Background and Aims
There is a growing need for effective models of care to maintain independence, quality of life and well being in an ageing population. Major reforms in the delivery of home care services will also result in an increased demand for approaches that supports ageing in place. Reablement approaches have been identified and recommended by the Royal Commission into Aged Care Quality and Safety to address this need. Allied health is integral in the provision of reablement services in residential aged care however, poor access and a lack of minimum standards limit the opportunity to achieve functional and quality of life benefits associated with reablement approaches. Well-defined models of care that incorporate a multidisciplinary allied health team and reablement principles are scarce. This project aimed to implement and evaluate an evidence-informed, reablement program to meet this gap.
The study objective was to determine the feasibility of a novel multidisciplinary allied health reablement model of care for older people living in residential aged care and community settings.
Study Aims
- Develop and implement a novel multidisciplinary allied health reablement model of care tailored to the needs of older people in both residential aged care and community setting.
- Explore the acceptability, feasibility and experience of participants and therapists involved.
- Describe outcomes including frailty, physical function and quality of life for older people before and after participating in the model of care.
What We Did
A mixed methods study was conducted to determine the effect of a novel multidisciplinary reablement model of care on frailty, physical function and quality of life of older adults based in residential aged care and community. Acceptability and feasibility of the model of care were also explored. A total of 57 participants consented to participate in the program, and 50 participants completed the program. Participants accessed a 12-week multidisciplinary intervention that included physiotherapy, occupational therapy, speech therapy and services from an allied health assistant, all led by a reablement coordinator.
Outcomes
Key finding from the study was that the multidisciplinary allied health reablement model of care was feasible. The withdrawal rate from the program was 12%, and the low number of adverse events and high attendance rate demonstrate that the model was safe and acceptable. Other outcomes include clinically significant improvement in physical function but no changes in frailty and quality of life. Participants reported meaningful change in their self-reported satisfaction and in occupational performance. Programs delivered were perceived to be occupation focused and facilitated engagement in meaningful activities by participants and their families. Therapists highlighted the integral role of a multidisciplinary approach in delivering positive outcomes compared to usual care and reported a renewed sense of professional satisfaction.
There were challenges delivering the program. Integrating reablement principles and practices are often different to usual care. This was challenging at times to deliver in systems that were not set up for these types of services. Participants and therapists had concerns about maintaining the positive outcomes of the project when it was completed. Therapists reported challenges around the flexibility of delivering some of the services as required.
Impact on Aged Care and Workforce
In Australia, the median minutes people living in residential aged care can expect from allied health is 4.05 minutes per resident per day. The program provided a median of 17 minutes per resident per day and achieving four times above the current allied health minutes being delivered. The project demonstrated acceptability and appropriateness for a highly frail and medically complex population within a residential aged care setting. Results from the project would lend itself to support further development and evidence base for multidisciplinary allied health support in residential aged care.
Resources Developed
This project was registered as a Clinical Trial and the methodology is available for replication for any aged care service provider and provider of allied health services.
See: Clinical Trial Protocol registered 12/1/24 [ACTRN12623000915651]: Implementing an allied health reablement program in the community and in residential aged care. Available from https://www.anzctr.org.au/
A summary of the intervention guide can also be made available from the Chief Investigators and study findings will be published in a peer review journal. For further information contact: angeline.violi@concentric.com.au
Next Steps
The findings from the program will be utilised for quality improvement purposes across all services that Concentric currently delivers within the aged care sector.
