industry & reform
Reablement returns
Reablement is the best aged care
policy no one ever heard of.
By Michael Fine*
S
ometimes the best ideas are so
obvious no one seems to pay
attention to them.
Reablement is such a clever idea that
it seems almost unnecessary to have a
specialised word in aged care for it. Yet it
may be a case in which linguistic confusion
has long compounded the problem of
invisibility and ignorance, even confounding
would-be advocates of the idea.
For a start, ‘reablement’ is not a word
found in many dictionaries. It cannot be
found in either the Collins or Macquarie
dictionaries, for example. Searching online,
I have learned that it is recorded in the
Oxford dictionary, where its first reported
use was in The Lancet in the 1940s. Its
meaning there is given as ‘rehabilitation;
frequently attributive’. A great word for
Scrabble, but hardly a candidate for the
most popular word of the year.
But knowing the dictionary meaning of
the term is not enough. Welcome to the
world of evidence-based policy in Australia.
Like climate change, the more evidence
has accrued, the more the approach seems
to have been ignored by our policymakers.
In many European countries, the
approach had been in use in various ways
for decades before it was recognised in
the English-speaking world. The efficacy
of the enablement approach in aged care
was clinically demonstrated in Britain
in the 1990s and it quickly spread to
New Zealand and Australia.
10 agedcareinsite.com.au
It first began to be adopted in Australia
after it was implemented by Silver Chain
in Western Australia from as early as 2000
following the work of Professor Gill Lewin.
It has been called ‘reablement’ in that state
for many years. But as the approach began
to spread across Australia, the term seems
to have been lost in translation.
In Victoria, it became referred to as
the ‘wellness’ approach. In NSW, it was
described as ‘restorative care’ or the
‘restorative approach’. In both states, the
principle soon became a key philosophy
informing the way support was provided
to people at home through the Home and
Community Care (HACC) program.
The brilliant idea was never taken up in
the home care packages. Nor did it make it
to residential care – despite the fact that a
number of the most progressive providers
have adopted key elements of the approach,
such as ‘geri-gym’ sessions, activity and
fitness programs, and the seniors gym
program offered by Uniting Care.
But while the approach was central
to the HACC program for a few years, it
was soon forgotten as reform focused
on marketisation and choice. When
services are intended to provide what
consumers want, the emphasis was soon
placed on ‘consumer choice’. And when
funding moves from block funding to a
fee-for-service principle, a philosophy of
preventive health and empowerment no
longer seems so attractive to providers.
If the term is confusing and unknown,
the idea is refreshingly clear. Put simply,
it is a rejection of the old assumption that
ageing is an irreversible and inevitable
process of physical and mental decline.
Because most people, including older
people, are at less than optimal fitness,
there is considerable scope to improve
quality of life by improving fitness.
Simple, targeted, repetitive exercise
can help – starting with the now-classic
exercise of repeatedly standing up and
sitting down at the table.
An enabling approach can go well
beyond this, extending to a wide range of
other activities – promoting fitness and
mobility, supporting social engagement,
developing creative engagement and
fostering self-care skills such as cooking for
those men who have never learned before.
Instead of promoting dependence,
care and support can be provided in a
more liberating manner that will enhance
a person’s independence and help them
maintain, rather than lose, existing abilities.
Done in the right way, this is a win for older
people and for the services they depend
on, freeing up resources for those whose
dependence on help is reduced or contained.
Certainly, many older people experience
health declines before they are first
accepted into community care. But once
necessary medical attention has been
provided, life can and should get better for
most older people. Enablement supports
and facilitates this improvement. For
others, an enabling approach can help
maintain existing abilities and prevent or
delay any decline.
Staff training of all personnel is essential
– this is not something that can be left to
a handful of specialised physiotherapists
or targeted at just a few select consumers.
Assessment also needs to play a part,
and all assessors need to understand the
concept and ensure that the right sorts of
support can be used.
There are some hopeful signs of a
reawakening of interest in reablement
among policymakers for those who receive
at-home support services. Amazingly, there
is even some additional funding identified in
the 2018–19 Commonwealth budget: a total
of $29.2 million over two years.
This is hardly enough when less than
$15 million is spread across about 800,000
consumers who use the Commonwealth
Home Support Programme each year.
And there is nothing for the home care
packages or residential care. But at least it
is a new beginning.
Perhaps, soon, everyone will at least get
to learn the meaning of reablement. ■
Professor Michael Fine is honorary professor
in sociology at Macquarie University.
* I contributed to a pre-conference workshop
on ‘Evidence-based Reablement Approaches
Across Aged Care Services’ at the Australian
Association of Gerontology’s Annual Conference
in Melbourne on 20 November 2018. I wish
to acknowledge here the contribution of
other speakers, workshop participants and
the facilitator, Dr Sandra South of the AAG.