumer Advocate and the Family Carers support worker attend Urana clients when this has been identified on a case by case basis.
Psychiatry is provided weekly to all case managed clients within the communities serviced by Wagga Wagga Specialist Community MHDA. Urana clients have access to the psychiatry consultations via telehealth at Wagga Wagga.
There is no private Dental service in Urana. Public dental is available from the Berrigan Community Health Building, primarily for paediatric clients, however some adult services are delivered. The residents at the Urana MPS are visited regularly by the Oral Wellness Lifelong program (OWL program). This service offers twice yearly dental services by visiting staff, this ensures regular review and dental health and comfort checks. There are also private dental clinics in Finley, Albury and Wagga. The community can link into the NSW public dental system and once assessed for eligibility can access the Wagga or Albury Dental Clinic, or private dentists participating in the oral health fee for service scheme (voucher) if their need and assessed priority enables that to happen.
Access to a Geriatrician service is available as a visiting service from Wagga Wagga Aged Care team as needed. Aged Care Outreach service has been expanded in recent years. Referrals can be made to the MLHD Aged Care Team which includes a Geriatrician, Nurse Practitioner and Clinical Nurse Consultants.
Referral to Pysco-geriatrician services is via Accessline. This will also provide support for consumers requiring the DBAMS sevice.
The MyStep is a program launched in 2020 , funded by the Murrumbidgee Primary Health Network, this program aims to support consumers with depression, anxiety and other mental health conditions who are residing in residential aged care across MLHD. The MLHD provide the service in the western side of the district and a referral is made directly to the team.The service also expands to include the family of residents living in residential care.
TeleLaw is a new service launced in 2020 to support consumers in MLHD aged care who are experiencing Elder Abuse.This is a joint initiative with Justice Health and St Vincents in Sydney.
There is no formal Interagency/continuum of care meeting however there is regular informal communication between the Facility Manager and different providers in the community. There are good relationships and easy referral pathways.
6.5.1 Non Admitted Patient Occasions of Service Non Admitted Patient service use is shown in table 19 below. Non-admitted Patient Occasions of Service (NAPOOS) data has to be interpreted with extreme caution, particularly in small services. Staff vacancies and conversely filling of vacant positions can have a large impact on service availability. Overall NAPOOS activity decreased by 53.7% between 2015/16 and 2019/20; however NAPOOS program reporting changes
Draft Urana MPS Plan-2020 page 46 of 82 Draft Urana MPS Service Plan 2020 occurred during this period and periods of vacancy and leave in some of these positions are likely to be skewing the data downwards and not indicative of the reported demand for these services in the community. Some services naturally fluctuate with demographic patterns e.g. child youth and family services. The changes to NAPOOS program reporting is evident in the data shifts in table 19, with gaps of data in some programs for some years. Tracking activity can be a challenge as some activity is reported to district wide service units even though it is delivered into Urana.
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Table 19: Non Admitted Patient Occasions of Service at Urana MPS SERVICE_UNIT_FULL_NAME 2015/16 2016/17 2017/18 2018/19 2019/20 Urana Multi Purpose Service ED Pathology Service 28 111 219 257 348 Urana Multi Purpose Service Aged Care Service 539 62 40 1 1 Urana Community Health Service Child & Family Service 291 294 269 192 280 Urana Community Health Service Statewide Eyesight Preschooler Screening Program 24 5 40 6 12 Urana Health Service DVA Home Nursing Contract 16 4 Urana Health Service Immunisation Identified 44 59 44 2 Urana Multipurpose service-Immunisation/Non Identified 19 15 13 Urana Community Health Service Community Nursing Service 169 Urana Multi Purpose Service - Wound Management 321 243 81 Urana Multipurpose service- Domicillary Midwife Urana Multi Purpose Service Palliative Care Service 15 1 9 Urana Multipurpose Service- General Practice 32 7 Urana Health Service Nursing Commonwealth Home Support Program 608 160 335 335 332 Urana Health Service Community Nurse Integrated Care 5 Urana Health Service Nursing Post-Acute Care 604 27 277 297 187 Urana Multi Purpose Service Staff Health Service 24 22 Total 2534 1189 1335 1094 1174 Source: NAPOOS data extracted November 2020 by K McLellan, Data Analyst
6.6 Aged Care Services Urana is within the Commonwealth Aged Care Planning Region of Riverina/Murray in NSW. Urana is a retirement centre for people within the Federation Shire looking to move from local farms but also has become popular with residents from larger cities and towns looking to retire to more affordable locations. There tends to be an outward shift of the younger population to other areas for study and work opportunities. This results in a more rapidly aging population and also in a lack of extended family support for older residents and a reliance on partners and community support services. The lack of public transport is a barrier to accessing facilities in other communities for the elderly and lower socioeconomic groups.
There are several organisations that provide services to the Urana community. In addition to the 19 Commonwealth Residential Aged Care (high care) beds at Urana MPS, there are community aged package options for Urana residents in the region. There are also 8 independent living units in Urana (managed by Federation Council). The remoteness of the town from larger centres does mean that allocated packages have to deduct travel time from their service allocations, and this means that face to face assistance is reduced.
While some regional aged care services in table 20 are considered close by metropolitan standards, the lack of public transport severely limits access, particularly for aged partners who themselves often have their own health issues and in most cases no longer drive. This continues to be raised strongly as an issue by the community. It has also been show in multiple studies that aged care residents have better outcomes when they are placed in their local communities where possible, it also demonstrates better outcomes when residents are not moved unnecessarily during the course of their residential stays. Realistically only the local Urana MPS aged
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Table 20: Commonwealth Funded Residential Aged Care and Community Packages Town Town (Kilometres) Distance Facility beds Care High beds specific Dementia Beds Respite Lockhart 47 Woodhaven Hostel 23 - - Lockhart 47 Lockhart MPS 15 - - The Rock 77 Emily Gardens 30 15 - Wagga Wagga 110 Yathong Lodge (Older Person 16 8 Mental Health Focus) Berrigan 72 Berrigan Aged Care Hostel 30 7* - Berrigan 72 Berrigan MPS 10 - - Corowa 80 Karinya Appartments 68 - - Corowa 80 Corowa District Hospital 31 - - Jerilderie 57 Jerilderie MPS 12 - - Source: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-servlist-download.htm and personal correspondence with facilities
6.6.1 Residential Aged Care Beds Urana MPS has 19 High Care Residential Aged Care Home Type Beds that are fully occupied and funded by the Commonwealth Government. All current residential clients have been assessed by the ACAT and are classified as high-level care.
Thirteen of the Aged care rooms are single bed rooms with own ensuite bathroom, 6 rooms share a bathroom. There are two combined lounge/ dining/ activity room one which is located amongst the acute inpatient bed wing the other in the high care wing. Outdoor areas are available for residents and families. The thirteen rooms in the high care wing have external doors into a large courtyard and grassed area. The facility has capacity for low level dementia patients integrated with frail aged residents; upgrades to alarm systems on external doors will enhance opportunities to care for wandering residents. Some of the rooms are not best suited to care of high care residents. The door widths are too narrow and entering with mobility aids and lifters is difficult or not possible. Some rooms are not suited to residents with mobility challenges, which means aging in place for some residents is difficult and they must be moved if their condition deteriorates. This is no longer to a suitable standard for modern models of health care delivery.
The 2018/19 average occupancy was 95% for High Care Residential Aged Care Clients. While some episodes of acute care occur for these residents, they remain in the Residential Aged Care bed. The level of occupancy for these beds equates to all 18 out of the 19 beds being occupied on most days of the year. Overflow is managed by placing potential residents in an acute bed initially until a residential bed is available at Urana, if this is required. The Community health team and the GP are aware of and monitoring clients in the community who are getting close to requiring residential care and availability of places. There is a waiting list with expressions of interest in places, over time this has generally had 2-3 clients waiting for services, but is higher at times.
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6.6.2 Community Units - Billabidgee There are 8 self-contained units adjacent to the Urana MPS. These are owned and run by the Federation Shire. The units are not exclusively for aged residents however preference is given to older residents where possible. There is no requirement for assessment for eligibility for aged care services to lease the units. There are often hospital staff using the facilities. There are periodic vacancies, and there is no current waiting list.
6.6.3 Other nearby NSW Aged Care Services Urana MPS is the sole provider of residential aged care in Urana. Lockhart’s Woodhaven Hostel is located 47km east of Urana. In August 2020 Woodhaven Hostel was purchased by Respect, they have not indicated they will be making any significant changes to services or bed numbers currently. They have 23 residential aged care beds. Ageing in place is provided. There is good utilisation of the facility. There are 9 high care dementia bed licences that have been granted and are yet to be built, 3 more are looking to be acquired. This will increase capacity to care for residents with dementia in the local area.
The Lockhart MPS has been recently been modernised has 15 high care residential beds. They have high utilisation and operate at 97% occupancy and has been at similar high rates for the last 3 years. Empty beds in both the MPS and Lockhart Woodhaven facilities fill quickly and are taken up by local residents, which generally excludes availability for Urana residents.
Emily Gardens at The Rock is a high care facility in the community of The Rock 77km west of Urana. It has 30 beds, 15 of which offer high level dedicated dementia care, particularly for wandering dementia. There is a substantial waiting list, particularly for dementia care places. It is the main referral facility for the region for high care and wandering dementia. There are no plans to expand residential aged care beds at this time, however there has been interest in increasing capacity in the past.
Wagga Wagga Base Hospital has an inpatient unit for high level dementia specific care for residents with wandering or aggressive/disruptive behaviours. This very high level of speiclist care is unable to be provided in Urana, in part due to the design and layout of the current facility and the very specialised skills staff would require. Staff at Urana go to significant lengths to manage difficult dementia behaviours at Urana through the use of consultant geriatrician and nurse practitioner and dementia nurse consultants. This prevents residents being moved from their home community unnecessarily.
Jerilderie MPS is 57km west of Urana in the community of Jerilderie. It operates at approximately 80% bed occupancy for its 12 high care residential care places. They rarely have permanent residents from Jerilderie.
There are two aged care providers in Corowa. Corowa is approximately 80km south of Urana. There are two larger facilities. Southern Cross Karinya Apartments 68 places, including a dedicated secure dementia wing, currently they are noting there is no waiting list and some vacancy at present. Corowa District Hospital with 31 places and also has places available. Both facilities offer high care.
Berrigan Township is located 72 kilometres south west of Urana. There are two aged care providers in the township. The Berrigan MPS has 10 high care beds, with high
Draft Urana MPS Plan-2020 page 50 of 82 Draft Urana MPS Service Plan 2020 occupancy. Berrigan Aged Care Hostel (Amaroo) currently has 30 aged care beds. There is a new seven bed wing offering dementia specific care. The facility prioritises local community members. The facility has high occupancy and has an undisclosed waiting list. Respite is provided.
In reality although there are 9 aged care facilities within a 100km radius of Urana local residents are very seldom sent away from Urana with most challenging resident behaviours managed at the MPS with supports from district teams. If residents need additional assessment residents are occasionally sent to Yathong Lodge at Wagga for intensive review and care planning and return to Urana or a higher level facility if needed. The distance to most communities around Urana is an obvious barrier with almost no public transport.
6.6.4 Community Aged Care Packages
The Australian government introduced new Home Care Packages on August 1, 2013, as part of its Living Longer Living Better reform package. A Home Care Package provides services that will help people to remain at home for as long as possible. Eligibility for Home Care Packages requires an ACAT assessment to determine the level of care required. MPS’s are funded for low flexible home care and high flexible home care.
There are now four levels of Home Care Packages.
Level 1 supports people with basic care needs; Level 2 supports people with low level care needs (formerly Community Aged Care Packages); Level 3 supports people with intermediate care needs; and Level 4 supports people with high level care needs (formerly Extended Aged Care at Home and Extended Aged Care at Home Dementia packages).
Home care packages are no longer allocated geographically or to particular providers. They are now offered on a needs basis to fully assessed clients who can decide how to best utilise a suite of services. Valmar and Intereach offer home care packages in the region. Local providers have indicated that there are adequate numbers of level 1 and 2 care packages, however level 3 and 4 care packages are not as accessible, often with extended waiting lists
6.6.5 Aged and Dementia Care, Aged Care Assessment Team The Aged Care Assessment Team (ACAT) works from Wagga Wagga. A team member visits Urana to complete assessments as required. Requests are made via the My Aged Care Portal. Visits are attended in the health service and in the home. While an ACAT assessment is not required for entry into an MPS, an assessment prior to or post admission is advocated to ensure the resident is provided with the appropriate level of care. An ACAT assessment will also determine whether the person can be supported at home with community services or Home Care Packages. The district wide aged care team is available to assist upon request, with consults from the district geriatrician, nurse practitioner and clinical nurse consultant, all of whom have specialist skills in advanced aged care support.
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6.7 Health Related Transport There is no Ambulance Station located in Urana. There are Ambulance stations in Lockhart (46 Km) and Jerilderie (56 Km) which service Urana. A “First Response” service through the NSW Fire Service is in place in Urana. These are volunteers trained by NSW Ambulance, who respond to emergency calls and manage the patient until the ambulance arrives.
The Ambulance transfers patients from Urana to higher level services as required, both urgent and a small number of non-urgent transfers. People with mental health conditions are transferred to Albury or Wagga Wagga. NSW Ambulance provide a backup for non-health related transport when required.
Aerial health related transfers are generally via fixed wing aircraft from Urana airstrip. Occasionally helicopter transfers occur.
The Murrumbidgee LHD patient transport service has facilitated 39 transfers in the last 3 years from Urana to various locations around the district. The main focus of these transfers is to move admitted clients from Urana to specialist care around the district.
For clients who are well enough to be transported, requiring no clinical supervision, there is community transport by Valmar. This alleviates pressure on ambulance and patient transport services.
6.8 Remote Health Care (Virtual Care) The NSW Agency for Clinical Innovation states that “there are opportunities to properly embed virtual care, self-care at home, and other web-based assets in healthcare delivery systems. Multiple wide-ranging reviews have examined the evidence base supporting the use of virtual care and concluded that telehealth interventions are associated with positive outcomes… Telemedicine has been shown to improve access to care, is acceptable to patients and clinicians, and the technology is able to provide high-quality and secure information transfer.” https://aci.health.nsw.gov.au/__data/assets/pdf_file/0004/586714/20200528-Evidence- Check-Virtual-Care-Telehealth-Conditions.pdf
Murrumbidgee Local Health District utilises virtual care to provide some services that are not accessible at Urana. There is access to the Mental Health Emergency Consultation Service video conferencing equipment in the acute care area.
Virtual technology is currently used for critical care in the Emergency department. The Critical Care Advisory Service uses cameras are linked to the District’s base hospitals. Nursing and medical staff can request assistance from doctors based in a central call centre, especially in instances when a local doctor isn’t available. This allows clinicians to easily consult with colleagues on complex cases using video conferencing and shared electronic medical records. Technology can also be used to provide remote medical coverage at facilities enabling local doctors to have time off. It enables clients to be treated in their home communities without needing to be transported to larger centres.
The plan is in line with MLHD strategic plan – “use of telemedicine services for emergency assessments in communities without medical officer coverage”. Urana has this technology and it will reduce the need for transfer of patients and should be considered as part of service enhancements when possible.
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6.9 Other Private Services
6.9.1 Visiting Specialists There are no visiting specialists to Urana.
6.9.2 Private Pharmacy Services
Urana has a local pharmacy with a licenced pharmacist. The Pharmacy is open six days per week (half day on Saturdays).
6.9.3 Private Pathology Services Corowa has pathology services provided by Australian Clinical Labs, Dorevitch Pathology and Laverty Pathology.
6.9.4 Blood Bank There is no blood bank at Urana. The closest blood bank is at the Red Cross Blood Service in Wagga Wagga and Albury, NSW.
6.9.5 Private Allied Health Private Allied Health services are available as follows:
Private Physiotherapy services are available through Corowa Back on track Physio; Private Podiatrist Wagga Wagga foot clinic; Marathon Health – care coordination.
An annual mobile Osteoporosis Bone Health service comes to Urana. There are multiple allied health services available through the local GP clinic including an asthma educator, women’s health nurse, psychologist, dietitian, and a social worker.
6.10 Other Community Services
6.10.1 NSW Home Care Services- Family and Community Services, Aging, Disability & Home Care The Home and Community Care program is designed to assist aged and disabled people (and their carers) with a home support service allowing some independence and the opportunity to remain in their own homes for as long as possible. This service is provided by Valmar.
Services provided include:
Nursing and personal care; Domestic assistance; Meals on Wheels - A prepared meal service to your home; Gardening, Home Maintenance and Modification - A handy man service as well as arrangements for certain home modifications; Community Transport - Assistance with individual transport for specialist and medical appointments; Neighbour Aid - A range of practical support such as visiting, shopping, etc.;
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Information, Referral and Co-ordination – Information and contact with other services to arrange assistance for any needs you may have that are not being met; and Hire of Equipment - Short term hire of special equipment, e.g. shower chair/stools etc.
Home Care provides personal and environmental care to clients in their own home.
6.10.2 Local Health Advisory Committee The Urana MPS Local Health Advisory Committee (LHAC) is operating. The existing LHAC is very active, interested and supportive of the Urana MPS. Meetings are held monthly with the Health Service Manager and Cluster Manager in attendance. There has been two visits by the District Chief Executive and Board Chairperson in the last 12 months.
6.10.3 Hospital Auxiliary The Hospital Auxiliary is supportive of the hospital. It meets monthly at the MPS Community Health building and raises funds for equipment and fittings for the hospital.
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7. PROPOSED SERVICES
It is proposed that Urana MPS is redeveloped as a Multipurpose Service (MPS) and continues to work closely with local GP services, NSW Ambulance Service, Community Aged Care services, the Murrumbidgee Primary Health Network and other community services. The current facility and its layout is no longer suited to contemporary models of care and would not be well suited to renovation.
The MPS works on a model of health and aged care service delivery that aims to help small rural and remote communities to tackle some of the challenges they face, such as:
Declining or changing populations causing shifts to occur in the community’s health and aged care needs; Being isolated, making it difficult to access a wide range of services; and Having difficulty attracting, retaining and training staff for health and aged care services.
The major objective of the MPS model is to help overcome some of these challenges and, in doing so improve:
Isolation from mainstream services; Cost inefficiency of delivering discrete services to small populations; and Meeting the need of residential aged care service demand.
The MPS model provides LHDs and communities with the opportunity to respond to the unique health care needs of the local community including provision of:
Emergency services; Acute hospital beds; Community health services including travelling services; and Residential aged care services.
This will: Match health services to the health needs of the Urana community; Promote sustainability and coordination of services within the community; Provide additional capacity for high care residential aged care services, including dementia care; and Provide Commonwealth funding for flexible aged care places and State funding for a range of other health services.
The proposed MPS model is consistent with the MLHD model of care, which has been adapted from the Government Action Plan for Rural Health, 2002 described in figure 7. This model supports an approach where people can access safe and quality health services as close to home as possible.
There will be formalised links with acute care (inpatient) services, GP services, community health services and residential aged care services.
The focus of the aged care service is to support people as long as possible in the community. The flexible care model enables services to be provided in the person’s
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The residents of Urana will continue to access District, Rural Referral, and Tertiary services for definitive care. There is an increased focus on offering care close to home where possible, appropriate and acceptable for the client. Opportunities to do this will be explored using virtual care options to increase local services. Networking with health services in Albury (in the Victorian health system) will be strengthened to improve patient journeys, increase consultation liaison services and provide training and development opportunities. Information management, integrated electronic medical records and technology and virtual care utilisation will support this.
The MPS will provide flexible accommodation including residential high care (suitable for those with low level dementia) palliative and respite care. The MPS will work in close collaboration with local community based aged care providers to ensure continuity of care and smooth transitions between community and residential care.
MLHD has various challenges when planning services to meet the needs of its population. These include: The poorer health status of rural populations – particularly the Aboriginal population; Issues of rurality and their impact on the provision of services; The ageing population and increased prevalence of chronic illness; Changes in lifestyle behaviours; Increased community expectations; Technological advancements and reforms; Workforce supply and sustainability; Increasing cost pressures of delivering services from geographically dispersed facilities; and Poor infrastructure.
The Urana MPS Health Service has been working as an integrated health service for many years with 19 High Care Residential Aged Care Type Beds. The existing Multi- Purpose Service model of care is a good fit, however functional layout improvements would enhance service efficiencies particularly in the emergency/acute care area, and ageing in place capabilities. Recommendations for future bed increases will require a review of functional relationships.
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7.2 Planning Principles Planning for the Urana MPS is guided by the following principles:
Consumer centred care delivery. Integration of all service providers wherever possible to reduce the duplication of services and space and to produce ‘seamless’ and ‘team-focused’ delivery methods. This includes the involvement of health and health related service providers. Strengthened partnerships with associated service providers to maximise the use of resources, reduce community confusion and improve service outcomes. This is of particular significance with the provision of residential aged care services. To better utilise resources (including recurrent funding, staff and equipment) in respect to the provision of appropriate health services that meet the need of the local community, asset management and support services in the provision of health services. Reviews of models of care for currency and appropriateness.
7.3 Factors Impacting on the Planning of Health Services in Urana As the Urana MPS already operates as an integrated health service, many of the benefits of becoming an MPS have already been realised including:
Improved access to a mix of health and aged care services that meet community needs; More innovative, flexible and integrated service delivery; and Coordinated and combined health professional roles.
Urana is a rural/remote community with population projections showing increasing proportions of people over 70 as the younger cohorts leave for study and work opportunities. This will add to the demand for aged care services locally.
The lack of public transport and extended family requires residential aged care to be available locally and accessible for partners of residents. Many older residents in small rural/remote communities rely on mobility scooters to maintain their independence and to access services. This needs to be considered in relation to the need for local residential aged care within Urana and also for facilities to be scooter friendly with undercover parking and recharging capacity. There are dementia friendly town initiatives that should be investigated and promoted for the community.
The ageing of the workforce and potential future increased use of locum/agency nursing staff and placements for students will make staff accommodation an essential component of any future development. The remoteness and small population of the community of Urana means that staff often have a substantial commute to get to Urana and appropriate staff accommodation ensures that staff doing late/early shift turn arounds are able to stay over removing risky long commutes. Staff accommodation provides the LHD with options for visiting LHD staff such as Educators and Clinical Nurse Consultants, Asset Management and other departments providing support and education to the Urana MPS. This reduces the reliance on commercial accommodation which is a considerable burden on the LHD given the distances required to visit the more remote sites such as Urana.
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7.4 Acute Care Services
7.4.1 Emergency Services Urana MPS will provide a level 1 emergency service equipped with resuscitation equipment and critical care Telehealth services. The emergency department (ED) critical care Telehealth camera will be linked to a critical care network in line with the MLHD Telehealth Plan. The Mental Health Emergency Consultation Service will continue to be provided via videoconference. There is a requirement for private consultation space to ensure confidentiality.
The ED will be supported by the on-call GP services and the NSW Ambulance Service. The emergency department will accommodate a resuscitation bay and one treatment space. It is proposed to incorporate a separated triage space which is currently not available.
The ED will have good oversight from the staff station. A quiet room, suited to quiet de-escalation is a newer model being incorporated into small hospitals and MPS’s to manage mental health/drug and alcohol clients and people with delirium prior to transfer. Time to transfer can sometimes be lengthy. These patients can be particularly difficult to manage with minimal staffing levels outside of business hours. There is currently no close observation or quiet room, but rather a Telehealth room for mental health consultations/remote assessments which does not have good oversight from the staff station or ED. A quiet room can be used flexibly and is suitable for managing a number of patient groups as noted above.
Security is paramount with low evening staffing numbers, no security staff and no local police presence.
A significant proportion of the activity of the ED is from outpatient clinic and planned return visits, as shown in the table below. There have been no triage one presentations in the last 4 years, and very small numbers of triage 2 presentations. The majority of ED activity is non urgent triage 5 visits (63%). Given the high percentage of triage 4 and 5 and return/outpatient clinic visits this activity may be better suited to provision in a community health or clinic setting. There are a significant number of dressings that are attended to by ED staff rather than community health due to the lack of a Community based Registered Nurse. There may be an opportunity to look into alternate models of care being trialled into the future for the ED and community health, especially noting that 81% of presentations to the ED are between 9am and 6pm. Ideally ED and community health spaces will have close functional relationships as there are opportunities for team collaboration and shared consulting spaces.
7.4.2 Inpatient Services The ageing population and increasing prevalence of chronic illnesses will impact on the demand for inpatient services in the future. Inpatient service demand is considered separately for acute and sub-acute categories in projections, however all beds at an MPS can be used flexibly in response to demand changes seasonally.
The actual acute bed day activity at Urana MPS has had average yearly increases of 27.9% per year over the last 5 years, while separations are projected to increase by 8.7%. This indicates longer stay separations for complex care needs and reflects the
Draft Urana MPS Plan-2020 page 58 of 82 Draft Urana MPS Service Plan 2020 increases detailed in population projections for people aged over 65 with complex health challenges.
The potential increased demand for acute inpatient services will be offset by effective discharge planning and enhanced community based services to prevent avoidable hospital admissions and reduce lengths of stay. There is a focus on new MoC to support reenablement of Chronic Disease consumers where possible in the community rather than via admission to hospital. This will include the contemporary models of service delivery including:
Community acute and post-acute care services; Early mobilisation and transitional care to reduce the functional decline of elderly patients following acute admissions; and Rehabilitation and self-management programs for people with chronic illnesses.
Local access to a Geriatrician will be investigated with the GP service.
Table 21: Projected Acute Activity Urana Health Service Row Labels Stay Type 2015 2021 2026 2031 Sum of Episodes Day Only 11 19 13 16 Overnight 43 48 43 40 Sum of Bed Days Day Only 11 19 13 16 Overnight 186 242 203 168 Urana McCaughey Sum of Episodes 54 67 56 56 Urana McCaughey Sum of Bed Days 197 261 216 184 Source: HealthAPP 2018, NSW MoH
There has been an increasing level of maintenance activity enabling elderly residents to be admitted for planned and emergency respite. Given the population is ageing, demand for this service is also likely to increase. Total sub-acute active episodes which include palliative care, rehabilitation and maintenance care are projected to increase by 24% and annual patient days to decrease by 39.9% from 2015 to 2021. And then decrease progressively, this indicates shorter lengths of stay with increased separations (higher turnover) for sub-acute care.
Requirements for respite, palliative care and sub-acute care such as the need for slow stream rehabilitation and transitional care will increase pressure on Urana inpatient beds.
Table 22: Projected Sub-Acute Activity Urana Health Service Row Labels Stay Type 2015 2021 2026 2031 Sum of Episodes Day Only 11 19 13 16 Overnight 43 48 43 40 Sum of Bed Days Day Only 11 19 13 16 Overnight 186 242 203 168 Urana McCaughey Sum of Episodes 54 67 56 56 Urana McCaughey Sum of Bed Days 197 261 216 184 Source: NSW HealthAPP 2018
Only one bed is projected to be required for palliative care, however having more than one person requiring palliation at any given time is not uncommon. In combination
Draft Urana MPS Plan-2020 page 59 of 82 Draft Urana MPS Service Plan 2020 with acute bed projections (3), the facility would require 4 flexible inpatient beds by 2031 at 75% occupancy.
Actual acute and sub-acute activity is trending upwards, despite HealthApp future projections tending downwards based on anticipated population declines. The current HealthApp projection tool data (Table 16) is still based on 2011 census data as this update has been delayed due to Covid-19 implications.
The actual activity increase is supported by a local GP who is open to accepting longer term sub-acute clients requiring stays after significant surgery, not only from Urana, but from Albury and Wagga Wagga. With additional inpatient bed capacity and increased telehealth support there will be less requirement to transport consumers requiring general medicine admissions to other facilities.
Inpatient bed recommendations should provide a sensible level of flexible inpatient beds that will meet demand for the next 10 years. In 2036 21.5% of the population will be over 70 in the community and this demographic typically utilises 72% of bed days at Urana (based on the last 4 years of activity), this growing demographic will place additional pressure on access to inpatient beds. Small numbers of beds do not allow much flexibility even at 75% occupancy.
Urana requires enough flexibility for seasonal fluctuations, emergency respite and to admit longer stay post-surgical clients from Wagga and Albury. The latter is often requested but unable to currently be accommodated. There is a need to flow people back to their closest health facility from Base and District hospitals as their care needs permit. This frees up beds at these facilities for higher level care, and allows people to be cared for closer to home.
Based on projections, the recommended configuration for the inpatient area should include:
4 Flexible inpatient beds
Lounge/ kitchenette for family caring for palliative family members
All rooms will be used flexibly. Family caring for and/or staying with a palliative relative will have access to a quiet room with kitchenette and ensuite facilities.
7.5 Support Services
7.5.1 Medical Imaging The redevelopment will not include digital imaging services.
7.5.2 Pharmacy Services Medications will continue to be provided for inpatients through a centralised MLHD pharmacy ordering system and delivered through the MLHD courier service. There may be options to utelise virtual pharmacy solutions within the LHD. Utilisation of local community pharmacy should continue where deemed appropriate.
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7.5.3 Pathology Services A pathology service will continue to be provided by NSW Health Pathology and point of care testing. Pathology services will be provided and negotiated as part of MLHD contract negotiations and cycles.
7.5.4 Mortuary Services A cool room will allow storage of bodies in an appropriate area, prior to collection by approved Funeral Directors.
7.5.5 Sterilisation Services Sterilisation services will continue to be provided by Wagga Wagga Hospital. This is on a needs basis.
7.5.6 Stores Management Purchasing of stores through a centralised MLHD stores ordering system will continue with sufficient supplies kept in stock to prevent shortages from occurring.
7.5.7 Maintenance Services The maintenance staff at Urana will provide general maintenance, while grounds maintenance services will continue to be outsourced to contractors. Outreach from Wagga Maintenance team will also continue as required. Various services will be contracted out in accordance with MLHD/ NSW Department of Health policy.
7.5.8 Waste Management General waste will be separated on site for clinical/ general waste and recycling. The clinical waste is collected regularly (8 weekly) as part of the MLHD clinical waste contract.
Clinical waste will be bagged and sealed in accordance with Standard Precautions and Infection Control standards and held until transported by the MLHD contractor for incineration in accordance with MLHD policy.
The principles of recycling and minimisation of waste advocated by the NSW Government will be implemented in all matters related to waste management.
7.5.9 Catering, Cleaning and Laundry Services Hotel services will continue to be provided through contractual arrangements with HealthShare Statewide Services. Personal laundry for residents will be provided in line with section 8.5.1 of the MPS Operational Guidelines 2019, which states that MPSs will provide a general laundry service for residents at no additional cost.
Fresh cooked meals will be provided at the Health Service for inpatients, residents and staff. Alternate light meals will also be able to be provided to residents as required. Cleaning services will continue to be provided on site. Linen will continue to be sent to Wagga.
A resident activities kitchen should also be provided as an adjunct to HealthShare food services. This enables residents to make small light snacks and also to work with activities officers or community members to cook different meals, snacks etc. in line with living well in MPS principles.
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7.6 Primary and Community Health Services Locally based primary and community health services will be collocated within the MPS. These services are managed in a stream model across the district, so do not report to the facility manager. Clinical spaces that are flexible and can be shared and utilised by different staff will ensure clinical space is well used e.g. strong functional relationships between community health and the emergency department. The integration and coordination of services across the care continuum will be facilitated through: Improved discharge planning; Case conferencing; Team care planning; The streamlining of referral processes; and Integration of communication systems including information systems to allow the sharing of patient records and information.
Management of chronic disease and health maintenance will be a focus for the facility. Community services are essential in meeting targets to reduce avoidable hospitalisations, promote wellness and support independence. Services/programs will include: Health promotion and illness prevention programs, including physical activity programs; Early intervention programs; Illness prevention including falls prevention; Healthy lifestyle and chronic disease self-management programs; Community acute and post-acute care; Access to community aged care packages; Transitional care community packages to reduce functional decline and the need for residential care; and Support Services.
Outreach services will continue to be provided from Wagga Wagga, Lockhart, Corowa and Albury. Local promotion of these services needs to be increased as some health providers and community members were not aware they are available.
Gaps exist for public dental services, local geriatrician services, Endocrinologist services, and respiratory health services. Opportunities for service enhancements for these services will be explored.
A new community health space should provide improved staff security, client way finding and separation of clinical and office space areas. Clinical and consultation space can be fitted out to meet the needs of multi-disciplinary teams and specialist visiting services. Ideally this will be integrated under the roofline of the MPS to easily enable sharing of clinical, stock/storage and staff spaces.
7.7 Aged Care Services The Australian Government Department of Health and Ageing use the numbers of people aged 70 and over for calculating the requirements for residential aged care. (Population projections are only available down to LGA level). The Urana catchment is calculated based on proportions of people within the age bands for the former Urana
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Shire. In 2020 the Estimated Residential Population (ERP) of people over 70 and Aboriginal population aged 50 and over in Urana was 235.
The Urana population of people 70 and over, and Aboriginal people 50 and over is projected to increase by 28.4% between 2016 and 2036 (table 23). This group will increase in terms of numbers and proportion of the Urana community. The Urana population as a whole is projected to decrease by 15% for the same period based on the 2019 Estimated Residential Population.
Table 23: Projected Urana Catchment Population aged 70 years and over and Aboriginal people 50 years and over 2016* 2021* 2026* 2031* 2036* % change 2016 to 2036 Aged 70 and over 183 201 213 223 225 + 21.5% Aboriginal 50+ 14 ^10 ^10 ^10 ^10 Urana suburb total 1234 1179 1139 1093 1048 -15% Total aged 183 211 223 233 235 +28.4% catchment Urana Source: ABS ERP November, 2020; ABS Census 2016, New South Wales State and Local Government Area Population Projections: 2019 *based on aged proportion in Former Urana Shire ^based on ERP 2020 proportion in Urana and assumes proportion will remain static
The former Urana shire population for those 70 and over is presented below to provide Commonwealth benchmarks for the Shire as a whole and assess how existing services compare against these figures (table 24).
Table 24: Urana Shire population projections for the age band 70 years and over Age 2021 ERP 2026 2031 2036 N % N % N % N % 70-74 68 5.8 62 5.4 64 5.9 59 5.6 75-79 61 5.2 73 6.4 68 6.2 70 6.7 80-84 42 3.6 45 4.0 55 5.0 52 5.0 85+ 30 2.5 33 2.9 36 3.3 44 4.2 Total 70 years and over 201 17.0 213 18.7 223 20.4 225 21.5 Total Population 1179 100 1139 100 1093 100 1048 100
Source: 2019 Department of Planning and Environment Population Projections, 2019 ERP base
The Australian Government planning benchmark aims to achieve national targets of 80 residential aged care places per 1000 people 70 years of age and older and Aboriginal/Torres Strait Islander people 50 years and over. Though not intended for application to single towns, the benchmark provides indicative information on the residential and community aged care requirements for the former Urana shire as a whole. Table provides a summary of the projected requirements to 2036.
Table 25: Urana aged care place requirements to 2036 Population 70 yrs and over and Aust. Govt. planning benchmarks
Aboriginal people 50 years Residential Care and over 2021 211 15 2026 223 17
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2031 233 19 2036 235 19
The Australian Government benchmarks shown in Table 25 suggests that by 2036 there will be a projected requirement of 19 places in Urana based on estimated resident populations. There are currently 19 places at Urana MPS, and no other providers in this planning area. There are challenges applying the Commonwealth formula to small planning areas accurately with small population numbers. It is for this reason, in addition to the Australian Government planning benchmarks, consideration is given to occupancy rates, waiting lists for existing aged care services and the need to move to other communities for care also informs aged care service needs.
There is very high occupancy of all residential aged care beds in the Urana MPS. This indicates there is currently a greater need for residential care than the commonwealth benchmarks indicate. The Urana MPS has operated at between 93-101% occupancy for the last 3 years, an occupancy over 90% indicates that most beds are utilised on most days and that there is some downtime for residents transitioning into the facility.
Given the high level of utilisation of the current 19 residential places at Urana it is recommended that an additional 5 beds be added to the current 19 places. 24 places will look to cater for the 21.5% predicted increase in estimated resident population over 70 up to 2036. This would be an increase in capacity of 26% in line with the increases in projected population.
There are high numbers of bed days attributed to maintenance clients in the inpatient beds at Urana. Anecdotally many of these admissions are for residents awaiting a place in one of the aged care rooms and also for planned and emergency respite. It is a benefit of the MPS model that beds are able to be utilised flexibly across the facility. All residents are ACAT assessed, and shown to require high care residential aged care. This utilisation of beds for non-acute reasons often causes challenges with limited bed numbers over peak periods. It could prevent admissions of acute patients locally, requiring them to seek treatment at other facilities, and prevent patients being discharged home to Urana in a timely fashion from larger facilities.
An increase in aged care bed numbers will free up inpatient bed capacity (both acute and sub-acute). It has also been reported locally that there are frequently frail and elderly residents utilising acute inpatient beds at Urana, whilst waiting for community based support packages. Access to high care packages is difficult across the country, but has been noted that it is very challenging to access them in the local area. The my aged care website notes that there are 12 month minimum waiting times for level 2, 3 and 4 home care packages. This is placing increasing pressure on both acute beds and residential aged care places at Urana MPS. Ideally increased numbers of Community Home Care Packages would offset residential care demand pressure at Urana. This would allow the elderly to be managed safely in their own homes for a longer period of time. However this is a national issue and not something that can be influenced locally, or by the state currently. There are recommendations from the National Royal Commission into Aged Care looking to address this problem.
Waiting lists over the previous 3 years have fluctuated between 2-6 interested potential residents at any one time. The local families, facility manager, GP and home care providers communicate regularly about how to best manage prospective residents if there are no current places available at the MPS. This is especially critical given the
Draft Urana MPS Plan-2020 page 64 of 82 Draft Urana MPS Service Plan 2020 nearest alternative aged care facility is nearly 50km away. This has prevented the need to place many local residents outside of the local community. But has put pressure on families and service providers (including community nursing) to keep people in their homes, despite this not being the best and safest outcome, until a place has become available.
The planned increase from 19-24 aged care beds also facilitates a staffing profile enabling pods of 4 residents to align with workforce and skills mix.
Issues for aged care services highlighted by key stakeholders include:
Equipment storage availability; Centrally located activity space with kitchen for resident activities with Activity Officer; Focus on living well in MPS principles; Calm social spaces; The need for mobility scooter parking and recharging areas at aged care facilities; Local Geriatrician/Psycho-Geriatrician service need; and Support for residents with complex dementia needs, especially safe wandering gardens and security.
Specific consideration must be given to the care of individuals with lived experience of dementia. There are more than 100 conditions which cause dementia, which are characterised by a progressive decline in mental functioning, including loss of memory, intellect, rationality, social skills and normal emotional reactions. Currently in Australia it is the second largest cause of disability burden after depression. By 2016, dementia was predicted be the largest source of disability burden.5
Consistent with population trends, dementia age care resource requirements are projected to increase significantly over the next 10 years for people aged 65 years and over, as the prevalence of dementia doubles approximately every five years from age 60. The Australian Government Department of Health and Aging calculate that approximately 1 in 20 people over 65 and 1 in 5 over 80 have some form of dementia.
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Figure 8: Projected increases in dementia
Source: Alzheimer’s Australia. It is assumed that the prevalence of dementia in rural communities is the same as for metropolitan areas. There is however little information on the prevalence of dementia in Aboriginal Australians. The projected increase in the proportion and number of people over 70 and future rates of dementia would support an increase in high care bed numbers and should be considered as part of master planning for the next 10 to 15 years. It is recommended that demand for residential care services is monitored as part of ongoing MPS reporting requirements and three yearly service statements reviews. The Royal Commission into Aged Care has a recommendation that states there should be a defined “Dementia Pathway” developed by 2023.
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Recommendations for Urana MPS aged care services include:
24 high care residential aged care beds with identified expansion zones; and Social spaces with kitchen area for food preparation activities
Future expansion requirements should be part of any development master plan. Placement of aged care and inpatient spaces near central social spaces will make for a more seamless experience for consumers using inpatient beds for respite in future. Good functional relationships between residential, inpatient and social spaces allow for future flexibility.
It is paramount that the proposed MPS caters for those experiencing low level dementia or delirium in order to provide appropriate and safe care that does not compromise the care of residents with normal cognitive function.
Dining, kitchen, lounge and activity areas are required to provide group and quiet social spaces. A comfortable homelike environment should facilitate social activities and interesting recreational activities. Recommendations for additional beds will require additional social spaces to enable smaller gatherings for residents with each other or family members. A fully weatherproof indoor/outdoor room has been suggested by staff to meet this requirement and would suit the local climate.
Services should reflect the living well in MPS principles:
Be safe and secure; Be simple and provide good ‘visual access’; Reduce unwanted stimulation; Facilitate meaningful recreational activities; Highlight helpful stimuli; Provide for planned wandering, inside and out; Be familiar; Provide opportunities for both privacy and community; Provide links to the community; and Be homelike.
The MPS will also need to reflect the trend of higher level clinical care requirements in the MPS environment due to the management of people for longer at home and in low care settings. Residents entering MPSs now have a greater need for mobility aids and nursing assistance.
The need for additional residential care places in the future will be negotiated between NSW Health and the Commonwealth Department of Health as part of a regular review process. Additional aged care licences can be applied for in annual funding rounds. Utilisation of current high care places will be monitored into the future. Any future redevelopments need to be responsive to the Royal Commission into Aged Care recommendations as they are approved/implemented.
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7.8 Health Related Transport NSW Ambulance and MLHD patient transport service will continue to provide the majority of health related transport, while NSW Air Ambulance will continue to coordinate air retrieval with AMRS (Aeromedical and Medical Retrieval Service).
7.9 Information Technology Urana MPS will have Telehealth facilities to provide increased access to consultation/liaison services with on call GP’s, specialist services, private and not for profit health and wellness providers, district based specialised nursing and allied health care, improved communication and staff development opportunities. This will reduce the need for travel to other centres for both patients and staff.
This improved technology access will ultimately enable residents and inpatient to access patient Wi-Fi, allowing connections with family and friends, access entertainment, manage their everyday lives, browse the web, social media and online streaming services.
There will be provision for the following range of information systems: Integrated and on-going data collection systems; Intra and internet access for staff and patient education and information; Centralised ordering of supplies via an ‘on-line’ imprest ordering system; Systems to support the utilisation of electronic medical records; and Clinical management systems including Telehealth.
Community members, either individually or in groups, with common interests will be encouraged to utilise information technology systems to access information and services not normally available in their rural location. Examples would be persons with a disease process contacting support groups to gain assistance in their local setting. This concept reinforces the local health service as a gateway to a wider range of services, promotes independence and self-determination for persons with a health need, and increases the relevance of the service to the wider community.
7.10 Staff Accommodation Small rural sites such as Urana are experiencing the impact of staff retiring at a higher rate than regional and metropolitan sites. Recruitment of permanent younger staff and new graduates is a priority, student placements are also a critical step in recruiting new staff. These staff need a reliable and safe place to stay. There is very little short term accommodation in the town, only a couple of units at the caravan park.
In rural and geographically remote facilities where staff vacancies exist there can be challenges and delays in filling positions. There is a trend in relying on locum or short term workforce who will require staff to fill vacancies. Accommodation is critical for housing temporary staff and permanent staff relocating to town until longer term rental accommodation is found.
Placing staff in commercial accommodation has significant budget implications for the service. Additionally, staff accommodation provides a non-commercial alternative for District staff who provide support to Urana MPS such as Educators, Clinical Nurse Consultants, Maintenance/Asset and other support staff. Commercial accommodation is often not available.
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A minimum of three stand-alone self-contained motel style units are recommended to meet short term staff accommodation needs.
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8. PROFILE OF PROPOSED SERVICES
8.1 MPS Services The Urana MPS will provide: Level 1 Emergency Services with Mental Health Emergency Consultation Service and critical care Telehealth and; Inpatient services including . Capacity for short term high care observation for delirium and mental health/drug and alcohol patients; . General medicine; . Palliative Care; . Maintenance Care; . Low level rehabilitation services; and . Respite Care. Residential aged care services in an environment suitable for people with low level dementia; Pathology collection services; A range of primary, community health, mental health and drug and alcohol services; and Staff accommodation.
Focus for future services will include: Chronic disease management; Support for transition from inpatient services to community services and independent living; Increased residential and community based services for people with low level dementia; Therapeutic activities for aged care residents and transition to the full suite “living well in MPS” program facets ; and Staff training and development to support the delivery of quality, evidenced based care across the continuum.
On an adjacent site will be: 8 Council owned accommodation units “Billabigdee”.
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Table 26: Proposed services – Urana MPS Type of Place Current Proposed Built Commissioning Capacity Profile Flexible inpatient beds including 3 4 4 Close observation room with good oversight from staff station, and palliative care and respite Emergency Department 1 1 1
Residential aged care beds – high 19 24 24 Total beds/bed equivalents 23 29 29 *Built capacity will be determined by Commonwealth support for commissioning profile residential aged care licenses.
8.2 Role Delineation The current and proposed role delineation levels for Urana MPS are provided in Appendix 3. Role delineations are in accordance with the 2019 NSW Guide to the Role Delineation of Health Services and 2004 Rural Companion Guide to the Role Delineation of Health Services.
The current role level of services is unlikely to change. However, services will be aligned to meet the needs of the community. This will be facilitated through ongoing community consultation, monitoring and review of services.
Strengthening of existing networks with referral centres will occur to achieve enhanced consultation/liaison services and outreach services based on identified community need.
8.3 Current and Proposed Staffing Levels The current and future staff mix needs to meet emergency, inpatient, residential high care and community health service needs. Table 25 summarizes indicative current and future staffing levels expressed in Full Time Equivalent (FTE) positions.
Staffing levels for the future MPS have been based on the relevant current Award determinations and MPS guidelines. The People and Culture unit in consultation with the Nursing and Midwifery Directorate have provided future indicative nursing position skill mix requirements in table 25 to reflect the current NSW Nurses State Award requirement for all MPS level facilities (See below).
Current staffing levels have been expressed in the actual skill mix of the staff currently employed at Urana rather than the skill mix profiled for the facility.
Table 25 demonstrates the shift required in current skill mix from current levels to future levels inclusive of the additional FTE for reconfigured bed numbers and level 1 Emergency Department. Workforce planning will consider future models of care and may recommend changes to skill mix and role design. Actual funding and staffing levels for future years will be subject to Service Agreement negotiations with the Ministry of Health based on funding principles applied in the relevant year.
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Table 27: Current and indicative commissioning staffing levels, Urana Position Current FTE Future indicative FTE MPS - inpatient component Facility Manager 1 1.12 Registered Nurses 4.56 7.51* Enrolled Nurses 6.08 3.62 Assistants in Nursing 3.18 1.81 Recreational Activity Officer/ Allied 0.5 1 Health Assistant Administrative and Clerical staff 1 1.12 Clinical Nurse Educator 0.42 Total Inpatient component 16.74
Community Health Child Youth and Family Nurse 0.29 0.2 Community Nurse 0.63 0.2 Total 0.8 16.40 Source: Senior Nurse Manager multi-site including Urana and Manager Workforce Planning.
Visiting health professionals will continue to provide a range of community health services as provided in table 18. An increase in allied health telehealth consults to the site has been proposed
There are no services that have agreed to collocate with the MPS.
8.4 Proposed Operating Budget
The following table outlines the operating budget for 2020/21 for Urana MPS. The estimated budget would then be adjusted annually in line with adjustments made to the commonwealth aged care subsidy, NSW Health funding and population health and aged care needs.
Table 27: Budget Details – Urana MPS as per Financial Statements 2020-21 Urana MPS Income and Expenditure Annual Budget
INCOME: $1,446,947 State’s Contribution
Commonwealth’s Contribution - 19 High Care $1,304,984
Commonwealth/State Contribution $33,048 (eg HACC)
Projected other revenue $453,809 (eg from aged care resident’s fees etc)
TOTAL INCOME $3,238,788
EXPENDITURE: $1,859,071 Total Salaries/On-costs Expenditure
Total Non Salary Expenditure $1,379,717
TOTAL EXPENDITURE $3,238,788
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Source: Terry Dowling, Finance and Reporting, MLHD
9. BENEFITS OF THE PROPOSAL
The redevelopment of an MPS at Urana offers several opportunities for the catchment community including improved functional relationships between existing services, increased activity and interaction for the aged care residents, and staff accommodation to improve staff recruitment.
The Multipurpose Service is a model of health and aged care service delivery that has been implemented throughout Australia to assist in meeting the challenges of providing health care in small rural and remote communities. These include: Access to the range of services required for the community; Declining and ageing population and the resultant increased demand for continuing and aged care services; Recruitment and retention of a skilled workforce; and Difficulties in coordinating services resulting in the duplication of services and disjointed health care.
The MPS model aims to overcome some of these challenges by: Active community involvement in the planning of health and aged care services; Increasing the range of health and aged care services in the community including Primary Health and Prevention services, emergency services, acute care services and aged care services (community and residential); Providing community and residential aged care services in partnership with local providers; Facilitating ‘ageing in place’, allowing elderly people to remain in their local township with supported care in the community or in residential care facilities; Providing services locally for people with dementia; Improving infrastructure (including facilities and technology) to provide a contemporary working environment for staff. This will assist in the recruitment and retention of staff; and Providing comfortable staff accommodation, which impacts on staff recruitment and efficiencies when locum staff are required to fill vacancies.
The collocation of inpatient/ aged care services, and community health, provide opportunities to integrate services and improve coordinated care for clients across the continuum. These include: Multidisciplinary care planning using case conferencing where applicable; Easy flow of clients utilising respite/transitional aged care into social spaces and activities; Potential future expansion zones; Streamlining referral processes; and
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Improved electronic communication systems including the patient record.
Partnerships with other health providers in Urana including Valmar and the GP will be formalised to achieve: On-going coordination to avoid duplication of services; Joint staff development and training opportunities; Smooth client flows between facilities and services; Sharing of information; and On-going joint resident/client activities.
Community based services will be enhanced to support wellness and independence within the community. This will include a focus on: Health promotion and illness prevention services; Early intervention services; Prompt referral to specialist services; Increased use of Telehealth facilities to allow remote access to specialist and allied health services; Rehabilitation and self-management programs for people with chronic illnesses; and Supporting people and their carers to remain in their own homes.
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10. COMMUNITY CONSULTATION
Community consultation in relation to service planning for the Urana MPS has been ongoing over the past few years. The senior planner consulted with two open forum groups of Urana community members including the: LHAC (Local Health Advisory Committee); Federation Shire; Aged care community providers; Primary Health Network; MPS staff; Auxiliary. These open forums occurred in August 2018. Additional meetings with local government October 2018, with various staff groups in February 2019 as well as regular conversations with managers, council representatives, local GP and the LHAC chair person.
Additionally the Chief Executive and Board Chair has had discussions during a site visit in 2019 with the LHAC about proposed upgrades and potential redevelopment of the Urana MPS.
Everyone was supportive of this MPS proposal moving forward.
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10. EVALUATION AND MONITORING
Evaluation and monitoring of services will be ongoing. This will include:
The Health Service manager, in consultation with the LHD, the Local Health Advisory Committee and staff, will prepare an Annual Business Plan to indicate the relevant service priorities for the coming year. The plan will be reviewed on a regular basis to ensure services are provided in accordance with current demand; Patient reported measures and outcomes will be implemented and reviewed ongoing; Health services will be provided in accordance with current best-practice guidelines; Appropriate benchmarking of services will occur to ensure they are cost effective and efficient; Performance indicators, as required by MLHD, NSW MoH, and the Department of Health will be monitored and routinely reported; Relevant questionnaires, surveys, interviews, etc., may be conducted to monitor and review service provision; and External surveys may be conducted to objectively evaluate service delivery and accompanying standards Three yearly reviews with community input will be conducted to assess if service levels are meeting demand. A Service Statement will recommend any changes required and be submitted to the Commonwealth.
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11. SUMMARY
It is proposed that Urana MPS is redeveloped, the current building no longer meets the community need, delivery of contemporary models of care and staff needs. It is recommended that a new facility be built to provide flexible integrated inpatient, residential and community aged care, and community health services to meet the needs of the community.
The recommended redevelopment is based on anticipated growth in the proportion of ageing population in Urana, the high occupancy of residential high care aged care beds, service flexibility and waiting lists for residential aged care across the region. The population of people aged 70 and over is projected to increase by 23% between 2016 and 2036, making up 21.4% of the local population, which will require residential aged care service expansion given current and projected demand.
It is proposed that the Urana MPS is redeveloped to provide capacity for 24 flexible high care residential aged care places and 4 flexible inpatient beds, including palliative care family support areas. At commissioning it is recommended there are:
24 high care residential aged care beds; 4 flexible inpatient beds; Level 1 emergency department with standard components; Community health and outpatient clinical spaces; and Staff accommodation (3 units).
It is proposed that the facility ensures future services are well connected with excellent functional relationships and there are identified expansion zones to accommodate the projected increase in residential aged care. Built capacity is reliant on Commonwealth support for the commissioning profile for residential aged care places.
The existing layout will require reconfiguration to achieve future need within the flexible MPS care model including the provision of separate lounge/quiet areas and activity areas.
The MPS will continue to provide emergency care and community health services in collaboration with other health service providers in the community. Refreshment and quiet areas/facilities for families with a palliative patient will be provided.
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Appendix 1: Abbreviations
ACAT Aged Care Assessment Team AHW Aboriginal Health Worker CACP Community Aged Care Packages CNS Clinical Nurse Specialist DOHRS Department of Health Reporting System ED Emergency Department EN Enrolled Nurse FLECC First Line Emergency Care Course FTE Full time equivalent GP General Practitioner HACC Home and Community Care HC High Care HSM Health Service Manager ISC Inpatient Statistics Collection LGA Local Government Area LHAC Local Health Advisory Council LHD Local Health District MHECS Mental Health Emergency Consultation Service MLHD Murrumbidgee Local Health District MoH Ministry of Health MOW Meals on Wheels MPS MultiPurpose Service NAPOOS Non-Admitted Patient occasions of service OT Occupational Therapist PHC Primary Health Care RN Registered Nurse SRG Service Related Group VMO Visiting Medical Officer
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Appendix 2: Activity data Activity at Urana by SRG 2018/19 SR Gv50 Name Total Separations Total Bed Days Maintenance 5 141 Non Subspecialty Medicine 18 65 Palliative Care 6 93 Respiratory Medicine 13 44 Cardiology 9 17 Neurology 5 48 Gastroenterology 5 17 Orthopaedics 1 1 Neurosurgery 4 28 Renal Medicine 3 9 Endocrinology 1 3 Non Subspecialty Surgery 3 5 Haematology 1 6 Psychiatry - Acute 3 3 Urology 2 5 Drug and Alcohol 2 2 Ophthalmology 1 1 Grand Total 82 488 Source: FlowInfo Version 19.0, NSW MoH
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Services Utilised by Urana LGA Residents 2018/2019 SR Gv50 Name Total Separations Total Bed Days Non Subspecialty Medicine 62 177 Respiratory Medicine 43 154 Palliative Care 9 139 Neurology 21 102 Gastroenterology 26 67 Cardiology 28 55 Rehabilitation 6 50 Haematology 8 48 Non Subspecialty Surgery 16 45 Psychiatry - Acute 13 38 Neurosurgery 6 32 Renal Medicine 9 22 Orthopaedics 5 21 Urology 9 20 Maintenance 5 19 Qualified Neonate 3 10 Pain Management 2 8 ENT & Head and Neck 2 6 Immunology and Infections 1 4 Vascular Surgery 4 4 Obstetrics 4 4 Drug and Alcohol 3 3 Upper GIT Surgery 2 2 Plastic and Reconstructive Surgery 1 2 Endocrinology 2 2 Unallocated 1 1 Gynaecology 1 1 Rheumatology 1 1 Ophthalmology 1 1 294 1038
Activity at Urana Hospital by age 2018/19 Age Group Categories Total Separations Total Bed Days 16 to 44 Years 3 3 45 to 64 Years 19 92 65 to 74 Years 14 49 75 Years and Over 46 344 82 488 Source: FlowInfo Version 19.0, NSW MoH
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Hospitalisations by patient type at any location for Former Urana Shire residents 2018/19 Sum of Sum of Bed days Separations (LOS days) Acute 417 950 Sub and Non-acute 20 208 Psychiatric 6 29 Grand Total 443 1187 Source: FlowInfo Version 19.0, NSW MoH
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APPENDIX 3: Role delineation levels Urana MPS Service Current Future Service Current Future Core Services Maternal and Child Health Pathology 2 2 Maternity NPS NPS Pharmacy 2 2 Protective Services 1 1 Radiology NPS NPS Neonatal NPS NPS Nuclear Medicine NPS NPS Paed Med NPS NPS Anaesthetics 1 1 Paed Surg NPS NPS Intensive Care NPS NPS Family &Child Health 2 2 Close Observation Unit 1 1 Youth Health 2 2 Operating Suites 1 1 Mental Health Clinical Services Adolescent Health 1 1 Emergency Med 1 1 Adult MH (com) 2 2
Medicine Child/Adolescent MH 2 2
Gen Medicine 2 2 Older Adult MH (Com) 1 1 Community Based Health Cardiology 1 1 Services Drug & Alcohol 2 2 Aboriginal Health 2 2 Dermatology NPS NPS Community Health (Gen) 2 2 Endocrinology 2 2 Surgery Gastroenterology NPS NPS Gen Surgery NPS NPS Haematology- Clin NPS NPS Burns 2 2 Geriatric Medicine 2 2 Thoracic/Cardio NPS NPS Immunology 1 1 Day Surgery NPS NPS Infectious Diseases 1 1 Ear, nose, throat NPS NPS Med Oncology 1 1 Gynaecology NPS NPS Neurology 1 1 Neurosurgery NPS NPS Palliative Care 2 2 Ophthalmology NPS NPS Radiation Oncology NPS NPS Orthopaedics NPS NPS Rehabilitation Medicine NPS NPS Plastic Surgery NPS NPS Renal NPS NPS Oral Health NPS NPS Respiratory NPS NPS Vascular Surgery NPS NPS Rheumatology 2 2 Urology NPS NPS Sexual Health NPS NPS
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