I commend the Australian Government and the Aged Care Quality and Safety Commission on the revision of the Aged Care Quality Standards. An increased focus on guiding older consumers into better health pathways through supported reablement and activities to enhance independence not only aligns directly with current evidence, but also offers an equitable alternative to decline.
In addition, the new strengthened standards positively acknowledged the Royal Commission into Aged Care Quality and Safety recommendation 36 – to include allied health care into all home care services and the irrefutable evidence that adults are never too old, too sick or too disabled to benefit from allied health and reablement.
Embracing this evidence will not just enhance the physical and mental wellbeing of the consumer, but it will also reduce provider staff and service stress, and support providers to address eight of the 11 quality indicators.
Historically, the aged care sector has been challenged by incorporating allied health into aged care services. As shown by the Australian Institute of Health and Welfare, less than 10 per cent of older adults are engaged in health modifying physical activity at or above the national guidelines, with approximately 60 per cent doing less than 10 minutes per day.
My fear is that providers will have a box to tick that says reablement and wellness was offered but declined
Provider service delivery data suggest the aged care sector has also facilitated low participation, prioritising care – domestic and personal – over allied health, which allows wellbeing to decline and provides a pathway to dependency.
This extends to the residential aged care space where on one hand the government has supported Dr Jennie Hewitt’s Sunbeam project that reports significant reduction in individual and repeated falls when residents undertake twice weekly allied health guided resistance exercise. On the other hand its move to the AN-ACC funding model has eliminated allied health hours and the provision of activity to counter falls, pain and decline.
The strengthening of the quality standards reinforces the importance of consumer independence, reablement, physical and mental wellbeing and evidence-based practice, and aligns these with multiple government directives acknowledging the aged care consumers’ right to better health and wellbeing.
With the evidence for older adult reablement nearly 50 years old, this unique stance to promote wellbeing and not just “normal care” is commendable. However, if this is truly the intention, the guidance material needs to be strengthened to steer providers towards this goal.
In the version released for comment several months back, numerous loopholes exist where providers would not have to offer reablement based on the “preferences” of the consumer.
As an example, in standard three a guiding action is: “The provider delivers care and services in a way that optimises the older person’s quality of life, reablement and maintenance of function, where this is consistent with their [the older person’s] preferences.”
My fear is that providers will have a box to tick that says reablement and wellness was offered but declined. Moreover, in the revised quality standards – which enforce the participation of the consumer in their care planning and strengthens their position in their care and services – is this last statement even necessary?
Equally concerning is that if providers can side-step their commitment to reablement services they will not be encouraged to take the consumer on a health literacy journey to better understand their health and wellbeing potential. Thereby denying the consumer the opportunity to push back on disability and instead facilitating their deterioration, loss of dignity and independence.
The removal of this statement is critical if the government is truly ready to embrace reablement evidence and break the care, decline, dependency aged care service planning cycle.
With most providers staffed to support care, it is acknowledged increasing reablement staff and services will come with its challenges. Adding to this, service delivery barriers include:
- the shortage of qualified, experienced allied health and therapy staff wanting to work in aged care
- organisational knowledge
- low health literacy among care staff to identify clients with reablement needs and have informative, encouraging conversations with them that guide them towards health modifying services.
These barriers can be overcome, but aged care boards and executives must embrace the evidence and guide their organisations away from just care and towards services with positive physical, social and mental health benefits for their clients.
For the government, with new quality standards, a new Aged Care Act and community reform coming soon, and the influx of the baby boomers into the sector, there is no better time to embrace reablement.
Or, looking at it from another perspective, with deleterious health escalating and local health systems at breaking point, and no new residential aged care beds on the horizon, if we don’t embrace reablement soon we will face a national community aged care health crisis.
It is well established that consumers fear falls, and their loss of function, dignity and independence. The most recognised goal of a community-dwelling aged care service consumer is they just want to be able to stay in their own home.
For the government, extending the length of stay in the community among aged care consumers has significant financial benefits, not to mention the health system implication of reduced general practice and hospital presentation.
The research evidence is irrefutable that decline can be prevented and rehabilitated and consumers can be healthier. For too long aged care providers have been held accountable on good care, but not necessarily on good health.
The Australian Government and the Aged Care Quality and Safety Commission are in the unique position to embrace evidence and its translation to practise by guiding the aged care sector towards a preventative, reablement model of care. While the quality standards suggest an improved provision of reablement and wellness care, if the Australian Government and the Aged Care Quality and Safety Commission are truly investing in this sector change the Quality Standards Guidance Material must be strengthened to facilitate this.
Specific to the allied health staff challenge, the NDIS supplies a parallel example, showing that when the market exists staff will be drawn into the space. This will drive universities in partnership with discipline accrediting bodies to modify their curriculums to educate aged care as a rewarding career pathway.
The Aged Care Taskforce Report also recognised allied health as a priority service to be included in the coming reform, but that as a non-priority service within a thin-market that it would require government support to deliver to its potential.
This was reinforced by the final report on the Integrated Assessment Tool, which talked to the assessors’ need for allied health expertise and scope of practice education, where better understanding at the referral level would not only move the client towards reablement, but could also raise their understanding of why this referral was being made.
Staff must be educated about the alternatives to decline, social isolation and unmanaged chronic disease
Also essential is modifying the health literacy of consumers and their representatives.
Under the current model, providers only offer and families only expect supported care. So going forward, consumers will continue to decline into dependence.
Staff must be educated about the alternatives to decline, social isolation and unmanaged chronic disease.
The new quality standards talk about evidence-based practice. However, if this evidence is to make it into consumer conversations, boards and organisations must be guided to disseminate it through an absorbable means to care staff.
As the primary contact to the consumer, care staff would then communicate the link between reablement and independence, falls prevention and the dignity of being able to stand up from the toilet.
Dr Tim Henwood is principal consultant at AgeFIT solutions and an exercise physiologist whose PhD research focused on resistance training for older adults
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