The hotel hospital that’s a symptom of a sick system
Former truckie Graham Rundle is spending his days at a five-star hotel in Adelaide. It’s not a holiday: this is the face of the nation’s hospital funding crisis.
It’s the public hospital equivalent of the Hotel California where ailing elderly patients can check in any time they like, but often never leave.
Welcome to the Pullman Hotel in Adelaide. It’s a lovely place but it’s also a stark example of everything that’s wrong with aged care and the bed blockages in our public hospital system, nowhere more so than in the more aged state of South Australia.
So desperate is the Malinauskas government to free up hospital beds that for seven months it has been paying Adelaide’s five-star Pullman Hotel to use three of its floors to house a fully equipped non-acute hospital known as a Transition Care Service.
This isn’t a ramshackle, makeshift hospital; it is a professional and welcoming operation run by national health provider Amplar under contract to SA Health.
Its location presents incongruities – you enter via the Pullman’s foyer where you are greeted by a friendly French-speaking doorman then walk through a leather-seated lounge offering fine local wine.
Once inside you could be in a ward in any major hospital, with the added benefit that the rooms are private, larger, and have nice views of the Adelaide CBD. The food is also made on site by the Pullman’s chefs, and the patients say it is excellent.
The SA Government has not revealed the cost of the contract between SA Health, Amplar and the Pullman, citing commercial confidentiality. It is believed to run into the millions but is still cheaper than the cost of funding beds in fully fledged public hospitals which average $1500 to $2000 a night.
Aside from a handful of younger trauma and rehabilitation patients, most of the 48 beds inside The Pullman are occupied by elderly people.
They are all hoping to find a place in aged care in a state where the Productivity Commission has found patients wait on average a staggering 253 days after receiving Aged Care Assessment Team approval – almost double the national average of 136 days.
Seventy-six-year-old Elizabeth pensioner Graham Rundle is the human face of this crisis, now in his fourth week at the Transition Care Service, and still waiting to hear back about his future accommodation.
Mr Rundle suffers from cellulitis and has mobility issues from his swollen legs. His wife died almost 10 years ago and he has two daughters in Queensland and a daughter and son in Adelaide, but his health needs are so significant he cannot be tended to by his children.
He’s seen a lot of Australia, having lived in Darwin and across the Top End, working as a fireman, truck driver and spending several years as head mechanic in the remote town of Yuendumu, 300km from Alice Springs.
“Most of my life has been out bush but I’m stuck here now,” Mr Rundle says.
“I have to say the care I have had here has been terrific. All the people I have come across are very good. I am feeling better than I did even though some of the swelling has come back.
“I’m not sure how much longer I’ll be here. I heard something that they had found a single dwelling for me but I am still waiting to hear back. I don’t know any more about it, I’m afraid.”
Aside from the huge eight-month average wait for an aged care spot, South Australia also has the highest national rate of hospital patient days by people waiting for an aged care bed – 24.4 days in 2022-23, compared with the national average of 13.2 days.
This is an increase of almost 35 per cent in two years and has led to a crisis situation where, as of this month, almost 300 elderly people remain stuck in the state’s public hospitals simply because they have nowhere to go.
That represents a five-fold increase from when the Malinauskas government was elected in 2022 when an average of just 60 older patients were occupying beds and unable to enter care.
With the SA government under pressure over failing to honour its keynote election promise to return ambulance ramping to 2018 levels, Health Minister Chris Picton said the biggest pressure on freeing up hospital beds was the crisis in aged care.
“Australians who have paid tax their whole life deserve to be able to get an aged care bed when they need one, not languishing in hospitals or hotels waiting,” Mr Picton told The Australian.
“This national aged care crisis is impacting families across the country and is only set to get worse unless strong action is taken. Not only does the crisis lead to awful outcomes for older people, it also deprives other people of the public hospital beds they need.”
Mr Picton chaired the recent health ministers meeting when the states confronted federal Health Minister Mark Butler over what they regarded as a lack of action on aged care places and a failure to provide adequate My Aged Care packages to get the elderly out of hospitals and into home support.
“Across Australia some 2500 hospital beds are taken out of the system because of federal aged care – that’s the equivalent of closing three Westmead hospitals,” Mr Picton said.
“All state health ministers have raised this issue with ministers Mark Butler and Sam Rae. They have said they are going to take action. Patients and families across the country are waiting to see what that action is.”
The South Australian branch of the AMA has declared the Pullman project “not a long-term solution” with president John Williams saying the real fix is for the commonwealth to move faster on aged care.
But Mr Picton said the SA Government not only would be continuing with the Pullman project but also would soon reopen the now-closed Parkwynd Private Hospital in the CBD to provide similar non-acute transitional care for another 70 patients.
However, he said it was unfair that state governments were being forced to foot the bill for what was a federal problem.
“While this is about the patients, not the money, there is also a real-world consequence for state budgets,” Mr Picton said.
“Every dollar spent putting aged care patients into hotels is a dollar states can’t invest in other areas like preventive health, education, environment … the list goes on.”
Amplar operations director Fiona Margrie is based at the Pullman and says that, aged care aside, there will be a growing need for transitional care as the population continues to live longer.
Ms Margrie has a background in nursing and has worked in Victoria and Perth. She helped to lead the set-up of the Transition Care Service at the Pullman ahead of its opening in March this year.
She said the reason the service was working well was that it was philosophically identical to any other hospital and was in no way a “fake” hospital plonked inside a hotel.
“I worked a bit in the country, and this is like a country hospital,” Ms Margrie told The Australian.
“We have always worked on the basis that health care isn’t a building. It’s the services you provide within a building. You can do health care anywhere. You can do it in a tent.
“It’s always going to be a challenge for the staff to understand that we are not in a hotel, we are in a hospital. So the question is what would you do in a hospital. It’s the same for patients. You can’t go down and have a drink at the bar. If you weren’t here you’d be in hospital.
“The benefits far outweigh everything else. The quality of sleep, the food, all the things you take for granted in a hotel, you get them here.”
Ms Margrie rejected any suggestion that the elderly patients at the care service were an imposition on the health system and said the need for transitional services merely reflected the ageing of the population.
“At the end of the day acute care is getting more and more acute,” she said.
“As people are living longer there is always going be that gap of people still needing a healthcare service of some description before going into aged care.
“But we are not a waiting room. People should not undervalue aged people, as if they are just waiting to go to aged care. We are proactively providing the health care that gives them good quality of life. We have so many people coming in who haven’t been able to do things, but they get allied health care, a complete package of care, so rather than needing to go to a level four nursing home they actually get better and need less health care.
“It’s not a space where people are just parked in the corner until something becomes available.”
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