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Calls for residential care to adopt a more restorative approach

Restorative care approaches need to be extended into residential aged care, allowing some residents the potential to return home, says a leading academic.

Michael Fine, Adjunct Professor at Macquarie University’s Department of Sociology, said models of aged care needed to reflect that understandings of ageing had shifted away from that of ageing as a period of deterioration, towards one of opportunity and possibility.

“We need to be shaping our aged care services away from this very negative, terminal decline model, towards a much more restorative approach,” Professor Fine told Australian Ageing Agenda.

Professor Michael Fine

Professor Michael Fine

Professor Fine, speaking ahead of his presentation at the AAG & ACS regional conference this week, said that there was potential for residential care facilities to operate as long-term rehabilitation facilities, and with greater emphasis on social aspects of care.

For example, a residential aged care facility could operate three streams: permanent residents, residents who are part of a rehabilitation program, and day care facilities, which could provide seniors in the community with access to services such as physiotherapy.

Further, Professor Fine said if consumer directed care and consumer choice were extended into residential care, there was the potential that residents would choose care that reoriented them back into their own homes.

“The crucial thing is that we start to get older people themselves involved in much more of the planning of things. I think we consult them too far too late and far too little,” he said.

A more fluid model of care that would allow people to move in and out of residential settings may also potentially free up the number of available vacancies, said Professor Fine, allowing consumers’ a greater diversity of choice in where they are cared for.

While Professor Fine acknowledged that not everyone in a residential aged care facility could be rehabilitated, it was wrong to presume that residents could not make functional gains.

Among residents living with dementia, research had shown reablement approaches, including that of music, exercise and social engagement programs, reduced dependency and slowed the onset of symptoms. These were also often cost effective to run, he said.

“The scope for improvement really lies in that social sphere, and that’s the cheap side. It’s quite cheap and it reaps incredible rewards,” said Professor Fine.

There were also potential cost benefits to a restorative approach in residential care in that clinical staff such as nurses could move into more consultative roles, rather than be required to be on-hand at all times, he said.

Residents returning home: one provider’s success 

John Pigdon with Ozcare staff member

John Pigdon with Ozcare staff member

One aged care provider that has already moved towards embedding reablement has successfully supported three of its residents to return home in the past 18 months after they made functional gains.

Ozcare’s Noosa Head facility has adopted a model of care that encouraged residents to maintain their independence wherever possible, according to facility manager Carmel Morgan.

“It’s about health and wellness; we help our residents focus on their ability to do things for themselves,” she said.

Former resident John Pigeon moved into Ozcare Noosa Heads two years ago after he was diagnosed with Alzheimer’s disease and his wife Anthea found it difficult to manage his care.

On admission, staff worked to get to know John as an individual and established his strengths. From there, they helped John and his family establish goals – including being able to return home.

Staff assisted John with his nutrition and medications, and encouraged his involvement in activity programs. They worked with him to improve his functionality, such as having a shower on his own, getting John get to a point where his wife felt she could manage caring for him again on her own.

For more on reablement and restorative care across aged care, the Active Ageing Conference 2016 on 4 August in Sydney will have the latest evidence and practice. Click here for more information

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5 Responses to Calls for residential care to adopt a more restorative approach

  1. Dave April 7, 2016 at 3:31 pm #

    A great idea that will never materialise under the current funding model.

    Aged care only performs the treatments ‘prescribed’ by ACFI…and they’re not designed to improve resident well being. Providers get paid for leg bandages, passive massages and useless heat packs that have no evidence-based benefit and actually contribute to physical deterioration…there’s no funding available for exercise classes and professional rehab, etc. (you know, the stuff that actually works).

    As it stands, ACFI revenue increases as resident condition deteriorates, so where’s the financial incentive to keep folks well? We all know it’s the right thing to do, but try telling that to the CFO when your average daily funding isn’t climbing in line with their projections. (Hmmm, better get a new ACFI coordinator?)

    The sad reality at the coalface is that restorative care and wellness promotion will just remain hollow industry buzz-words unless we revamp the funding model and reprogram the bean-counters.

  2. Alison April 8, 2016 at 7:42 am #

    A great idea but I agree with Dave it will not happen with the current funding model. The current funding model is driven by so called
    ‘not for profit agencies’. They are keeping more than 50% of the fees allocated for aged care for administration. How do I know? My mother is in this situation. She is 90 years old and has no health problems except for dementia. I want to look after her at home but the most assistance I can get from the agencies is 12 hours for $1000/week. There are private agencies who will provide me with the help I need but the government won’t fund them. The government needs to listen to the families not the agencies and they could save money. I am now being forced to consider putting my Mother into a nursing home instead of being able to care for her at home. It would cost less to fund families to provide assistance at home than to fund greedy agencies or to put people in nursing homes.

  3. Mark McBriarty April 8, 2016 at 3:03 pm #

    Consumer Directed Care is coming to residential care in 2018 and opens up a world of possibilities for individuals and families to have a far greater say in how their services are delivered, in turn, residential care will need to come up with innovate, flexible workforce demand models that cater to each an individuals taste.
    We should, however, remember that only 6% of 65+ will ever move into residential care – the far bigger challenge is in ensuring that Home Care Package funds are spent on enabling/assisting and not spent on cleaning services that an individual is more than capable of, at the very least, participating in.
    We are often met with the line, “I have never cleaned my house and I am not about to start now!” -then hire a cleaner – enabling individuals to maintain their independence is a two-way street and government funding will need to be carefully targeted.

  4. Anna April 10, 2016 at 7:19 pm #

    I agree whole heartedly with previous comments regarding the incompatibility of ACFI and reablement for residents. Having previously worked as a Physio for 20 years in ACF’s, I especially agree with the comments about the funding of passive pain management strategies which attract considerable funding via ACFI.
    It is very concerning that the selection of pain management strategies available to residents in ACF’s is so limited and lacking in evidence of efficacy. Older clients living in the community receiving Physio through CDC’s or clinic based services have options which include exercise (which has strong evidence of efficacy in pain management )and yet this is denied to residents in ACF. Often there is also a tendency to maximise dependency. Once again this attracts more funding. It is time for an overhaul of the system. So far it seems this may still be a long way off!

  5. rjrs April 19, 2016 at 12:07 pm #

    Oh what a great idea, re-ablement, would that be for benefit of the resident at the expense of the facilities bottom line?
    It would take a health policy officer with a forward thinking line manager, and a minister who plans beyond the next election cycle, to establish this. We are stuck with outmoded thoughts, procedures and applications when it comes to ageing.

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