New research on helping older people live at home longer

Short-term specialist reablement intervention is effective at improving the capability and quality of life of older adults experiencing functional decline in 99 per cent of cases, a new study has found.

Researchers from leading dementia-care experts HammondCare have published a retrospective cohort study showing the far-reaching benefits of a tailored, multidisciplinary approach to restorative care for older adults.

The provider’s Short-Term Restorative Care (STRC) Programme brings together a variety of allied health professionals to deliver up to eight weeks of support for older people living at home who may be at risk of losing their independence. This can be increased with Support at Home to 12 weeks with potential for a further four-week extension.

The cohort study looked at the experiences of 484 STRC clients, with an average age of of 81, to determine its effectiveness. The study used the government-mandated modified Barthel Index (mBI) – designed to assess an individual’s functional independence in performing Activities of Daily Living (ADLs) – and additional individually tailored outcome measures, such as nutrition, frailty, patient-reported outcomes, and goal attainment.

Results showed significant improvements in clients across the board with 99 per cent of them remaining in their own home at the conclusion of the STRC Programme.

The study’s lead author Dr Lindsey Brett said the future success of STRC in Australia relies on setting the right goals, assessing effectiveness and checking on how the client is feeling.

“It's about finding what is the most appropriate outcome for the individual so that we can show if the treatment that they’re having is effective and is meaningful for them,” she said.

The Goal Attainment Scale (GAS) used by the HammondCare STRC team allows health professionals to deliver tailored care programs. More importantly, it can be used to help inform older people about which provider they want to engage with for their services.

Similarly, a Patient-Reported Outcomes Measurement Information System (PROMIS10 Global Health) questionnaire keeps track of how a client perceives their own physical and mental health.

“This gave a much fuller picture of where the person was at, at the beginning of the programme, and what the person had achieved at the end, rather than just relying on an mBI,” Dr Brett said.

“If we’re going to be putting all this funding into community services, you want to make sure that it is being effective; it is achieving the intended target.”

Why is STRC so important?

With an ageing population experiencing increased rates of comorbidity, a hospital system strained by residential aged care bed shortages, and more older people choosing to live at home for longer, the demand for programs like STRC is increasing.

National data shows that the number of older Australians using home-care services has almost quadrupled in the last decade, with the number of people opting to receive care at home increasing 357 per cent (from 57,000 to 258,000 people) between 2013 and 2023.

The delivery of short-term restorative care (STRC) costs the federal government over $74 million a year, and is included as part of the new Support at Home program beginning November 1.

According to the team from HammondCare, the amount of available research into the effectiveness of STRC is “scarce”.

This recent study advocates for updated monitoring practices from government level down, and suggests that implementing person-centred outcome measures – alongside a system of sector-wide benchmarking – will ensure a focus on “person-centred, early intervention and preventative services.”

“Aged care services are often reactive, episodic and fragmented, and may not address the underlying source of the functional decline for the services being requested,” the study said.

“Examples include traditional home care services that lack a focus on optimising independence, and acute care models that contribute to loss of functional ability through prolonged bed rest.”

HammondCares STRC model combats this by creating a multidisciplinary team that address a client’s needs from start to finish. Thorough initial consultation is supported by regular team meetings to ensure the delivery of a coordinated and dynamic person-centred care plan.

The changing face of success

One participant in the STRC programme is 91-year-old Laurie Sucic from Sydney’s Northern Beaches .

As the sole carer of her husband, Nandy, who lives with Parkinson’s disease, Mrs Sucic was motivated to stay living at home for as long as possible, but was also experiencing breathlessness, mobility issues and weight loss.

Mrs Sucic was allocated a team of allied health professionals, including a physiotherapist, occupational therapist, exercise physiologist and dietician, who she now refers to as “my angels”.

“It’s been an enormous help, and I feel thoroughly supported,” she said.

Daughter Kim also noted the change STRC achieved in just a few short weeks saying “it’s like the sun has shone into my parents’ house again”.