Understanding Terminology
These three approaches aim to help older adults maintain the highest levels of function and recover from injuries and illness. This promotes a high quality of life by enabling by allowing people to continue to live independently, engaging socially and participating in the activities that bring them enjoyment.
Although the meanings of these three terms differ, all can be considered short-term, intensive, and individualised programs designed to help older people regain or maintain their physical function.
Rehabilitation
The term ‘rehabilitation’ has various meanings across health care disciplines and professional groups. A recent study identified 187 definitions of the term with different understandings of what rehabilitation involved, as well as who provided it, and who received it.
On an international level, the World Health Organisation (WHO) defines rehabilitation as ‘a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment.’
Reablement
Australia’s Aged Care Quality and Safety Commission defines reablement as ‘a consumer-directed process to support restoration of function or adapt to some loss of day-to-day function and regain confidence and capacity for daily activities. It may promote consumer independence, capacity, or social and community connections. Supports could include training in a new skill, modification to a consumer’s home environment or having access to equipment or assistive technology.’ (Aged Care Quality and Safety Commission)
Restorative Care
In the Australian aged care context, restorative care is a form of flexible care ‘aimed at reversing and/or slowing functional decline in older people through the provision of a package of care and services designed for the individual.’ (Section 106A of the Subsidy Principles 2014 made under section 96 1 of the Aged Care Act 1997)
The overarching principles of rehabilitation
The WHO provides the following overarching principles of rehabilitation.
- Rehabilitation contributes to the provision of comprehensive person-centred care.
- Rehabilitation services are relevant along the continuum of care.
- Rehabilitation is part of universal health coverage; efforts should therefore be made to increase the quality, accessibility, and affordability of services.
- Policies and interventions are required to address the scope and intensity of needs for rehabilitation services in various population groups and geographical areas so that high-quality rehabilitation services are accessible and affordable to everyone who needs them.
These principles have been adapted to suit specific populations such as adults with mental health conditions. However, how we use these principles to support rehabilitation in aged care is less clear.
Rehabilitation and Australian aged care
While rehabilitation is an approach that could improve the lives of those receiving aged care services, structural issues with funding and barriers to access for older adults living in residential facilities can be problematic. Allocative approaches can highlight constructs such as ‘dependency’ and ‘deficit’ to access and justify the need for funding. [1] Given the Department of Health’s guidelines for aged care homes state that providers cannot charge a resident for rehabilitative programs or assessments (Item 2.6. Rehabilitation support) [2], this can lead to uncertainty about whether older adults residing in residential care services are entitled to receive rehabilitation following acute injuries such as hip fractures. [3]
Currently, community aged care service users appear more likely to receive proactive rehabilitation than those living in residential care facilities. In the homecare context, the Australian Government provides financial subsidies for older Australians to access restorative care and reablement services through the Short-Term Restorative Care (STRC) Program and requires Commonwealth Home Support Programme (CHSP) services to embed wellness and reablement services into their organisation to remain eligible for government funding.
The Expert Advisory Group working with the Hub has suggested a series of issues that could require further exploration in developing resources for this priority topic. These included:
- Examining the availability of multidisciplinary rehabilitation services across all aged care services, regardless of the setting
- Addressing the role of allied health professionals in delivering rehabilitation services. It was noted that only two per cent of Home Care Package funding has been spent on allied health services. [4]
- Reviewing the training and contribution of nurses and carers to providing rehabilitative care. [5]
Knowledge and Implementation project team is currently completing a scoping review which will examine some of these issues more fully.