The value of allied health and exercise therapies in residential aged care
The Royal commission on aged care investigated the quality of aged care services in Australia to define if the services provided met the needs of the community, and also looked in the pathways to improved services, leading into recommendations to government on required changes.
The final report was delivered three years ago, in February 2021, with 148 recommendations for the reform of aged care.
The royal commission stated that despite the important role of allied health to older people's health and wellbeing, allied health was significantly underprovided and underfunded – particularly in residential aged care.
Royal commission highlighted the role of active, patient centred care. One key aspect was the change of the funding model to Australian National Aged Care Classification, AN-ACC, a tool that focuses on individual needs and allows for therapist-directed care based on sound clinical reasoning.
When AN-ACC was introduced, the Australian Government Department of Health stated,
“Providers are required under legislation to make available allied health services to residents who need them.”
Despite the positive ideas behind the model, the lack of defined care minutes has led to worse care, as reported late last year by Australian Ageing Agenda. A report by Mirus Australia stated that the allied health care minutes had decreased by 50% in one month only (October 2023), leaving aged care residents to receive 4.11 minutes of allied health services per day.
Allied Health Professionals Australia (AHPA) survey collected in September-October 2023 from 218 respondents showed a significant change in the workforce – 56% stated that their roles had changed since the introduction of AN-ACC ; 18 % had lost their role completely, 19 % had been redeployed, 48 % had their hours decreased, and 25 % had increased referrals.
Even with the many issues and the apparent lack of supported services in the middle of the change process, many residential aged care facilities have kept up their programs, and continued providing appropriate allied health services that play an important role in maintaining health and wellness for every resident.
Below are some great examples.
Riverview Lutheran Rest Home Inc, is a not-for-profit 60-bed residential aged care facility in Loxton, South Australia. The facility includes aged care beds, a purpose-built specialised Memory Support Unit, as well as Independent Living Units and Serviced Apartments.
The CEO of Riverview, Nicolle Jachmann, is leading the facility using a total wellbeing model. The site has been refurbished with the vision of supporting every resident towards their best health and wellness, supported by allied health and lifestyle teams. The refurbishment includes an open multipurpose wellness space, also including a kitchen for all residents to use, and outdoor areas.
The purpose and vision for the site is to provide every resident with a sense of purpose, and something to look forward to. This is supported by the lifestyle team that is on site daily, to deliver a variety of activities that enhance the residents’ physical health, mental wellbeing and social engagement.
The site also includes a gym fitted with HUR equipment, including a HUR Smart Balance with the freshly introduced Sunbeam module, developed together with the lead researcher of Sunbeam, Dr Jennie Hewitt. This site is the first globally to have this new edition as part of the program.
All staff were introduced to the gym, via a visit from HUR training staff. A physiotherapist from a local practice visits the site weekly and creates training programs for all residents, who can be further supported by allied health assistants and lifestyle staff.
When discussing health and wellness in residential care, the Sunbeam project should always be a consideration. Since the publication of the original protocol paper in 2018, the evidence based strength and balance training program has been rolled out in hundreds of aged care facilities.
With 55% of falls prevented, and physical ability increased, this protocol has changed the allied health practice. Dr Hewitt has been a guest speaker multiple times in our webinars, with the latest talk also including discussions on AN-ACC. You can find this webinar and other materials via this link.
Another site that was discussed in mainstream media recently was New Direction Care's Micro Town® in Bellmere, Queensland. This dementia friendly community includes shops, café, cinema, salon and a wellness centre. The CEO, Natasha Chadwick, has crated a space where all residents can live a happy and fulfilling life despite the diagnose.
Bellmere is built valuing individuality, community, relationships, respect and empathy. It is a place where people can stay active, pursue hobbies and play a role in the community, even while living with dementia.
Channel 7 aired recently a feature story from Bellmere:
The Australian Government released its final report of the aged care taskforce on Tuesday, March 12th. The report makes a few references to allied health: When discussing support at home it is stated that for clinical support “government contributions would be highest, and consumer co-contributions lowest (if any) for supports that are essential to prevent a decline in health” as well as for Independence – “, a middle tier would include items that may support independence and reablement”.
Whilst the role of allied health is not emphasized, the report also mentions “suggestions for a reablement model of care with specific funding for allied health care”.
Our latest webinar, with Dr Tim Henwood as a key note speaker, touched on the topics mentioned in that report, including a recent publication by Dr Henwood and his colleagues (Falland L et al, 2024). This publication discusses the results of the extremely successful restorative care programs of Southern Cross Care (SA, NT & VIC) Inc, whilst reflecting the program towards age care reform.
You can access this article here and all our latest webinar materials here: huraustralia.com.au/postwebinar9
The Lancet, Healthy Longevity recently published an article that summarised the effects of physical exercise on physical function in residential care (Valenzuela PL et al, 2023). This literature review concluded that all exercise types (balance, endurance, strength, multicomponent) had a significant benefit when compared to usual care. The most consistent beneficial effects were gained with around three hours of exercise per week. Also, exercise training had a significant effect on many physical function tests.
The current average of 4.11 minutes per day as reported in the Mirus Australia study, is far from 3 hours recommended by the study published in the Lancet. We can only be hopeful that others will model the successful stories of the facilities that embrace health and wellness in their offering. Quality of life belongs to everyone, everywhere. Work is being done, now we need more processes and actions to provide healthy ageing to all.
Dr Tuire Karaharju-Huisman
Physiotherapist, Accredited Exercise Physiologist (ESSAM), PhD (Biomechanics)
Research Lead, Area Account Manager (Vic, Tas, SA)
