Understanding terminology
Rehabilitation, reablement and restorative care approaches aim to support older adults to maintain their levels of physical and cognitive function and often assist in recovery from injuries and illness. These approaches promote older adults to a high quality of life by enabling people to continue living independently and participate in enjoyable social and physical activities.
Although the meanings of these three terms differ, rehabilitation, reablement and restorative care can all be considered short-term, intensive, and individualised programs designed to help older people regain or maintain their physical and cognitive function.
Rehabilitation
The term ‘rehabilitation’ has various meanings across healthcare disciplines and professional groups. Arienti and colleagues [1] identified 187 definitions of the term with different understandings of what rehabilitation involved, as well as who provided it and received it.
On an international level, the World Health Organization (WHO) defines rehabilitation as ‘a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment.’ [2] This can involve a problem-solving approach tailored to each person’s priorities, needs and goals. [3]
Allied Health Professions Australia provides a more holistic definition of rehabilitation:
Rehabilitation has a whole of person approach that aims to achieve the highest possible level of function, maximise quality of life and minimise the need for ongoing health and community support. Rehabilitation aims to restore function across physical, psychological, social, and vocational domains. Allied health professionals play essential roles in delivering cost-effective rehabilitation services. [4]
More recently, the World Health Organization has called for rehabilitation to be integrated into palliative care services where it can help people with life-limiting, incurable conditions to enjoy the best quality of life until the end of life. [5]
Reablement
Australia’s Aged Care Quality and Safety Commission defines reablement as a goal-oriented ‘… process directed by the older person to support restoration of function or adapt to some loss of day-to-day function and regain confidence and capacity for daily activities. It may promote independence, capacity or social and community connections.’ [6, p57] Staff who adopt a reablement approach to care work with people to help them regain the skills they need for everyday living or develop compensatory strategies to do what they want to do. Reablement may therefore involve learning new skills, making changes to the home, or adopting aids or new technologies to perform tasks independently. [7]
A reablement approach to aged care is emphasised in the Revised Aged Care Quality Standards (Standards 3 and 5). [6] It is also a core responsibility of Commonwealth Home Support Programmes. Home care staff working for these programs are required to move away from doing things for people or taking over tasks they can do for themselves. Instead, staff should build on what people can do to help them regain confidence and independence. [8]
Restorative care
The purpose of restorative care is to reduce or delay a person’s need for residential care or reliance on home care services. In Australia, restorative care programs are usually short-term and less intensive, costly, and complex than rehabilitation programs. While directed by allied health professionals and nurses, they often include other staff and family and take place in the community. [9]
The Australian Government’s Short-Term Restorative Care Programme is of eight weeks duration and excludes people in permanent residential care or receiving a home care package. Although people in residential aged care cannot access this program, the program can be delivered in a residential aged care facility. [10]
The overarching principles of rehabilitation
WHO provides the following overarching principles of rehabilitation within health systems:
- Rehabilitation contributes to the provision of comprehensive person-centred care.
- Rehabilitation services are relevant along the continuum of care.
- Rehabilitation is part of universal health coverage; efforts should therefore be made to increase the quality, accessibility, and affordability of services.
- Policies and interventions are required to address the scope and intensity of needs for rehabilitation services in various population groups and geographical areas so that high-quality rehabilitation services are accessible and affordable to everyone who needs them. [11]
These principles have been adapted to suit specific populations such as adults with mental health conditions. However, how we use these principles to support rehabilitation in aged care is less clear.
Rehabilitation and Australian aged care
While rehabilitation is an approach that could improve the lives of those receiving aged care services, structural issues with funding and barriers to access for older adults living in residential facilities can be problematic. Allocative approaches can highlight constructs such as ‘dependency’ and ‘deficit’ to access and justify the need for funding. [12] Given the Department of Health and Aged Care’s guidelines for aged care homes state that providers cannot charge a resident for rehabilitative programs or assessments (Item 2.6. Rehabilitation support) [12], this can lead to uncertainty about whether older adults residing in residential care services are entitled to receive rehabilitation following acute injuries such as hip fractures. [13]
Currently, community aged care service users appear more likely to receive proactive rehabilitation than those living in residential care facilities. In the homecare context, the Australian Government provides financial subsidies for older Australians to access restorative care and reablement services through the Short-Term Restorative Care (STRC) Program and requires Commonwealth Home Support Programme (CHSP) services to embed wellness and reablement services into their organisation to remain eligible for government funding.
- Examining the availability of multidisciplinary rehabilitation services across all aged care services, regardless of the setting. The Royal Commission into Aged Care Quality and Safety highlighted the inadequate levels of subacute rehabilitation following major injury or illness received by older people, particularly those living in an aged care facility. [14]
- Addressing the roles of allied health professionals in delivering rehabilitation and reablement and improving access to their services.
- Reviewing the training and contribution of nurses and carers to providing these forms of care.