Aims
Older Australians (≥65 years) account for 43% of hospitalisations and 21% of emergency department (ED) presentations nationally (2021–2022). Co-HIVE aims to deliver place-based, specialist-led virtual care to residents of Residential Aged Care Facilities (RACFs), reducing avoidable hospital admissions and facilitating earlier supported discharge so older adults can remain in familiar, supportive environments.
Methods
Based at Royal Perth Hospital, Co-HIVE delivers multidisciplinary virtual care across East Metropolitan Perth. The team includes Consultant Geriatricians, Psychogeriatricians and specialist older adult Nurses. Key interventions include Comprehensive Geriatric Assessment for frailty, management of Behavioural and Psychological Symptoms of Dementia, complex Advance Care Planning, dementia and Parkinson’s care, polypharmacy review, and urgent prescribing.
Results
Between February 2022 and January 2026, Co-HIVE supported 2,560 patients across 289 RACFs, delivering 9,276 clinical events. Of these, 2,168 were Supported Discharge Pathway patients and 275 were managed via the Pre-Emergency Pathway. Referral acceptance was 98.9%, with 100% actioned within required time limits. Satisfaction was high, with discharge survey scores of 7.6/10 (Net Promoter Score 7.6) and 97% of respondents reporting concerns addressed.
Conclusion
The Co-HIVE model demonstrates that geriatrician-led virtual care can safely scale, reduce avoidable ED transfers, and preserve dignity through supporting residents to receive specialist care within their own familiar, place-based environment. The model has strong potential to expand into rural and remote regions, transforming how aged care residents are managed within their own facilities.