Home' Australian Ageing Agenda : AAA MAR-APL 2018 Contents “A
reinforcing dependence. It is first and foremost
about ensuring the environment is not disabling.
While many regard the concept of time-
limited reablement interventions focused on
physical training as having limited applicability
within residential settings, a reablement
approach more broadly has much to offer. As a
philosophical approach to care, it comprises:
• a positive view of ageing that focuses on
resources and capabilities rather than deficits
• a person-centred, goal-oriented approach
focusing on what matters to the individual
• an empowering approach that aims to maximise
both functioning and quality of life.
These principles are exemplified in Benetas’
new model of residential care being piloted,
emphasising resident choice and control in a
home-like environment that facilitates active,
meaningful engagement for clients.
Residents and their families are central to the
model, with other elements including the built
form and rostering designed around the person,
making it truly person-centred. The model uses
regular staff who have the personal attributes
and the training to empower residents to make
choices and be as independent as possible,
supporting good wellbeing.
The reablement approach means a holistic
approach to care, focusing broadly on
quality of life outcomes rather than narrowly
on management of health conditions and
impairments. In practice, this means working
with each resident to identify what matters most
to them – what is meaningful and fulfilling – and
supporting them to participate in these activities.
Active participation in decision-making is central
to the reablement approach – no matter how
small the decisions may seem. A sense of control
over when to get up and have breakfast, which
clothes to wear, can be a major contributor to
wellbeing and quality of life.
Providers need to support and empower
residents to exercise, and where necessar y,
develop their decision-making skills. While
families usually have the best intentions
about their relative’s safety and security
they can sometimes be over-protective and
disempowering. While providers must strive to
work collaboratively with families, their primar y
responsibility is to the wellbeing, and rights, of
residents. A reablement approach brings these
to the fore.
Challenges and opportunities
Last year the CEO of Access Care Network
Australia, Ricki Smith, told Australian Ageing
Agenda’s Active Ageing Conference that Australia
was well positioned to be a global leader on
Despite that, there are limitations in the sector
that are hindering the adoption of reablement.
The Tune Review recommended training for
assessors in wellness and reablement, and while
welcome this needs to be accompanied by a
raft of additional policy changes to support the
required shift in the sector.
These changes include modification of the
assessment framework, training for care delivery
staff as well as assessors, and broad education
about rights and responsibilities. Shifting the
mindset of both staff and clients from “doing
for” to “doing with” is a major challenge.
Perhaps the major barrier to wellbeing
and reablement approaches, however, is the
current funding model. The model is built
around funding specific tasks in response to
specific impairments and health conditions, and
per versely incentivises greater dependence. The
model proposed in the review of funding models
by the Australian Health Ser vices Research
Institute (AHSRI) incorporated wellness
into the base (fixed per capita) portion of the
payment, in line with its assumption that this is
“core business”. The key concern about this is
whether the base rate will be sufficient to fund
this approach to care. The ongoing Residential
Aged Care Resource Utilisation and Classification
study will need to inform government about the
true costs of reablement-based approaches to
care. Increased use of wellbeing and reablement
strategies will not happen unless a revised funding
model provides sufficient support and appropriate
incentives to do so.
Making way for a reablement paradigm
At Benetas we’re exploring ways to better
measure our clients’ quality of life, developing
our focus on the preferences and the rights of
our clients, trialling new models and engaging in
dialogue within our networks to collaboratively
work towards embracing a reablement paradigm.
Internationally, reablement inter ventions
have been applied widely, primarily in home
care ser vices. However, public discussion about
best practice in both home care and residential
aged care in Australia is increasingly focused on
wellness and reablement.
In order to satisfy these growing expectations,
the government must provide guidance on how
providers should be implementing a reablement
and wellbeing approach and remedy the barriers
inherent in the current system against its
implementation, particularly in residential care.
With this direction, aged care ser vices providers
can better deliver a positive, fulfilling experience
of ageing to older Australians. n
Paula Trood is general manager residential
services and quality and compliance and Dr
Catherine Joyce is research and innovation
manager at Benetas.
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