Nearly 10,000 extra patients could have been accommodated in Illawarra hospital wards in the past year if it wasn't for the hundreds of older people who have been stuck in hospital with nowhere to go.
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Illawarra aged care expert Mark Sewell says he is growing increasingly concerned about the scale of the aged care problem in the region - which left 1600 people languishing in hospital well past their discharge date in the past 13 months.
"We now know that the average length of stay for the 1600 people over the last 13 months in Illawarra and Shoalhaven hospitals is 35 days after they're ready for discharge," the former CEO of Warrigal who is now an Aged Care Consultant for the Community Industry Group said.
"So some may already have been there for several weeks getting treatment, trying to get things fixed - maybe a bone fracture, maybe an infection - before those 35 days.
"And this is shocking because the average length of stay in an Illawarra hospital for everyone else is five days."
"That means - say if there's 1000 people blocked in hospital in the last 12 months - that could have been 6000 other people using our public health system.
"The numbers are pretty stark."
This problem is being repeated around Australia, but for the past two years has been markedly worse in the Illawarra due to the massive shortfall of aged places.
Mr Sewell said about 500 beds in the region had closed in the last 10 years, while federal Department of Ageing figures showed the region should have 900 more places than currently exist.
"So we're 900 behind where we should be, and we're going to need another 1000 in the next 10 years to keep pace with the need," he said.
He said more aged care providers were considering closing beds soon, and that there were only two new facilities - still years away - in the pipeline.
A federal issue the state must deal with
Despite aged care being firmly in the federal government's remit, it has been plaguing NSW Health Minister Ryan Park since the start of his term.
Last week, a frustrated Mr Park spoke about the issue on ABC radio, saying nearly 1200 people waiting for aged and disability care were occupying hospital beds across the state, with 700 waiting well past their discharge date.
"It's a terrible situation for them and it's a terrible situation for a system under pressure needing those beds," he said.
Mr Park said, with a six-to-12-month wait for people to access home care packages and not enough aged care beds, many people were left with no alternative than to take up an acute bed in hospitals.
He said winter flu, RSV and COVID were putting pressure on emergency departments - with 12,500 people arriving in hospital with the flu in one week - but hospitals were unable to admit people due to the patients stuck waiting for care.
"Our hospital system is not designed for people to be staying in there for months on end," he said, agreeing that it was critical the federal government pull its weight to fix the problem.
NSW Health, and the local health district has been working hard to try and relieve some of the pressure locally over the past couple of years: it opened up new transitional aged care beds at Figtree Private Hospital, and also set up an aged care flying squad to keep people already in aged care out of hospital.
The flying squad has been a relative success, Mr Sewell said, keeping "good numbers" of people who need treatment for an infection or wound from going into hospital.
However, it was of little help to those who simply can't get a spot in aged care.
How do people end up stuck in hospital?
"Most people in those beds - who have an assessment that says they need aged care - are in shock, and it's not what they thought would happen," he said.
"Their families, their kids, are in a bit of shock and they haven't thought about it, they haven't planned for it."
He said many of those waiting in hospital would have been living in their own homes, but a sudden change in their health - due to illness, or most likely a fall - meant it was no longer safe for them to return.
In May, the Australian Institute of Health and Welfare published data showing that more than 549,000 people aged over 65 entered hospital each year across Australia.
More than half of them (233,000) are injured from a fall - the majority of which are from a level surface like a footpath or carpeted floor - and most suffer significant loss of function and independence, and many take a long time to recover.
"Older people are proud of their independence, and they love where they live - and unfortunately Australia doesn't have much seniors friendly housing, and not many people move to retirement villages," Mr Sewell said.
"So older people are in their own homes in old suburbs, ageing with their old houses and these houses are unsuitable."
"Simple things like rugs and mats and fluffy slippers and a step here and there, or stepping into the bath to have a shower - which may have worked for a person's life for decades - no longer work as they turn 70, 80 or 90."
He said people living in purpose built, accessible homes were likely to fall, while living in communities where they knew their neighbours were less likely to be lonely and depressed.