Diverse views on restoring function

Claire’s perspective

As the need for aged care services increase, policies and government recommendations look to embed rehabilitation and reablement into aged care. We know that these approaches can restore and improve function for older people to enable participation in activities that are enjoyable and provide a sense of purpose. However, in terms of practical care delivery, there are many barriers that prevent these approaches being used.

In late 2023, Aged Care Research & Industry Innovation Australia brought aged care service providers together at national roundtables to discuss the complexities of integrating rehabilitation and reablement into aged care delivery.

We met with a range of allied health professionals including physiotherapists, occupational therapists, managers, academics and a psychologist who shared their experiences, concerns, and ideas of how to improve future services. The group widely agreed that rehabilitation and reablement should be part of daily life for those receiving aged care.

However, our published white paper details the challenges of variable terminology, funding systems, inequalities, ageism, and the expectations of older people, their advocates, and the aged care workforce to the implementation of these changes.

Ironically, one of the difficulties for organisations when attempting to provide rehabilitation and reablement in aged care is that these approaches “get people better”. They improve function, allowing people to be more independent with self-care, attend to their gardens and live happily at home.

You are probably thinking, “well isn’t that a good thing?” Yes, it is certainly what I would want for myself and my relatives. But this means that individuals become less dependent and require fewer services.

Aged care providers receive more funding to deliver care to older people who are less able and more dependent. Indeed, funding is approved based on the deficits that a person has at a point in time not on what might be achieved through interventions based on evidenced solutions and strategies.

Here lies the conflict between funding models, business sustainability and best care outcomes for older people and is part of the reason why terminology is important to allied health professionals as it is directly linked to funding.

If I do my job well, I am no longer needed

As a physiotherapist, with a passion for rehabilitation, I have found great joy in teaching people to walk again following a stroke, throwing out their walking sticks and getting back to living their lives.

This is one of the big perks of the job. By successfully restoring someone to their previous function, there is ultimately a point where they no longer need physiotherapy. If I do my job well, I am no longer needed; they have the motivation and ability to head out and live.

This is a different concept and purpose to those systems and businesses where dependency and continued repeat business is valued over positive outcomes for care recipients.

Allied health professionals are essential in aged care, bringing the expertise to motivate individuals and help them to achieve meaningful and personalised goals. Delivering person-centred care that focuses on these goals and takes the time to understand a person’s past interests, current abilities and future aspirations are invaluable.

While service providers participating in the roundtables recognised allied health interventions as a crucial aspect of care, they also acknowledged the challenges.

For physiotherapists, accomplishing this in a 30-minute session is demanding. It may be even more challenging for care workers who must learn and implement new skills as part of an integrated program while prioritising their essential daily tasks.

Our roundtable discussions were extremely valuable. However, these conversations lacked the voice of older people receiving care. Continuing these reflections from different perspectives, gives us the opportunity to address key points and discuss what we think the future looks like.

Understanding the expectations of those delivering and receiving care is important to allow us to focus on the key issues, and the reason Judith Leeson and I came together as an aged care consumer and physiotherapist, to explore the role of allied health in restoring function for older people receiving aged care.

Dr Claire Gough is a research fellow at Aged Care Research & Industry Innovation Australia]

Judith’s perspective

I love a good white paper, especially one that looks at improving the lives of older people receiving support and care in their own home or in residential accommodation.

The outdated medical model of care has certainly reached its use-by date, and a more holistic model will demand a transdisciplinary approach to the provision of self-directed, client-centred services that motivate and empower.

Allied health professionals will become an essential part of the team where knowledge and skills are shared, and care workers become integral to the process of reducing dependence.

Clients will be supported to articulate their goals through a facilitated process dependent on understanding the individual’s experiences, values, skills and interests to underpin the development of services which encourage agency and are meaningful.

This is not a dream, but a gradually emerging reality, supported by a passionate learning community that is developing in the aged care sector, driven by rigorous academic and industry research and experience, rich consumer input, and supported by translational research organisations like ARIIA.

I just want to know how you can help me.

A debate on terminology – rehabilitation, reablement and restorative care – may be valuable to professionals, and essential for bureaucrats, but as an older person receiving support and care at home, I am not interested in what the service is called. I just want to know how you can help me.

And therein lies the conundrum for the client of improving function and decreasing dependence with a consequential reduction in services and interaction with people with whom you have formed a relationship.

What is worse you may have been told, as I was, that my aged care services would train me to do housework. After 70 years of balancing domestic duties, family, work, leisure and other responsibilities the suggestion was a distinct disincentive to participation.

Although I do not enjoy housework, a little gentle questioning would have revealed that I absolutely love gardening, and surely many of the interventions planned to teach me long forgotten skills of sweeping and vacuuming would be like those needed for gardening.

What is more important, I would be motivated by the hope that I could once again engage in horticultural activities. I may even be tempted to do some sweeping.

The essence of the newly drafted Aged Care Act is that services will be client-centred, with the ability to have a self-determined future, and that the client’s story will be the starting point for innovative and creative thinking on how to provide services that give hope, motivate action and strengthen agency in and for whatever stage the client is at in their ageing process.

While the current funding model for residential support and care reinforces dependence and rewards providers for higher, not lower, levels of dependency, the proposed model will encourage independence by acknowledging the client as the expert in their life and that hope is the essential driver of motivation to live a life of purpose and meaning.

The client centred-model of care will change the face of services for some, but utilising allied health professionals as allies will make a considerable difference over time, as aged care workers will become involved in the process of shaping client capacity and gradually relieve them of some of the more repetitive and onerous daily tasks.

This sharing of implementation, and deeper understanding of the power of reablement to restore or improve capacity, and to transform practical interventions, will transform the careers of care workers, provide satisfying learning pathways, and improve both retention and attractiveness of an aged care career option for the next cohort of helpers.

Future aged care services must emphasise meaningful physical and social activities

The new Aged Care Act and strengthened quality standards set the stage for a collaborative engagement among service providers, allied health professionals and consumers.

Future aged care services must emphasise meaningful physical and social activities, recognising their value for older people. This presents ARIIA and the broader allied health community to move beyond outdated medical models and champion an approach that supports the best in aged care delivery.

Judith Leeson – who was appointed as a Member of the Order of Australia for services to the community in 2005 – is an aged care consumer, founding director of Vector Consultants and a member of ARIIA’s independent board of directors

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