With a population that is more likely to have chronic disease and which is ageing at a faster-than-average rate, the Illawarra's health system faces a long list of challenges.
And one of the biggest, according to the region's health bureaucrats, remains the number of people stuck in hospital due to a lack of beds in aged care and challenges in disability or in-home community support.
For more than a year, the Illawarra has been one of the country's worst-affected regions in the aged care bed shortage - with far more patients stuck for long periods in hospital as they are unable to be discharged to aged or disability care than in other regions.
Last month, new figures from the federal health department stated the Illawarra was short of 600 residential aged care places as of 30 June 2023.
All year, the number of people waiting for an aged care bed in Illawarra hospitals has teetered around 90 - sometimes dipping in to the 80s and climbing well into the 100s.
On November 20, there were are 92 patients awaiting placement, the health district said.
This problem - which is well known by the state and federal governments - has once again been highlighted in a submission to the NSW Government's inquiry into healthcare funding.
The Illawarra Shoalhaven Local Health District paper said there had been "a marked increase in patients occupying hospital beds who are unable to be discharged to Residential Aged Care Facilities due to lack of beds in local aged care facilities".
Likewise, more disability patients needed to stay in hospital as they were unable to be discharged "due to challenges in disability or in-home community support".
The district also said the Illawarra's patients were finding it harder to access GP and primary care services, which was increasing the burden on services provided by the state system.
"Whilst responsibility for primary care sits with the Commonwealth Government, ISLHD as an LHD has been increasingly required to fill the gap in primary care due to pressures in the sector," the submission said.
Later this week, the health district will officially open temporary aged care beds at Figtree Private Hospital, which were announced in a joint funding agreement by the NSW and federal government in July.
The health district said the unit was already operating to help discharge some older people from hospital.
"ISLHD staff are now working within a newly refurbished Transitional Aged Care ward at Figtree Private Hospital, where they will support the safe hospital discharge of older people who will benefit from additional therapy services whilst waiting for a residential aged care place to become available," a spokesperson said.
Another measure designed to help address the "particularly acute" problem with the number of elderly people stuck in hospital in the region, was an Aged Care Outreach Service (ACOS) launched in 10 aged care facilities in July.
It it's first weeks, the health district said it had saved 109 elderly people from heading to the emergency department.
However, no further figures on the update or effectiveness of the program since then were available.
The health district also told the funding inquiry that greater investment in building maintenance for existing hospitals and health facilities needed to be prioritised to ensure environments are suitable to the services being provided.
that schedules are more aligned to protecting against extreme weather events, which are becoming more frequent.
It also said more guidance could be provided on the management of end-of-life planning and decommissioning of assets including how LHDs may benefit from sale of assets deemed excess to need.
The district is in the process of decommissioning Port Kembla Hospital.
The NSW government appointed Richard Beasley SC as commissioner of the inquiry, which will look into the governance and accountability of NSW Health and which strategies are available to limit escalating costs and wastage.
More than 200 submissions were lodged by local health districts, LHDs, not-for-profit and industry organisations and researchers.
Mr Beasley, who worked on the Ruby Princess inquiry, will deliver a final report to the government by August 24 next year.
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