PRACTICAL ADVICE FOR IMPROVING RESIDENT OUTCOMES

Tristan WhiteAged Care

PhysiotherapistAPA National Gerontology

Group

PHYSIOTHERAPY IN AGED CARE

SESSION OUTLINE

• Aged Care Act 1997• Current Trends in Aged Care

Physiotherapy• Improving Outcomes for your

Residents• Medicare EPC• Action Plan to improve outcomes in

your facilities

AGED CARE ACT 1997

• ‘The Accreditation Standards under the Aged Care Act 1997 require approved providers to ensure that optimum levels of mobility and dexterity are achieved for all residents and that residents are assisted to achieve maximum independence’

AGED CARE ACT 1997

• Approved providers must meet the Specified Care and Services provisions under the Act which require:– High care residents assessed as needing

allied health services must be provided with these services by the approved provider at no cost to the resident.

– Low care residents assessed as needing therapy are assisted in obtaining these services.

CURRENT TRENDS

• Physiotherapists in a consultant-style role

• Tasks currently undertaken by physiotherapists:– Assessments and Care Planning– Prescribing Equipment– Education Sessions–Majority of time on non-therapy tasks– Very little time for 1:1 consultations and

interventions

CURRENT TRENDS• APA Aged Care Survey 2007

– July to September 2007– 157 Aged Care Physiotherapists surveyed– Topics surveyed included

• Current number of physiotherapy hours per facility, per week

• Adequacy of current physiotherapy programs• Appropriateness of non-physiotherapy staff

interventions• Use of Medicare funding for physiotherapy

services in RACF’s

CURRENT TRENDS• APA Aged Care Survey 2007 Results

– 54% of physiotherapists believed RACF clients’ therapy needs were NOT adequately met.

– 66% of physiotherapists believed RACF clients did NOT receive the physiotherapy treatment they required from a physiotherapist

– 53% of physiotherapists believed clinical consultation time with clients in RACF’s was currently INADEQUATE

– Only 20% of RACF’s surveyed were using funding under the Medicare Enhanced Primary Care initiative.

IMPROVING OUTCOMES• Potential for improvements are significant

• Simple equation: Physio + therapy plan + effective

implementation = marked improvement in resident

• Combination of – Resident and condition-specific programs– Team approach with resident and facility goals

identified

IMPROVING OUTCOMES• ‘Betty from Bundoora’ – Previously immobile for 18 months– Enthusiastic and very motivated to mobilise– Fortnightly physiotherapy sessions over 2

months– Now mobile in her room with a 4 wheel

frame and supervision– Recently went home for lunch with family– Happier, healthier and less staffing care

now required

IMPROVING OUTCOMES• Chronic Pain Management– Residents with dementia often have significant

underlying pain– Challenging behaviours are often an expression

of pain– Physiotherapy intervention including manual

techniques, exercise therapy, heat and electrotherapy (in a controlled environment) can result in remarkable outcomes

– Dementia is increasing in prevalence and is an ongoing challenge. Physiotherapy has a real and measurable role in caring for sufferers.

IMPROVING OUTCOMES

• Additional Scope– Post hospital admission– Chest Conditions and for prevention of

complications– Falls Prevention– Group Exercise Classes– Psycho-social benefits of regular

physiotherapy intervention

MEDICARE - EPC• The Enhanced Primary Care (EPC) program

was introduced to provide more preventive care for older Australians and improve coordination of care for people with chronic conditions.

• Quite simply, the EPC initiative enables people with chronic conditions and complex care needs access to Medicare-funded physiotherapy or other allied health services

MEDICARE - EPC• In summary:

–Maximum of five (5) services per patient each calendar year

– Sessions are a minimum of 20 minutes of 1:1 intervention

– GP refers to allied health professional – Allied health professional must report back to

the referring GP

• Ideal for residents of RACF’s – which residents are not suffering from a chronic condition and could benefit from more therapy?

SUMMARY• Specific physiotherapy intervention for

appropriate residents can achieve significant outcomes for residents and staff

• Physiotherapists in RACF’s completing assessments and care planning alone is not effective and an inadequate use of resources

• A proactive and measured approach using appropriate funding streams can achieve remarkable outcomes

ACTION PLAN• Engage a physiotherapist with knowledge,

skill and a genuine interest in aged care• Establish a framework with the

physiotherapist to complete assessments and care planning time and cost-effectively

• Identify what outcomes could be improved – falls, pain management, etc

• Ensure cooperation and a team approach by clearly explaining therapy plans and expected outcomes with families & care staff

• Maximise Medicare funding by cooperation of Facility Management, GP’s and Physiotherapist