New pain management program wins award: Q&A

An aged care provider has received recognition for trailblazing a new pain management and reablement program.

Aged care provider Whiddon has spearheaded the 'Exercise 4 Life Program', a pain management and reablement initiative focussed on partnering with residents to customise it to their needs.

The program was scooped up by the innovAGEING National Awards 2022 and received the Increasing Access to Care and Services award.

"We're delighted about it," Whiddon's General Manager of Strategy and Innovation, Kern Nelson, said.

"We see this as a new vision for aged care, which is much more about reablement and enriching quality of life."

Join Aged Care Insite's conversation with Nelson about the inspiration behind the program and how it's helped Whiddon's residents.

ACI: Could you tell me about the new program and what role AN-ACC has played?

KN: We've been designing and trialling the Exercise 4 Life program with Dr Jennie Hewitts, a clinician-researcher and physiotherapist.

In March this year, we started to develop an evidence-based pain management program that could also work as a reablement program. As we know, pain management is a key area of care in aged care. 

In the past, under the ACFI instrument, there was a very descriptive approach to pain management. It was all around massages but not evidence-based and of limited effectiveness. 

We knew the new AN-ACC model was coming in and saw that as a great opportunity. Whilst allied health services are not directly funded under the AN-ACC model, the instrument encourages a reablement approach. 

That gives the provider freedom to develop and offer evidence-based programs around pain management, fall prevention and reablement. 

Dr Jennie Hewitt designed a prototype for us and trialled it in one of our care homes. She worked with the residents to find the most effective way to engage them and get the most benefit out of it. 

Then, Whiddon trained their [contract] physios and went on a trial across three aged care homes. So far, we have gotten great results. 

We hope that most of our homes will be running the program by Christmas.

We're now training our physio partners and developing a new position, a therapy assistant role, that will support the reablement side of the program. That means we can make the program more sustainable and offer it to more residents.

And it fits into our holistic care model because it works across all different types of needs. It integrates care for our residents' physical, emotional, social and clinical needs. 

It's really focussed on improving and enriching the quality of life of our residents. 

What's the feedback been so far?

So, we evaluated it with measuring tools around pain and mood and interviewing as many residents as possible.

We found an average of 55 per cent reduction in pain, and that's a fantastic result after only following the program for six weeks. 

Typically, we would be running a program and would expect to see minor improvements after about six months. 

But under the new program, some residents got rid of their pain completely.

There was also a 20 per cent improvement in mood, which is a crucial finding and positive result.

When you're working on a program about reablement, it's not only about physical and functional improvement. It also has a real impact on quality of life and mood. 

Especially when you're seeing high levels of depression and anxiety in residential aged care and among older people in the community, improvement in mood is meaningful.

Interestingly, we noticed residents who'd been in our aged care homes for a shorter period (average of 1.8 years) made more significant improvement in a short time compared to people who'd been with us for longer than six years.

We saw that they had much more significant benefits around reduction in pain, mobility, function and mood.

I think this emphasises the importance of early intervention and offering help to people as early as possible.

What makes this program different from other programs targeting pain reduction and reablement?

There isn't an enormous amount of research, but we know the only objective evidence-based approach is around exercise and pain. 

What's different about this program is that it's a bit like medicine. You have your physiotherapist who sets the dosage for each individual resident. We're targeting the dosage of exercise to the individual. 

For some residents, you need to start on a one-on-one session, particularly if you're dealing with acute pain. 

Ideally, as we see things improve, residents transition through to small social groups of three to four people. So, the program can be delivered in different structures, and we try to make it fun.

The improvement in mood comes from results but also from the social aspects of the program. 

Residents enjoy being in that social group and interacting, making new contacts, and seeing other residents improve. They encourage each other. We learned that that is very good for the motivational side of this program. 

Because particularly in aged care [and actually for all of us], we'll have the best intention when it comes to exercise, but it can be pretty challenging to stick with it. 

So, we had to design it to make it enjoyable, and something residents wanted to keep doing. 

Is this a program that other providers could adopt into their homes if they wanted to?

Definitely. We designed it so that it's easy to implement.

As long as the provider ensures they embed it into their systems and manage the care home around it, having the right roles and staff in place, it's easy to implement.

It's also scalable across the industry. 

We'll be offering the program in our community care services because we have just as many people living in the community who have pain and want to maintain their physical function and mobility. 

This program lends itself to any setting, really. 

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