An Australian study has shown a continuing tailored exercise rehabilitation program can help aged care residents maintain physical function despite an expected decline in this group.
The Macquarie University study investigated the functional outcomes and satisfaction over six months of 38 residents participating in an ongoing physiotherapist-led exercise program in a Sydney aged care home.
The tailored program was created by Concentric Healthcare Services and delivered from their rehabilitation centre in Opal Aged Care’s Cardinal Freeman home (read more about the model below).
The aged care residents participating in the study were aged 45 to 103 with a mean age of 83. Most participants were female (68 per cent), required physical assistance for mobility (61 per cent) and had a cognitive impairment (63 per cent).
Participants attended an average of one-and-a-half tailored exercise sessions per week and an average of 36 sessions altogether during the study period, equating to 94 per cent compliance.
The study found more than half of participants improved their walking speed (55 per cent), and a maintenance in average walking speed across all residents.
Almost all of the participants recommend the program to other residents (92 per cent), according to the findings published in the Australasian Journal on Ageing in June.
“The results suggest that a rehabilitative program can maintain the physical status of aged care residents, despite the common decline in physical performance in this population,” the researchers concluded.
Co-author and Concentric Healthcare Services CEO Nicholas Young said the best outcome was that participants improved or maintained functional outcomes such as walking speed and timed up and go.
“We know there is an inevitable functional decline upon admission into aged care so if we can slow that, if not turn that around, then I think we have won with what we are doing,” Mr Young told Australian Ageing Agenda.
The key element of this study is that the program is ongoing and continues to be implemented, he said.
“It is not just the six weeks we have made an improvement in balance. This is a long-term measure of psychosocial as well as physiological markers.”
The results have already been provided to the aged care royal commission. Mr Young also expects to give evidence next week when hearings resume.
Hopefully it is one piece of evidence that will lead to a reablement and rehabilitative approach to allied health in aged care, as opposed to traditional pain management, he said.
Thecurrent funding model is restrictive and seems to reward for disability rather than improvement, Mr Young said.
Program runs under additional services model
The first Concentric Rehabilitation Centre opened in September 2017 at Opal Cardinal Freeman in Ashfield in Sydney’s inner west.
Concentric has since partnered with multiple aged care providers to establish seven centres across New South Wales, Western Australia and Victoria. An additional five are due to open this year and a further 10 are planned to open next year, Mr Young said.
The individualised and structured rehabilitation program is offered to residents as an additional service.
“They or the family can choose to opt in to a clinically-beneficial product, which will improve their quality of life and their functional status,” Mr Young said.
“The rehabilitation package is implemented by highly-skilled allied health practitioners implementing person-centred therapy. Each resident is taken through a comprehensive assessment that includes a battery of tests such as timed up and go, five minute walk, sit-to-stand, other psychosocial measures and goal setting.”
Rehabilitation packages are tailored to suit individuals’ needs and reviewed every 13 weeks. Residents are triaged according to their predominant impairment, Mr Young said.
“If they have a neurological condition then they will go down a particular stream of treatment, probably biased toward more one on one intervention.
“If they present with some functional decline in their orthopaedic or their balance or something like that they will go down a particular stream with a little less one on one and more tailed exercise group classes for them,” he said.
The group classes are still individualised according to participants’ impairments and functions, which is far and above the traditional lifestyle model where the lowest common denominator determines what the rest of the group does, he said.
“We have a high performing group of individuals who might be slightly younger, slightly more mobile standing on wobble boards as opposed to the more frail, less functionally able who might be standing in a single leg with support from the rails.
“We put them with their peers that are functionally in a similar level to them so they can push each other and they can progress accordingly,” Mr Young said.
Residents are encouraged to practice their individual exercises as often as they can. Their support network including relatives, friends and carers are encouraged to participate during sessions to increase engagement, he said.
The 13-week review assesses for any improvements or changes to inform the resident’s program for the next period. The information is also collected to be used as data for future studies, Mr Young said.
The business model
The model works by Concentric partnering with aged care providers that want to give their residents access to onsite quality allied healthcare. Together, they design and fit-out an area of the home where Concentrics’s trained allied health team delivers rehabilitation to residents and members of the general public.
“The partnership invests heavily in age specific and disability specific equipment,” Mr Young said. And the centres act as a community hub by introducing members of the public to the aged care home.
“This encourages residents to interact with the community and increases their socialisation. We have witnessed many friendships blossom between residents and community members, especially young people with disabilities. It is truly heart-warming.”
Many of the centres are adjacent to retirement living communities, which offers easy access and a potential continuum of care for those residents, Mr Young said.
“Across all the locations we have about a 70 per cent uptake of the residents in the facility accessing our services.
“We even have a significant portion of financially supported residents and their family seeing the value in it and chipping in together to pay the additional service fee so that mum or dad can have access.”
Current and future planned centres are located at a mix of for-profit and not-for profit run facilities, he said.
“It is easy for a not-for-profit that may have never dabbled in an additional service model before to see value in this,” Mr Young said.
“It is common for our aged care partners to receive a return on investment within 12 to 24 months.”
The next stage of this study will involve aged care participants from Concentric Rehabilitation Centres across Australia to test a larger number of participants and the impact of other allied health integration, Mr Young said.
Main image: Angeline Violi with Concentric Rehabilitation Centre client Maria McGurk