Clinical issues in aged care: managing the interface between acute, subacute, community and residential care.

Although there is considerable evidence for the use of geriatric assessment and rehabilitation in many clinical settings, there exists relatively poor access in various regions of Australia. There has been considerable growth of community support services to assist in personal care of older people. Unfortunately, a lack of uniform assessment has hindered prioritization of clients, with the resultant need, and delivery, of post-acute hospital care services. In addition, there has been considerable progress in the clinical management of the age dependent disabling problems, such as dementia, osteoporosis, incontinence and falls, but the appropriate mix of funding between primary, secondary and tertiary interventions has not been determined. The health care needs of older people in residential care have been totally neglected, placing the sector at considerable risk. There need to be a fundamental rethink in managing the interface between acute, subacute, community and residential care.