By Hilary O’Connell

Wellness and Reablement Lead, iLA.

The Australian population continues to increase in age and supporting older Australians to live well and have the best quality of life for as long as possible is a key government objective.

Ageing is a normal experience for everyone and affects people differently through their lifespan. Healthy ageing means different things to different people. To some it might mean living independently at home, for others, it means having the best possible physical and mental health or maintaining social connections with family, friends, and the wider community.

As we age, for some people, managing everyday activities of daily living can become compromised and support from the aged care system may be sought. At this stage, the response is often for services to be provided such as cleaning, personal care, social support, and meals to compensate for what a person is having difficulty doing as opposed to providing support to help a person retain or regain their capacity to manage, without that support.

Whilst ageing itself is inevitable, how we age according to the World Health Organisation (WHO) is prefaced by healthy behaviours throughout life. WHO defines healthy ageing as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’ and ‘creating the environments and opportunities that enable people to be and do what they value throughout their lives’. [1]

Importantly, WHO reiterates that being free of disease or infirmity is not a requirement for healthy ageing as many older adults have one or more health conditions that, when well controlled, have little influence on their wellbeing.

Maximising a person’s chance of ageing as well as possible

In the context of WHO’s definition of healthy ageing and the need to create the environments and opportunities that enable people to live and age well, how do we better support people to:

• move more/be physically active
• maintain a balanced diet
• be socially connected
• stay cognitively sharp
• maintain a sense of purpose and,
• have a positive attitude towards ageing.

And importantly for older Australians receiving support from the aged care system, how do we move away from predominantly task-based care delivery to supports that actively enable and maximise a person’s capacity, health and wellbeing?

Changing the discourse

The need to change the discourse within the aged care sector to one which has a preventative focus was identified in the 2021 Royal Commission into Aged Care Quality and Safety Final Report. The report referenced the need for a greater focus on healthy ageing and reablement, and a requirement for increased access to preventative care and early intervention to address risk factors that delay the need for aged care services. [2]

Additionally, the Australian Government’s Commonwealth Home Support Program requires service providers to deliver support within the context of a wellness, reablement or restorative care approach. This means providers need to focus on supporting older Australians to actively retain and/or regain their highest level of function, independence, and confidence to manage daily living activities and in so doing reduce their need for longer-term support.

Yet despite the plethora of information around how age-related decline can be minimised through reabling approaches, there continues to be an entrenched stereotype of individual ageing as an inevitable process of decline and degeneration over which we have little control. And worryingly a seeming lack of association between the abundance of information available about how to actively support people to retain and/or regain capacity and the delivery of aged care services.

Everyone should have access to the information and support they need

LiveUp is an initiative launched in 2022, to bridge this important interface between promoting healthy ageing behaviours and empowering older Australians to remain independent for longer. Developed by iLA with funding from the Australian Government Department of Health and Ageing, LiveUp is a free national healthy ageing platform designed to promote early intervention and delay the premature decline of a person’s capacity to live or function independently. The site, liveup.org.au, is a valuable resource not only for individuals but also for aged care providers and can help people take what could be seen as an investment approach to ageing, to help us think about what healthy ageing looks like and consider how we want to live our later years. With the knowledge that even small changes make a big difference.

LiveUp offers an online quiz, screening tool, and access to impartial information and personalised suggestions. The site encourages people to take action. This might include making a minor lifestyle modification to optimise their level of ability, commencing an exercise routine, self-selecting and purchasing a low-cost assistive technology product, connecting with locally relevant activities and community support or contacting My Aged Care. LiveUp also features regularly updated healthy ageing articles designed to provide information on various age-related issues, and people can join their online community – the ConnectUp Facebook Group - to share their healthy ageing journey, ask questions and support others to optimise their health and wellbeing.

It is never too early or too late

We all know there are everyday things that we can do to help us fully live our later years. The premise of LiveUp is that by helping people understand how to take control of many of the changes that occur as we all age, people can take action and continue to enjoy the highest quality of life. The site highlights the importance of that old adage, ‘use it or lose it’–something that is relevant to us all.

*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.