This year marks the start of an era where reablement and wellness will be the underlying principles in community care services.
In both home support, through the Commonwealth Home Support Program (CHSP), and in home care, through the consumer directed care element of the new home care packages, reablement is the philosophy that must underpin care and service delivery.
But, for all the research, debate and campaigning to embed a focus on wellness and reablement within home support and home care, questions remain about the sector’s readiness to actually deliver this new approach.
A key issue will be ensuring the community care workforce is educated on the reablement and wellness philosophy, and capable of delivering it.
Six months ago, the National Aged Care Alliance (NACA) urged the Department of Social Services (DSS) to fund the Community Services and Health Industry Skills Council (CS&HISC) to develop a nationally recognised skill set to sit above Certificate III “on wellness and reablement to address the competence gap for the vocationally trained workforce.”
Chief executive officer of the CS&HISC, Rod Cooke says he was unaware of NACA’s training proposal, adding that reablement and wellness were within the realm of employers’ responsibility.
However, he says that new standards in training packages to be implemented midyear incorporate the philosophy of reablement, promoting health and empowerment, and wellness, focusing on independence and wellbeing.
The upgraded packages follow an intensive review requested by the DSS with a view to aligning the qualifications to match practice.
However, entrenching the concepts of reablement will depend on employers and a change in culture, Mr Cooke adds.
Council on the Ageing (COTA) chief executive Ian Yates says he believes the concept of reablement is a problem for parts of the sector, some of which think it is “a load of rubbish.”
“They think that older people don’t want to get back on their feet… Let’s give them the opportunity, let’s be aspirational,” he says.
While reablement will not work for everyone, Mr Yates says that research supports the health and economic benefits for consumers and funders.
He predicts that within five years, all the resources will be in the hands of consumers, perhaps as part of an integrated community care program – a possibility that was flagged by Assistant Minister for Social Services Mitch Fifield in a speech in November.
Leading researcher in reablement, Professor Gill Lewin is concerned that for all the talk of wellness and reablement, it will not be realised in practice. “That really concerns me,” she says.
“I see it almost as a human rights issue.” Lewin, who is Silver Chain’s research director and Professor of Ageing at Curtin University, says that engagement is the key. “Enablement is a generic term, where reablement is a specific time with strategies for furthering health and wellbeing.”
Professor Lewin says the tendency to “over medicalise and over professionalise” is detrimental and funding would be better spent on non-health professionals. “The problem with health professionals is that they see every problem as one that they need to solve. They have difficulty helping people help themselves.
“Real resilience is learning to adapt and we have to be in the business of helping those who find it more difficult, to ensure they have a life worth living as long as possible.”
Dr Tracey Mackie, regional services manager with RSL Gold Coast, received a Churchill Fellowship in 2011 to investigate active ageing and reablement models around the world. Mackie says that the terms of enablement, reablement and wellness all target quality of life and good health.
“The underlying concept and principle is to support and guide patients to encourage reablement and improve their health,” Dr Mackie says. “But how that is practically applied is a big challenge for providers. Putting it into practice is difficult.”
While the sector has done some work to be ready for reablement, the cultural change will take time, as has been the case in the UK, says Dr Mackie. She says it will be particularly important for broad and strategic partnerships to be developed along with a skillset around motivational interviewing.
Translating into service
General manager of Benetas Home Care Jeremy McAuliffe says it is hard to argue against reablement and wellness, but translating it into services is another matter.
Mr McAuliffe highlights potential issues in the transition to the CHSP. “Wellness and reablement are pretty nicely packaged up in Victoria’s HACC model,” he says. “There has been a lot of debate about not wanting to lose what has been good and effective in HACC. It is important that we don’t lose what is already there.”
Cameron Holland, acting CEO and chief operating officer for retirement living at Australian Unity, points to its Remedy Health Care project, which is linked to its health insurance sector and has a focus on reablement.
The health coaching stems from the claims history of a client. Where there is a regular pattern of claims, a health coach contacts the client to see if some assistance can be provided as part of their insurance. For example, if someone has a diabetic history, the insurers might organise a dietician or a physiotherapist to visit.
Mr Holland says that Australian Unity will continue to focus on reablement as part of its research into ageing issues.
“There is still a bit of work to do around reablement,” he adds.
This article first appeared in the January 2015 Community Care Review.