This involves making a plan for future health and personal care should a person lose decision-making capacity. It allows patients to express preferences to inform medical treatment. It can also include provisions for palliative and end-of-life care. More information on services and resources can be found here.
Older adults and aged care
In 2020, 11.1 per cent of people in the North Western Melbourne Primary Health Network (NWMPHN) catchment were aged at least 65. That is expected to rise to 12.2 per cent by 2030.
Brimbank currently has the highest population of older adults. This is not expected to change, but Hume and Wyndham are predicted to experience the largest increases across the remainder of the decade.
As our population grows older, the pressures on the health system will be felt across the entire region.
We support older adults by:
- increasing access to care, particularly for at-risk populations and people with multiple diseases or conditions
- ensuring that residential aged care homes (RACHs) are equipped to provide, or facilitate access to, high-quality primary health services delivering end-of-life care
- working with a range of stakeholders to support the physical and mental health of older adults.
As people age, performing daily tasks independently can become increasingly difficult. This can impact maintaining a clean living space, managing health issues, and even moving around.
“Aged care” refers to the assistance provided to older adults – including those who require aid in their own homes and those who can no longer live independently or choose to live in an RACH.
There are approximately 130 RACHs in the NWMPHN region.
Our role in aged care is to:
- improve access to multidisciplinary primary health care services, including COVID-19 vaccinations
- improve the connection between GPs, RACHs and hospital services
- increase access to mental health supports for RACH residents and staff
- co-design and commission exercise programs to decrease fall risks
- support aged care staff in building their after-hours capabilities.
Advance care planning
In line with the care finder policy guidance provided by the Australian Government Department of Health and Aged Care, NWMPHN has commissioned care finder services in its region.
Service providers establish, deliver and maintain a network to provide specialist and intensive assistance to support older adults who have significant difficulty accessing aged care services and are at risk of missing out.
More information is available here.
COVID-19 vaccination services for at-risk homebound people
NWMPHN accepts referrals from health care agencies and providers, general practices, and community health services within its catchment for in-reach home visits to provide COVID-19 vaccinations to people who cannot leave their home. For more information or to refer, visit here.
COVID-19 vaccination services for RACHs
RACHs are responsible for ensuring residents have access to the recommended COVID-19 vaccine dose as soon as they are eligible.
They can do this by securing a local general practice or pharmacist to administer doses. However, if a RACH has tried all options and is unable to organise a local primary care vaccination provider, they can contact firstname.lastname@example.org to discuss ways to connect with one.
Find more information on responding to COVID-19 outbreaks at health.gov.au
NWMPHN has developed a suite of resources to support GPs to diagnose and care for people with dementia. It includes clinical tools, referral and consumer resources and professional training. More information is available here.
We have also developed a Dementia Directory listing care, support and respite services operating across Melbourne. It complements resources available through My Aged Care and NDIS.
Early intervention initiatives for chronic illness in primary care
The Australian Government Department of Health and Aged Care funds NWMPHN to support older people to live at home for as long as possible. This will be achieved through commissioning early intervention activities and models of care for chronic disease management to support healthy ageing and reduce pressure on hospitals, aged care and other health services.
The organisation commissioned 10 general practices to join the project through an open tender process in April and May 2023. More information is available here.
HealthPathways Melbourne is a clinical management and referral resource designed for use during consultations. It gives clinicians a single website to access referral pathways and resources.
With a focus on local conditions and preserving clinical autonomy, it offers concise guidance and facilitates seamless referrals to local health services, enhancing the quality of care provided to older people in the region.
Mental health services for older adults
With funding from the Australian Government Department of Health and Aged Care, NWMPHN commissions Merri Health to deliver a mental health support program for adults aged at least 65. The program is available for Aboriginal and Torres Strait Islander adults aged at least 50.
It is a free service for people who have a mild to moderate mental illness or are at risk of developing one. It is available in the local government areas of Hume, Merri-bek, Darebin, Yarra, Melton, Brimbank, Melbourne, Maribyrnong, Hobsons Bay, Wyndham, Moonee Valley, Macedon Ranges (Gisborne part only) and Moorabool (Bacchus Marsh part only).
For more information visit the Merri Health website.
NWMPHN also commissions a range of other mental health services suitable for older adults but not specifically targeted at them. Health professionals should visit HealthPathways Melbourne to find local clinical and referral information. Older people and their supporters can visit nwmphn.org.au/mymentalhealth to browse services.
- Palliative care in general practice
We provide education, resources and deliver other activities to support GPs and primary health care providers to provide palliative care as part of usual practice. Find out more here.
- Greater Choice for At Home Palliative Care
This Australian Government initiative includes a range of activities that boost palliative care coordination and integration for people who have a known life-limiting condition. This includes improving choice and quality of care, and support in the home. More information is available here. The Precious Time website is an example of this initiative in action.
- Palliative care in general practice
Residential aged care – after hours support
NWMPHN has developed tools for RACHs to better support residents during after-hours periods.
These are the result of a collaboration with South Eastern Melbourne Primary Health Network, Ambulance Victoria and the Victorian Virtual Emergency Department.
Find them here.
Residential aged care – allied health services
With funding from the Australian Government Department of Health and Aged Care, NWMPHN commissions several providers to provide allied health services inside RACHs. They deliver group therapy programs aiming to improve physical function of residents at risk of deconditioning.
Therapy is based on the Sunbeam Program, which has been proven effective in preventing falls in older adults. Group sessions for up to 4 residents run twice a week for up to 6 months.
This program is available to all RACHs in the NWMPHN region. More information is available here.
Residential aged care – grants to upgrade telehealth
NWMPHN invites all RACHs in its catchment to apply for grants of up to $20,000 (ex. GST) to upgrade virtual consultation facilities and technology.
The grants, funded by the Australian Government Department of Health and Aged Care, will enable residents to access clinically appropriate primary health care professionals through telehealth.
For more information or to apply, visit here.
Residential aged care – psychological treatment services
With funding from the Australian Government Department of Health and Aged Care, NWMPHN commissions providers to deliver a free, low to medium intensity psychological treatment service for aged care residents experiencing (or at risk of) mild to moderate mental illness.
Supports are delivered by mental health practitioners and can be accessed by phone, telehealth, or face-to-face (when possible and safe to do so). The service can be provided on an individual basis or, if appropriate, through group sessions with other residents.
It is available to all RACHs in our region. Find out more here.
Precious Time is our website for people at the end of life and their carers, family and friends. It provides expert advice on how to talk about dying, how to live fully supported and with dignity, how to sort out legal and financial issues, and many other issues. It also features a lively blog, and a searchable database containing more than 400 organisations and businesses that provide useful services.
It was developed in consultation with our community, including a panel of 27 people who came together in 2018 to explore the topic “What does dying well look like and how can we help people achieve this?”.
Older Adults Expert Advisory Group
Our Older Adults Expert Advisory Group aims to ensure NWMPHN’s operational and strategic decisions and actions improve health systems and outcomes for older people. It means we are informed by community and clinical subject matter experts, and grounded in our systems view by local real-world experience. This helps us to better meet the growing population health needs of our region.
If you, or an older person you know, needs support here are some organisations and services that may be useful.
- My Aged Care – The Australian Government’s My Aged Care phone line and website helps you to access services and find information in one spot for yourself or for a family member, friend or someone for whom you’re caring. Services range from help at home to finding aged care homes.
- Older Persons Advocacy Network (OPAN) – OPAN’s free services support older people and their representatives to address issues related to Commonwealth-funded aged care services.
- Elder Rights Advocacy – Elder Rights Advocacy supports older people in Victoria, their families and representatives to address issues related to Commonwealth funded aged care services. The service is free, independent and confidential.
- The Translating and Interpreting Service (TIS National) – TIS National is an interpreting service for people who do not speak English and for agencies and businesses that need to communicate with their non-English speaking clients.
- Financial Counselling Victoria (FCVic) – Financial counselling is a free, confidential and independent service. Financial counsellors provide information, support, advocacy and advice to people experiencing, or at risk of, financial hardship.
- National Elder Abuse Hotline – A free-call phone number – 1800 ELDERHelp (1800 353 374) – automatically redirects callers seeking information and advice on elder abuse with the phone service in their state or territory.
- Victorian Aboriginal Health Service – A primary care clinic for Aboriginal and Torres Strait Islander people and their families.