industry & reform
“ All older people should receive restorative and reablement care to ensure they can live their best lives for as long as possible .
Restore and reable
Older people are in danger of receiving the cheapest , not the best , care .
By Scott Willis
Harrowing stories of neglect and abuse shone a much-needed spotlight on the aged care sector and led to the landmark Royal Commission into Aged Care Quality and Safety . These stories were powerful and easily understood .
Less easy to understand are two words that the Royal Commission identified as critical to improving the quality of life of older Australians – restorative and reablement . Yet these two words mean the difference between someone living and dying , being bedbound or walking .
Restorative care refers to the type of care delivered to address a sudden decline in health or an injury . An example of this type of care is post-operative rehabilitation , without which older people are too often left with avoidable disabilities and pain .
Reablement , as defined by the Australian Association of Gerontology , challenges the belief that physical and mental declines are irreversible and unavoidable as we age .
In fact , certain exercises and activities can help older people to maintain – and in some cases even regain – their coordination , strength , cognition and balance . Without this type of care , older people are more likely to fall , which is the leading cause of preventable death among their cohort .
The Royal Commission stated : “ The aged care system should help people to maintain independence , and the funding arrangements for residential aged care should be aligned with this goal . We recommend funding incentives for providers to invest in restorative care and reablement .”
Promoting and maintaining mobility and reducing the risk of life-threatening falls in older people was noted as critical in the final report , which found that access to physiotherapists , who are highly trained and skilled in strength , balance and mobility training , was often lacking in aged care .
Research has shown that physiotherapy can reduce falls by 55 per cent , the number one cause of preventable death in older people , and save the taxpayer money by avoiding costly surgeries and hospitalisations . It also spares older people the debilitating and excruciating injuries and recovery periods of preventable falls that are caused by lack of balance , coordination and strength .
Despite its headline-grabbing investment in aged care , the Australian Government has failed to address critical Royal
Commission recommendations to ensure provision of allied health services , such as physiotherapy , that would help older people in residential aged care live more independently .
The government has adopted the new residential aged care funding model , the Australian National Aged Care Classification ( AN-ACC ) which , positively , does not incentivise illness as the current Aged Care Funding Instrument ( ACFI ) does .
However , the AN-ACC fails to include specific funding for allied health such as physiotherapy . Without specific funding for critical physiotherapy services , older people are in danger of receiving the cheapest , not the best , care .
The ACFI directly funds residential aged care facilities to contract physiotherapists to deliver pain management for up to 80 per cent of residents . The new funding tool will no longer provide payment for pain management and is expecting aged care providers to pay for physiotherapy out of their profits . Currently only 1 per cent of residents receive a reablement or restorative physiotherapy program .
There is a temporary program adopted by the Federal Government and currently being rolled out in a number of COVIDaffected residential aged care facilitates across the country that has been based on the work of physiotherapist Dr Jennifer Hewitt .
Recognising the effectiveness of this type of program in residential aged care is an important first step , but this program is only temporary . Permanent programs need to be rolled out in response to the Royal Commission ’ s final report .
All older people should receive restorative and reablement care whether at home or in residential care to ensure they can live their best lives as long as possible . We are calling on the government to introduce an additional layer of funding to enable this , particularly in residential aged care where it is most needed . ■
Scott Willis is the Australian Physiotherapy Association national president
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