Home' Community Care Review : CCR MAY 2016 Contents SPONSORED FEATURE
Ultimately, the results from the pilot were very encouraging: 90 per
cent of clients improved their level of functioning, all clients achieved
at least one physiotherapy goal and 88 per cent achieved at least one
occupational therapy goal. Improvement in functioning was seen in
key domains including mobility, transferring, feeding, showering and
walking, says Davies.
"Those are the key domains where when people improve, the need
for traditional care services can be reduced, which is consistent with
the government's definition of restorative care." Overall there were
38 distal goals and 97 proximal goals coded against the 157 World
Health Organisation's International Classification of Functioning
domains. This demonstrated a reasonably wide spectrum of goals,
and acknowledged what were the areas that people wanted to improve
upon in their lives. Mean changes across the functional and quality of
life outcome measures supported evidence of change.
Carers and case managers reported a 75 to 100 per cent overall
client improvement in activities of daily living.
Significantly, the pilot also suggested there was a reduced burden
on carers, which was a surprise finding, says Buckley. "Around 90 per
cent of the carers rated the improvement of the clients and the impact
of that on their activities of daily living as extremely high," she says.
This high impact reduction of carer burden could be significant, as
carer burden has been linked to rates of hospitalisation and premature
admission to residential aged care. However, Buckley stresses that
studies with larger samples are needed to more thoroughly examine
the potential impact on carers.
ISSUES THAT AROSE
As Catholic Healthcare's community services expected, the pilot also
highlighted some key issues and challenges that need to be addressed
as the organisation seeks to progress its health and wellness agenda.
For instance, some clients were reluctant to accept a reduction in
personal care or domestic assistance hours as they were concerned
about whether they could get that help back again if they needed it,
For Davies, this highlighted that although there was currently
flexibility within the system to utilise a higher or lower package, a
decrease to a lower level package was usually not being taken up by
senior citizens. Arguably there are a few key reasons for this; the length
of time it takes to change packages, the lack of level 3 or 4 packages
available if the senior citizen requires a higher level package in the
future, and the lack of options to stay on a lower package and receive
additional funding for brief intensive restorative programs.
Therefore, in turn, the client's health and wellbeing does not
progress in a positive direction. "Surely for many senior citizens
the expectation of progressing to a higher funded package sets
the expectation that there is inevitable
functional decline! Our pilot study clearly
indicated that senior citizens can make
functional improvements and prevent this
progression," says Davies.
"If society is to truly move away from
the illness model, there should be better
availability of brief intensive support, as well
as more incentives to remain on a lower level
package and actively manage your health."
The pilot has also highlighted that
the organisation's frontline care workers
can be supported to act as therapy aides,
says Davies. "It's shown we can utilise our
Certificate III and IV trained community
workers in some circumstances, under
the direction of a health coach, to provide
guidance for repetition of exercise and
activities of daily living. They performed the
task very well," he says.
Armed with these insights from its pilot,
Catholic Healthcare's community services
is now working with their research partners
at the University of Auckland, as well as
researchers at the Hunter Medical Research
Institute, with which it has subsequently
formed a partnership, about what future
research projects could be undertaken.
Catholic Healthcare's community
services is also implementing a new training
curriculum for staff focusing on health
and wellbeing to further support them in
embedding wellness for senior citizens.
"We've been undertaking this work for a
while, but it's a significant culture change,"
says Davies. "It's more about continuously
improving and refining the model of care.
These are exciting times." n
*Names have been changed
ABOUT CATHOLIC HEALTHCARE'S
Catholic Community Services
NSW/ACT is a division of
Catholic Healthcare, which
was established in 1994.
Catholic Healthcare owns 41 residential aged care services,
10 independent living communities, operates two healthcare
services and provides services to over 6,500 persons in the
community across NSW and South East Queensland.
The not-for-profit provider works with older people, people
who are homeless or at risk of homelessness, people with a
disability or mental illness and carers.
For further information, contact: Janis Redford,
General Manager, Catholic Community Services NSW/ACT,
02 8876 2100 or visit catholichealthcare.com.au
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