Greater role for allied health in aged services

Current reforms are opening the door for greater involvement of allied health services in home care, much to the benefit of clients, but providers and professionals must work together to overcome existing barriers, writes Martin Bending.

 

Current reforms are opening the door for greater involvement of allied health services in home care, much to the benefit of clients, but providers and professionals must work together to overcome existing barriers, writes Martin Bending.

The introduction of consumer directed care (CDC) into community care represents an exciting development for both consumers and aged care providers. CDC’s emphasis on reablement and restorative care also presents a great opportunity for exercise physiologists and allied health generally to be more involved in home care.

This increased participation for allied health is also very timely, as the ageing population is leading to a rise in the prevalence of conditions such as dementia, diabetes, stroke, Parkinson’s disease and other comorbidities. To effectively manage these conditions, as well as secondary issues including poor balance, decreased mobility and physical deconditioning, the clinical expertise of allied health professionals will be critical.

Martin Bending working with a client
Martin Bending working with a client

Research by Professor Gill Lewin and colleagues, which Australian Ageing Agenda reported on in November 2013, highlights that incorporating a reablement and restorative care approach in home care maximises the capacity of those in the community to be independent. The research also shows that this approach is more cost-effective in terms of personal care costs in subsequent years, compared to conventional home care services only.

Similarly, research by Thomas Vogel and associates, published in 2009, shows that decreased muscle strength and fitness are the two most important factors that lead to an increased risk of mortality, decreased quality of life and impaired functional capacity. We see this frequently in the community. Through a tailored exercise physiology program it is possible to reverse, or at least manage, these two factors.

At its core, home care is about supporting individuals and carers to live at home for as long as possible, with the best quality of life as possible. In this way, while domestic support and personal care may differ greatly to allied heath interventions, together they work towards the same goal in a holistic approach.

Greater collaboration

I have been fortunate to be involved in prescribing exercise programs to maximise an individual’s independence and quality of life. With the expansion of home care I see a closer relationship with our home care team naturally develop to the point where we share and cross refer a number of clients.

Having met with a number of home care providers I understand that implementing a restorative and reablement care focus can, understandably, be new and unfamiliar, particularly for local care coordinators. This is where marrying the knowledge of allied health professionals and care providers can result in significant learning for both, thereby enabling consumers to experience a holistic journey of care. However, in order to embed this into home care, change needs to be driven by both providers and allied health professionals.

CDC will facilitate greater allied health services in home care
CDC will facilitate greater allied health services in home care

Change agents

On the part of providers, the key is listening to consumers and identifying behaviours and signs that indicate they could benefit from an allied health professional. For example, a client who has difficulty getting out of chair may be a reflection of poor lower limb strength, which the research shows is a major risk factor for falls. Additionally, difficultly getting out of chairs may translate to problems with everyday activities such as getting off the toilet, in and out of cars and standing up from bed. An exercise physiologist could be involved to address the client’s leg strength and coordination. The client could be further aided by involving other allied health therapies such as occupational therapy, which may recommended assistive aids in the form of adjustable height chairs, elephant feet (blocks that go under the legs of chairs or bed to increase the height) and grab rails.

On the part of allied health professionals, we can assist providers in identifying other common triggers where reablement and restorative care may assist in the consumer’s care in the short, medium and long term.

As is often the case, funding is a crucial issue, particularly with lower level packages where there is less capacity to pay for this care. This is often a topic of conversation I have with providers; indeed it is an area where providers, consumers and allied health professionals need to collaborate in order to find solutions. Exploring home-based versus centre-based therapy, group versus individual therapy, and other avenues of funding (for example, through a GP referral or private health insurance) should be part of the conversation to address issues of price and access.

There are opportunities to attract allied health professionals to aged care
There are opportunities to attract allied health professionals to aged care

Engaging the profession

The increased scope for allied health in home care also brings greater opportunities to attract new allied health professionals to aged care. Undergraduate students often have no idea what to expect when they enter an aged care placement.

Through the Wellbeing Centre at the Australian Unity Constitution Hill site we provide over 3,000 hours of clinical exercise physiology placement annually. Our students quickly find that working and exercising with an older demographic is rewarding but also exposes them to a multitude of different conditions and provides a great learning environment. I encourage providers to, where possible, take on students as university programs are often looking to expand their placement options. On a number of occasions I have employed standout students, either on a casual or part-time basis, after they have graduated. As they know our processes and clientele, it is often a smooth transition. The enthusiasm of younger professionals is a great asset, particularly in times of change, as we are currently seeing in aged care.

The future interest in reablement and restorative services from care providers and consumers needs to be reciprocated by allied health, and in my experience this is happening. At a recent aged care education event hosted by a Medicare Local in Western Sydney, the turnout exceeded expectations with over 80 allied health professionals from a variety of different backgrounds attending. Additionally, in October, I presented an aged care webinar to about 90 exercise physiologists. Clearly, there is interest among allied health professionals in being more involved in all aspects of aged care.

With research and best practice supporting the scope of the home care packages, it is exciting to see allied health and aged care providers work closer in coordinating and providing services to consumers. In doing so, there will be many success stories. I hope they will be shared to demonstrate the potential of what allied health professionals can do in the home care setting.

Martin Bending is allied health services manager at Australian Unity Retirement Living Services and Associate Conjoint Lecturer at the University of NSW. He won the Rising Generation award at the 2013 Retirement Living Summit. Click here for more information. 

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