title: Acute Transition Alliance: rehabilitation at the acute/aged care interface.
abstract: The acute/aged care interface has presented many challenges to funders, providers and planners in the health and aged care sectors. Concerns have long been expressed in the aged care sector about the changing needs of clients admitted permanently into residential aged care from hospitals where the decision for placement would often have been made in a crisis situation, without the opportunity to explore appropriate options. This article describes the process and outcomes to date of a collaborative effort between the acute care and aged care sectors in South Australia to develop a more integrated approach to discharge opportunities for older people. The program involves both residential and community care elements and seeks to provide rehabilitation, to restore function and to avoid inappropriate permanent residential care for older Australians following acute admissions to a public hospital. Interim outcomes are promising and show only 17% of those admitted to the program are discharged to long-term residential care.
authors.affiliation: Acute Transition Alliance, Aged Care and Housing Group, Fullarton, SA.
authors.forename: Dawn J
authors.initials: DJ
authors.lastname: Kroemer
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bloor
authors.forename: Jeff
authors.initials: J
authors.lastname: Fiebig
mesh_terms: D000208:Acute Disease / Q000534:rehabilitation*; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D011383:Progressive Patient Care / Q000458:organization & administration*; D012017:Referral and Consultation; D014218:Triage