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WHEN IT COMEs to rehabilitation
programs in the community, Victoria has
had something of a pioneering role in the
While community rehabilitation services
have still been predominantly administered
via the acute sector, there have been
a number of innovative and effective
programs developed and implemented at
the regional health service level.
Dr Briony Dow, director of the health
promotion division of NARI -- National
Ageing Research Institute -- has had a
long-standing interest in this area and has studied and published
on the benefits of different home-based rehabilitation models.
With a social work background, she ran a successful state
government funded, community-based rehabilitation program
for older people in the Ballarat Health Service, in the late 1990s
working with the innovative pioneers, the geriatrician, Dr John
Hurley and physiotherapist, the late Doreen Bauers. She says,
while it was most common for people to enter the program
following an event such as a hip replacement or a stroke, a
hospital admission wasn't a precondition for receiving the service.
"It was a bit different to other 'rehab in the home' programs
because a person could be referred to the service without having
experienced a major health incident - just because it was noticed
that they were deteriorating and needed some assistance.
"A GP could refer someone directly to the program and
we would bring in the interdisciplinary team and assess them
in their home and look at what assistance they might need
to prevent further decline or make them safer in their daily
activities or whatever they needed, all within a short, sharp
period of about four to six weeks."
CASE IN POINT
Dr Dow says a good example of the program was an
elderly male client who was referred to them by the GP, who
was concerned about his lack of family support and his
"We looked at his home and his health problems and the
things he was doing day to day where he was at most risk," she
says. "He wasn't cooking meals for himself any more and he was
going down to the pub for lunch each day. But he was having
some mobility difficulties and the journey was quite unsafe.
"So we got someone to walk down to the pub with him and
work out the problem areas and how he could negotiate them.
And we gave him a walking stick and showed him how to use it
to help him to get there safely.
"Another thing we identified was that his shoes were unsafe,
so we helped him to buy new shoes that were a better fit and
more comfortable. There were also some problems with the
way he was putting the rubbish bin out each week and the real
risk that next week or the week after, the thing would come
crashing down on him."
Dr Dow says they were able to arrange for a neighbour to
take the bin out for him each week and they introduced some
strength training exercises and a personal safety alarm that he
could use if he needed help.
"The approach involved social work, physio, OT, podiatry
and an allied health assistant who would work with each client
around completing specific functional tasks or orientation tasks
that were important to that client.
"A lot of it was aimed at just preventing problems from
arising. Older people can get very frightened of going to
hospital, and worry that they'll end up in a nursing home. That
man had refused to go to hospital, and didn't have to go at all.
And as far as I know, he never needed to!"
Dr Briony Dow
acute care beds so you still
need to have had an acute
episode and a hospital
admission to qualify."
Prof Poulos is currently
developing new models
reablement service provision.
"Programs need to be time
limited and targeted to those
people who are likely to
benefit; and we also need to
make sure that the outcomes
are measured so we know
what works," he says.
"We need to trial and
evaluate some innovative
service models across a
number of sites, including
regional and rural areas. The
models need to explore not
only how best to provide
the rehabilitation care,
but also how much it costs
and how we can bring the
workforce together. The
aim is to develop a robust,
model of community-based
reablement and rehabilitation
where the outcomes can
be demonstrated to be
worthwhile for both the
consumer and the health
and aged care system. n
"If there is no funding
rehabilitation then we
won't establish a workforce
for those services; but the
workforce will appear if the
funding is there."
62 | MARCH -- APRIL 2012 | AAA
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