Professor Lee-Fay Low

Faculty of Medicine and Health, University of Sydney

I am tremendously excited that ARIIA is offering research partnership grants to improve aged care in Australia. Unfortunately, at the moment it’s a really challenging time to be planning and undertaking research in aged care. I’ve been an aged care researcher for 20 years, and the conditions make it really, really difficult. Here are some of the problems that my teams have been facing. If you have solutions, please share them. Tweet @leefay_low and we can keep this conversation going.

COVID-19 was a huge disruption to research

 With ongoing workforce issues exacerbated by COVID-19, aged care organisations have had extremely limited bandwidth for research since 2020.  Many aged care research partner organisations have had markedly less capacity to participate and contribute, despite a strong commitment to the projects. We have paused or downsized projects because aged care staff could not help with our research. I personally feel like some projects have lost momentum in terms of showing efficacy or being ready to scale.

Current aged care reforms make rigorous relevant study design harder

At the time of writing, the new Aged Care Act is passing through Parliament. There will be major changes to the way that home and residential care is structured, funded and regulated, but policies and programs have not been finalised yet.

This means that some observational data we collect now might be less relevant after reforms (e.g., why do home care clients ‘save’ so much of their budget). It also means that long intervention studies (e.g., a 12-month staff practice change randomised trial rolled out over 2 years) might be confounded by system-wide changes. As we write our grants for funding for 2023 and beyond, it is trickier to design a potential impactful, competitive-for-funding project.

Implementation of aged care reforms will continue to occupy the aged care sector 

Implementation of aged care reforms will likely result in strategic changes in aged care organisation priorities. Executive teams and managers will be busy working to implement changes required by the reforms, and providers are likely to continue to have reduced bandwidth to collaborate on research over the next few years. We need to figure out how to reengage our aged care partners.

What can aged care researchers do?

In planning future grants, we’ve started to think about research that might be useful in terms of implementing or evaluating the reforms. We are also talking to aged care providers and policymakers about the research questions most of interest to them. We may need to budget in more support for aged care organisations if we want our research projects to be feasible.

We shouldn’t strive to conduct easier research projects; we should strive to conduct research projects which answer important real-world questions. I believe it is critical that right now we should be conducting research that answers questions about how to improve aged care.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.
 

Dr Claire Gough

Research Fellow, ARIIA, Flinders University

‘Rehabilitation, reablement, and restorative care’ were recently identified as high-priority issues by the Australian aged care industry. It was therefore surprising that Australian rehabilitative aged care resources were difficult to find. An initial review of the literature suggested that agreement on a single definition of rehabilitation is problematic and perhaps a contributing factor. The Australian Government Department of Health has stated that medical rehabilitation ‘involves the diagnosis, assessment, and management of disability due to illness or injury.’ [1] This definition varies significantly from the World Health Organisation’s (WHO) definition of rehabilitation as a set of interventions ‘designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment.’ [2]

In discussing this difference with our Expert Advisory Group (EAG), the issue of defining rehabilitation was considered more significant than a simple variation in terminology. It was perceived by the EAG that the disparity was also evident between professional bodies and therefore healthcare professionals who often work together closely in aged care. For example, physiotherapists and occupational therapists consider that rehabilitation should include optimising function and reduction in disability for individuals with health conditions. However, the applicability of definitions was particularly unclear in the context of aged care settings across Australia.

A more pertinent issue for Australian aged care is perhaps that service users residing in the community were much more likely to receive rehabilitation than those living in residential aged care facilities. At present, Australian aged care focuses on terms such as ‘dependency’ and ‘deficit’ to justify funding. Yet these terms can act as a disincentive to embed the rehabilitative approach of ‘progression’ and ‘improvement’ into aged care services. [3] Despite the Australian Government providing funding and subsidies for restorative care and reablement services, rehabilitation is funded by the Australian health care system. The issue, therefore, lies in the Australian Government’s ‘Care and services in aged care homes guidelines’ which emphasizes that aged care providers cannot charge a resident for rehabilitation programs or assessments (Item 2.6 Rehabilitation support). [4] This has prompted much debate as to whether older adults residing in residential care services are entitled to receive rehabilitation following acute injuries such as a hip fracture, [5] or whether this is viewed as ‘double dipping’ from multiple funders.

Despite the issues around defining what rehabilitation entails across varied settings and the issues around access and funding, the call for rehabilitation to be expanded throughout aged care services in Australia continues [5]. Integrating rehabilitation throughout aged care services therefore requires deeper consideration, exploration, and involvement from providers, service users and aged care advocates to inform change.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.