With all the focus on pensions in the recent Federal Budget reporting, you may have missed an important new measure that was introduced which at least one large aged care service provider has described as “bringing transformational change to the lives of older Australians.”
HammondCare Chief Executive, Dr Stephen Judd was referring to the introduction for the first time of short-term ‘restorative care’ places into the Government’s aged care planning ratios.
The ‘aged care planning ratio’ is the framework the Government uses to ensure that an appropriate amount of aged care ‘places’ are funded across Australia to meet demand.
The current goal for provision of places, to be achieved by 2021-2022, has been 125 residential and home care places for every 1,000 people aged 70 years or over. Of these 125 places, there is a ratio of 80 places in a residential setting and 45 places in a home care setting.
In the budget, the Government announced it will be tweaking that ratio to include two formal ‘restorative care’ places. The new ratio means that out of the 125 places, two places will be specifically for restorative care, 78 for residential care places (two less) while home care places remain at 45.
Why will this bring ‘transformational change’ to the lives of older Australians? Well, Dr Judd says it means that “permanent residential aged care placement is no longer inevitable as a result of gradual functional decline.”
Instead, he says, “these new places provide an opportunity for older Australians to get back to the home of their choice for longer.”
It’s not surprising that HammondCare, a specialist health and aged services provider in NSW and Victoria, has welcomed the announcement. It is an organisation which has advocated for rehabilitation and restorative services, as well as palliative care and dementia services, for many years. They co-sponsor a Chair of Positive Ageing at the University of NSW, a rehabilitation specialist, and have made restorative care a key component of their services.
A new approach
If you were paying attention when you read my story last week about changes to the home care system due to kick in from 1 July, you will know that there is a whole new philosophical framework coming in around home care services in Australia. It’s being called a ‘wellness and reablement’ approach and it can be described as a deliberate shift away from the idea of largely providing services that help by ‘taking over’ functions for older people who have had some sort of debilitating set-back like a fall or surgery.
Rather, the approach is to understand what might be needed in order for the person to regain lost functions and resume their independence and then providing intensive, short term rehabilitation or other support that aims to get them back to that point, ideally back at home.
An increased focus on wellness and prevention, including an emphasis on ‘assistive technology’, equipment and home modifications is likewise part of the approach.
Good for government coffers
It might be tempting for some cynics to think of these things as fashions in policy or even a fancy way of governments avoiding paying the greater costs of ongoing home care or residential care. Actually, it is fair to say that helping more people to regain independence and get back home will help to reduce pressure on the long term health and aged care budgets for all future governments.
As the Productivity Commission reported in its seminal inquiry of 2011, Caring for Older Australians (page 82):
“An aged care system with a focus on promoting wellness, active ageing and enhancing the independence of people in later life might not only enhance the wellbeing of older people, but could also be effective in reducing demand for more expensive and ongoing services (box 4.2). There is emerging evidence that timely intervention, restorative home support, education and assistive technologies can improve quality of life and the functional status of older people, and reduce costs because of a reduction in the ongoing use of home care services (Ryburn et al.2009).”
To put a figure on it, one study in Western Australia found that, “individuals who had received a reablement service were less likely to use a personal care service throughout their follow-up period – or any other type of home care over the next 3 years.” It led to a reduction of home care services “associated with median cost savings per person of approximately AU $12,500 over nearly 5 years.”
Good for people
While it makes sense that a restorative approach is good for the public purse, it happens that this comes as a by-product (if not an unintended consequence)of good policy for people.
Most of us don’t want to have our choices limited to either a move to an aged care home; or a tenuous future at home relying on home care staff to do basic things like help us to shower or get dressed. If there is a chance of regaining our old life after a setback, most of us would at least like to have the opportunity to take it.
The peak body representing older people, COTA Australia, has consistently argued that older people “should not be pushed from the hospital system to residential care without considering their capacity and their desire to regain function and return home with appropriate support.”
Of course, in the context of that other ‘reform’ of ‘consumer directed care’, the options for how you might regain independence and who you have involved in the process, have become much wider.
HammondCare’s Chair of Positive Ageing, A/Prof Chris Poulos, says he is particularly excited about the new form of short-term restorative care “because it addresses an important unmet need.”
“Currently the only way older people can access comprehensive restorative care is through the transition care program, but this requires a hospital admission first. This meant that the large number of older people who experience functional decline gradually, and don’t go to hospital, miss out,” said Prof Poulos.
“This new program, for which we have advocated over many years, opens up new possibilities for supporting older people to reduce or reverse decline in function, allowing them to live in the home of their choice for longer.”
A win-win
In my book, this measure is a good one. It’s one of those hard-working policy measures that has benefits all round. That same WA study looking at the savings measures associated with restorative care concluded:
“The inclusion of reablement as the starting point for individuals referred for home care within Australia’s reformed aged care system could increase the system’s cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age,” it concluded.
Presactly! It’s early days and it won’t change the world but it’s definitely a step in the right direction. Even a win-win, don’t you think?
