Victoria's long-established Geriatric Evaluation and Management (GEM) program has evolved according to policy directions, local innovation and demand. The Department of Health undertook an evaluation of Victoria's GEM program to determine whether GEM is optimising value both in terms of:
- improving outcomes for older people with complex health and psychosocial needs
- supporting the health service system to meet demand from an ageing population.
Through extensive consultation with the sector, support from an expert advisory group, a review of the literature and analysis of data and other sources of information relevant to the GEM program, this evaluation sought to:
- understand the extent to which GEM is delivering an efficient and effective service
- understand how GEM supports the broader health service system including interfaces within health services and with external community and aged care services
- identify the current and future challenges and enablers for GEM and how it needs to evolve to meet the needs of older Victorians now and into the future.
While the focus of the evaluation is on Victoria’s GEM program, its evolution is intrinsically linked to developing a system of care for hospitalised older people, especially for those who are frail and vulnerable to poor outcomes while in hospital. GEM is underpinned by a model of care that focuses on the multidimensional needs of older people who would benefit from comprehensive geriatric assessment and management by an interdisciplinary team skilled in the care of older people with complex care. Components of the GEM model underpins a universal approach to care for all older people to reduce functional decline and avoidable harm. Such care should be readily available to older people irrespective of where the care is provided.
Based on key findings of the evaluation several recommendations are made. Broadly these are:
- All older people who are vulnerable to harm in hospital are identified early and have ongoing access to models of care that are designed to keep them safe, deliver targeted interventions to reduce functional decline or access to early comprehensive geriatric assessment and management irrespective of where the care is provided.
- The specific care needs of patient groups identified within GEM are defined to ensure models of care and clinical care pathways are efficient and effective.
- The workforce and the environment need to support existing and emerging service models that focus on the complex needs of older patients.
- Develop system and outcome metrics that monitor service improvement and outcomes for older people across hospital and community care settings.
- Funding reflects resource use and the costs of delivering care for patients in GEM, with a focus on the distinct patient groups within GEM.
The recommendations provide direction for both the department and health services to improve care delivery and clinical pathways to:
- reduce poor outcomes
- provide better experiences for older patients and their families.
These recommendations seek a sustainable system response through redesigned care pathways and innovative tailored care interventions. Initial work underway includes:
- a review of the current GEM in the Home service model
- piloting of a frailty screening tool in acute care
- working with health services and the National Ageing Research Institute to develop a model of care for managing patients with extremely challenging behaviours associated with their dementia.
Current and future work will require collaboration within and across the department and the health service sector to achieve sustained benefits for older people, the workforce and the health service system.
Reviewed 24 May 2022