[Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay]. / La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse.

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.

The geriatric workforce in Romania: the need to improve data and management.

Facing severe under-funding and significant workforce maldistribution, the health system in Romania is challenged to provide adequate care for the ageing population. The aim of this article is to connect health labour market data of the geriatrics workforce in Romania with individual perceptions of front-line workers in geriatrics in order to better understand the 'human' factors of effective health workforce development. Comprehensive health workforce data are not available; we therefore used a rapid scoping review and interviews to combine quantitative and qualitative data sources, such as the 'Healthcare Facility Activity Report', policy documents and available reports. They show that despite a consistent increase in the overall number of geriatricians, their majority is based in Bucharest, the capital city. The initial review points to possible geriatrician burnout, caused in part by high workload. The geriatrics workforce in Romania is poorly developed. Significant efforts are still needed to create policies addressing inflows and outflows, training, maldistribution and inefficiencies related to their practice. Addressing burnout by improving teamwork and collaboration is vital for maintaining and improving the workforce morale and motivation. Two major policy recommendations emerged: an urgent need for better health workforce data in Romania and development of more effective workforce management.

How many geriatricians should, at minimum, be staffing health regions in Australia?

In any particular region, determining an adequate, quantifiable geriatrician full-time equivalent required to run geriatric medicine services comprehensively - that is spanning both inpatient and outpatient settings - remains an imperfect science. Whilst workforce planning may be addressed through 'demand versus supply' simulations, 'specialist-to-patient ratios' (SPRs) may be a useful additional workforce metric. There has never been a yardstick SPR, which 'defines' a satisfactory level of geriatrician manpower in any particular Australian hospital catchment. Here, a new methodology is proposed (tailored specifically to Australian geriatrics), illustrating how we may begin to transparently deduce such a national benchmark SPR. Allowing for some empiricism, the method presently favours an SPR approximating '0.4 full-time equivalent of geriatrician time per 10 000 head of population' in regions with 'average' population age distribution; this level of manpower may afford specialist assessment of targeted patients (widely capturing geriatric cases from acute to community settings). Further discussion on workforce planning methodologies is warranted.