Providers encouraged to back goal-based exercise programs

The new funding tool provides an opportunity for evidence-based allied health treatments for aged care residents, the researcher behind a successful strength and balance exercise program tells Australian Ageing Agenda.

The SUNBEAM trial (Strength and Balance Exercise in Aged Care) consisted of individually prescribed progressive resistance training plus group balance exercises for 50 hours over 25 weeks followed by a six-month maintenance program.

The trial – led by physiotherapist Dr Jennie Hewitt – involved 221 aged care residents from 16 facilities in New South Wales and Queensland. As previously reported, it resulted in a 55 per cent reduction in the rate of falls among residents and led to the current implementation of a government-funded program now under evaluation.

Dr Hewitt said there had been renewed attention in the SUNBREAM program because of the new funding instrument – the Australian National Aged Care Classification.

“There has been a surge of interest in how to roll out the SUNBEAM program because allied health therapists are now allowed to perform evidence-based exercise, rather than just the previously prescribed very outdated interventions,” Dr Hewitt told AAA.

“AN-ACC provides an opportunity for allied health to branch out into individualised exercise programs that address the person’s goals, diagnoses and their multiple morbidities,” said Dr Hewitt, a lecturer and clinical educator with The University of Sydney Northern Rivers Clinical School.

On 1 October, AN-ACC replaced the Aged Care Funding Instrument, which had provided funding for non-evidence-based allied health treatments including massage and TENS (transcutaneous electrical nerve stimulation).

The change in policy – and no benchmarks for allied health – has many stakeholders concerned that providers will cut spending on these services and lead to an exodus of allied health professionals. However, Dr Hewitt is still hopeful for better resident outcomes.

“Even though it is true the hours may reduce, the fact that we can now do evidence-based treatment means our efficacy should increase,” she said.

Dr Hewitt supports the calls for an allied health benchmark in aged care. “You can’t perform miracles if you’re given five hours for 100 people. But if you’re given reasonable, comparable times to what they get outside of residential care – appointment times and frequencies of treatment – then we should be able to get amazing results.”

Evaluation due later this year

The results of Dr Hewitt’s SUNBEAM trial were published in the Journal of the American Medical Directors Association in 2018. She gave evidence to the royal commission in 2020 and later that year the government announced funding to roll out an allied health group therapy program based on SUNBEAM in aged care homes affected by Covid.

“There are wonderful opportunities if we’re given the freedom to prescribe best-practice exercise to make a difference to people’s lives. I’ve seen it firsthand.”

Dr Hewitt supported the rollout with resources and training materials – which are freely available (links below) – to ensure aged care facility staff and allied health therapists had training in best-practice exercise.

“The department appointed me as technical advisor for the project that included 119 aged care facilities eligible to roll out the SUNBEAM program out across the 11 Primary Health Networks,” she said.

The 11 PHNs included four in New South Wales – Nepean Blue Mountains, Northern Sydney, South West Sydney, and Hunter New England and Central Coast; six in Victoria – Murray, North Western Melbourne, Eastern Melbourne, South Eastern Melbourne, Gippsland and Western Victoria; and Tasmania.

The program aimed to improve physical functioning of residents at risk of deconditioning due to Covid-19 lockdowns. It provided funding for twice-weekly group therapy sessions for up to 26 weeks led by a physiotherapist, occupational therapist or exercise physiologist.

The program is currently being evaluated. “The evaluation for that will come out at the end of the year and we’ll be looking at recommendations from the office of the Chief Allied Health Officer around that,” Dr Hewitt said.

The health and aged care department has published information about the evidenced-based allied health package for aged care homes, and an instructional video for group therapy in residential aged care and initial assessment resource for allied health professionals.

“Hopefully the residents will be the winners out of this, but that’s only going to happen if allied health professionals are given the opportunity to use our skills and training to deliver best practice.”

Student program shows what’s possible

Dr Hewitt has been supervising allied health students in aged care since 2017. “Because we are outside ACFI, the students can do all sorts of innovative, evidence-based allied health programs with the residents and achieve amazing results,” she said.

“The students come to the University Centre for Rural Health on their clinical placements and we go into aged care facilities and talk to people about what their goals are, and then set up programs to try and achieve them,” Dr Hewitt said. “One fellow was in a float chair and he called me and said he wanted to walk again. So the students worked with him over about 10 weeks and he went from being reliant on a sling hoist and a float chair to being able to walk with a forearm support frame.”

AN-ACC provides the opportunity to scale these types of interventions, Dr Hewitt said. “There are wonderful opportunities if we’re given the freedom to prescribe best-practice exercise to make a difference to people’s lives. I’ve seen it firsthand.”

While the change might be stressful for some service providers, being able to individually assess somebody to find out their goals and give evidence-based treatment means better outcomes for residents, more job satisfaction for allied health therapists, and an opportunity to show aged care providers what’s possible, Dr Hewitt said.

“We want aged care providers to see what we can do; allied health can deliver fantastic outcomes for residents. Hopefully the residents will be the winners out of this, but that’s only going to happen if allied health professionals are given the opportunity to use our skills and training to deliver best practice.”

Main image: The SUNBEAM program in action – Dr Jennie Hewitt (left) with a participant who told her he ‘walked better at 90 than he had at 80’

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