Empowering people, enhancing independence, enriching lives

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1 Towards a eablig approach i commuity care Empowerig people, ehacig idepedece, erichig lives Towards a eablig approach i commuity care

2 Cotets Foreword 1. Backgroud 2. What is a eablig approach? 3. Why use a eablig approach? 4. Supportig a eablig approach i NSW 5. Future directios i commuity care 6. Next steps: How you ca be ivolved Refereces Appedix 18

3 Miister s foreword Approaches to service delivery that eable people to build o their stregths have bee show to improve the idepedece ad overall wellbeig of older people ad youger people with a disability. The commuity care sector is cotiually workig to achieve these outcomes so that people are able to participate i the commuity as fully as possible. This paper describes a eablig approach. This is a relatively ew approach ad oe way of supportig frail older people ad people with a disability to live at home i their commuity. The purpose of this paper is to highlight how people ca beefit from a eablig approach, ecourage discussio ad suggest some ext steps for people ad orgaisatios iterested i this approach. I usig a eablig approach, the idividual requirig support becomes a active decisio maker i the plaig ad implemetatio of their commuity care support arragemets. As they become ivolved i idetifyig goals that are importat ad meaigful to them, ad participatig i decisios that affect their lives, their cofidece ad persoal wellbeig is ehaced. A eablig approach ca improve physical fuctioig ad mobility, social ad emotioal wellbeig, ad commuity coectedess. This paper aims to egage everyoe ivolved i commuity care by raisig awareess of the issues surroudig a eablig approach ad opeig the topic for discussio ad debate. The NSW Govermet ackowledges the valuable cotributio of the commuity care sector ad the may people who provided feedback throughout the developmet of this paper. I am delighted to give you the opportuity to fid out more about a eablig approach ad I look forward to workig together to cotiue improvig the idepedece ad wellbeig of older people ad youger people with a disability. Peter Primrose MLC Miister for Ageig Miister for Disability Services Towards a eablig approach i commuity care 1

4 1 Backgroud A atioal Home ad Commuity Care (HACC) forum was held i Victoria i February The forum showcased iovative commuity care programs, evidece based better practices ad ew models of service delivery that have demostrated improved quality of life outcomes for idividuals. Followig this forum a workig group amed IMPACT was formed i NSW. IMPACT comprises commuity care represetatives from key cosumer groups, carer bodies, service provider orgaisatios, idustry bodies, the HACC Developmet Officers Network, govermet agecies ad local govermet. IMPACT has played a vital role i stimulatig discussio, promotig the exchage of ideas, ad geeratig uderstadig ad ethusiasm for better practices that put the perso at the cetre of service delivery by icorporatig a doig with as distict from a doig for or doig to approach. This paper ad the eablig approach it describes, supports the perso cetred, socially iclusive ad culturally appropriate approach to providig commuity care services beig advocated by IMPACT. A eablig approach focusses o doig with ad supports the perso to do rather tha doig for or doig to the perso. 2 Towards a eablig approach i commuity care

5 What is a eablig approach? 2 A eablig approach is a ew way of supportig frail older people ad people with a disability to live at home i their commuity. It is based o the followig priciples: 1. Frail older people ad people livig with a disability have the capacity to make gais i their physical, social, ad emotioal wellbeig. 2. The best outcomes for cliets accessig commuity care occur whe services are resposive to idividual eeds rather tha beig implemeted o the basis of the types of services that are available. 3. A idividual s eeds are best met whe there are collaborative workig relatioships betwee the perso, their carers ad family, social etworks, support workers ad betwee service providers. A eablig approach focuses o what the perso ca do ad wats to be able to do, ot just o what they are uable to do at preset. It offers people the opportuity to be actively ivolved i idetifyig goals that are importat ad meaigful to them ad to participate alogside their support worker to achieve their goals. Evidece from aroud the world shows that whe well targeted ad implemeted, a eablig approach i commuity care ca beefit people by buildig their cofidece ad self esteem, empowerig them by actively ivolvig them i decisios about their care eeds, ehacig their autoomy ad idepedece ad improvig their persoal wellbeig ad quality of life. Successful eablig programs may iclude a short term restorative compoet. This is suitable for people who have recetly etered the commuity care system, existig cliets who have experieced a recet chage i fuctioig or existig cliets who idetify goals aroud improvig their fuctioig ad idepedece. A eablig approach is perso cetred ad uses where appropriate, a umber of evidece based better practices to achieve agreed goals ad outcomes. These iclude practices aroud welless, active ageig, early itervetio ad prevetio, social iclusio, ad short term restorative care (also kow as re ablemet). A eablig approach is cosistet with the aims of the HACC program. These aims are to: provide a comprehesive, coordiated ad itegrated rage of basic maiteace ad support services for frail aged people, people with a disability ad their carers support these people to be more idepedet at home ad i the commuity, thereby ehacig their quality of life ad/or prevetig their iappropriate admissio to residetial care provide flexible, timely services that respod to the eeds of cosumers. This approach is cosistet with the NSW State Pla which commits govermet agecies to embeddig early itervetio ad prevetio ito service delivery ad to reducig uecessary hospital admissios. A eablig approach is also cosistet with Towards 2030: Plaig for our chagig populatio, a whole of govermet strategy to actively pla for the ageig populatio i NSW. Towards a eablig approach i commuity care 3

6 2.1 What people have said about eablig practices Whe I first came, I was strugglig to do 10 to 15 miutes of the exercises. After a couple of moths, I was doig 30 miutes ad after a couple more moths, I was doig the whole class. I get a lot of beefit. So does my wife. She was havig to do everythig for me before. Now I do it all myself: my shower, gettig dressed, everythig. Participat Acacia Livig Life, UitigCare Ageig NSW ad ACT Norther Sydey Regio, Brookly, Our goal is to make sure cliets succeed i whatever it is they wat to do. Maager Magolia Cottage Demetia Day Therapy Cetre, LivigCare, Nowra, I had t bee out for years socially, util this started. I ve made cotacts ad frieds ad it has tured my life aroud. Staley loves comig; he always gets up early o Coffee Club Tuesday. Carer, Coectios Coffee Club, Wester Sydey Demetia Advisory Service, Blacktow, I ca ow do so much more for myself at home. I hope the Commuity Kitche keeps goig. If we were t here we d be sittig at home gettig melacholy. Participat Berridale Commuity Kitche, Sowy River Home Livig Support Service, Sowy River Shire Coucil, Berridale NSW Sowy Moutais Regio, At the Berridale Commuity Kitche Elders choose the activities they wat to do ad the coordiator eables ad supports this process. Maager, Multipurpose Allira Gatherig Associatio Ic, Dubbo NSW, Towards a eablig approach i commuity care

7 2 2.2 A eablig approach i practice: a case study Idetifyig eeds ad goals Mrs C is 81 years old ad lives aloe. She had bee actively ivolved i her church ad local commuity before experiecig a stroke earlier i the year. Followig the stroke, Mrs C stopped goig out o her ow, fearig that her poor balace could result i a fall. Withi her house she has also cut dow o the heavier housekeepig tasks like vacuumig, large cleaig jobs, laudry ad gardeig. The assessor who saw Mrs C focussed o her stregths ad abilities as well as her eeds. Together they discussed what Mrs C would most like to achieve from a support pla. Mrs C s expressed goals were to get stroger, resume her church activities, do more about the house ad get back out i the garde. Adoptig eablig strategies to achieve Mrs C s goals Mrs C s support pla was cetred o her achievig her ow goals. To help her do this, she agreed to: Outcomes cosult her GP ad udertake a light home exercise program desiged with a allied health worker whe stroger, joi a twice weekly exercise program at a local eighbourhood cetre work with a domestic assistace service ad divide housekeepig tasks ito the followig categories: too heavy for ow (to be doe by the service) I ca do with help (to be shared with the service) I will do (to be doe by Mrs C) review ad re egotiate these housekeepig tasks at least every three moths receive assistace to idetify ad make cotact with a perso, eg a pastoral care team member, to discuss her cotiued iterest i participatig i church activities accept referral to a easy care gardeig service for discussio ad plaig o covertig her garde to become low maiteace. After masterig basic stregth ad balace exercises, Mrs C progressed from usig a frame to a walkig stick whe out ad was evetually able to walk uaided iside her home. A more cofidet Mrs C the arraged a buddy to drive her to ad from church activities i retur for a home cooked meal oe ight a week. After six moths, some housework tasks were moved from the I ca do with help to the I will do category, meaig that Mrs C eeded fewer hours of domestic assistace each week. She was delighted to fid that the ew raised garde beds, dry spell platig ad better mulchig reduced the amout of garde maiteace eeded without affectig her ejoymet of the garde. Towards a eablig approach i commuity care 5

8 2.3 Comparig a traditioal approach i commuity care with a eablig approach The table below cotrasts a traditioal approach of providig a service to meet a perso s eeds ad a eablig approach whereby a perso s goals are idetified, alog with their potetial to improve fuctioig, social coectio, wellbeig ad to the implemetatio of strategies to achieve these goals. Table 1 below compares critical stages i both approaches. Ideally commuity care providers will have the skills ad ability to use the best approach i order to achieve the desired outcomes for the idividual. Table 1 Assessmet Care plaig Traditioal approach Assessmet focuses o what the idividual is uable to do for himself/herself (eg uable to shower ad dress without assistace; uable to prepare meals). Care plaig takes place i the cotext of what services the agecy is able to provide (eg persoal care, social support services). The pla focuses o what the service provider will do, idetifyig the broad areas ad the specific type of formal services to be provided. Eablig approach Assessmet focuses o what the idividual is able to do ad wats to be able to do for himself/herself (eg wats to regai the ability to shower ad dress themself; wats to be able to prepare easy meals). Care plaig focuses o what support the perso eeds to achieve their goals. This support is specific to the idividual ad may ivolve iformal ad other support (eg self care aids; stregth buildig exercise program; utritioal pla). The pla has a joit focus o what the perso receivig support will do ad what the service provider will do to help achieve the perso s goals. Strategies ca be either: formal (eg home support services; aids ad equipmet; adaptig the home eviromet) or iformal (eg coectig to social etwork supports ad tappig ito existig commuity resources). 6 Towards a eablig approach i commuity care

9 2 Service delivery Traditioal approach The focus is o outputs (eg four hours of persoal care per week). Eablig approach The focus is o achievig outcomes (eg goals that are importat ad meaigful to the perso receivig support). Reviews occur whe the situatio or cliet s eeds chage (eg the cliet s health has declied ad more support services are required). Regular review is built ito the care pla. The focus is o whether ad to what extet the perso s goals have bee achieved. New goals are established as eeded. Service teds to be o goig util packaged care or residetial care is eeded or the cliet dies. The program eds whe the perso has achieved their goals or dies. Support ca be ogoig or provided o a episodic basis if required. A eablig approach offers people the opportuity to be actively ivolved i idetifyig goals that are importat ad meaigful to them ad to participate alogside their support worker to achieve their goals. Towards a eablig approach i commuity care 7

10 3 Why use a eablig approach? There are a umber of key drivers for iovatio, better practice ad ew models of service delivery i commuity care which iclude: the eeds ad expectatios of the people requirig support a growig evidece base that is cofirmig what better outcomes people are achievig ad how the decreasig availability of carers challeges aroud recruitig ad retaiig skilled staff i the sector the eed to effectively maage icreasig demad for services due to the ageig populatio. Key drivers for a eablig approach are: the eeds ad expectatios of the people requirig support the evidece base demostratig the results achieved the eed to effectively maage icreasig demad for services. 3.1 The eeds ad expectatios of people requirig support People who are frail ad/or livig with a disability geerally wat ad expect to live at home ad be coected to their commuity. They place a high value o support that will help them live idepedetly ad avoid the ecessity of movig to a residetial care eviromet. Cosumers today expect commuity care services to be coordiated, effective, efficiet, flexible ad resposive to their eeds. The commuity also expects this resposiveess to iclude services to assist people who may otherwise have more difficulty tha most people i accessig services. Idetified special eeds groups iclude Aborigial ad Torres Strait Islader people, people from culturally ad liguistically diverse backgrouds, people livig with demetia ad people livig i remote or isolated areas. With more people livig loger, our attetio has shifted over the last few decades towards improvig quality of life. This has bee accompaied by a shift i focus from the treatmet of disease to early itervetio ad prevetio, with special attetio to: the role a healthy lifestyle plays i prevetig disease, disability, ad premature death, to improvig quality of life, ad to promotig successful ageig. The eeds of people requirig support to live at home ad i their commuity vary; some have low eeds, whereas others have very complex eeds. Some people are able to maage with little or o support, ad others are ot. Some people require support from their social etworks whereas others eed formal support services. While commuity care is targeted at people who are frail aged, those livig with disability ad their carers, the iitial request for assistace ca be brought about by either a sudde deterioratio i fuctio eg followig a fall, or by a slow deterioratio due to health problems or lifestyle factors. I some cases the perso s deterioratio ca be slowed or 8 Towards a eablig approach i commuity care

11 3 reversed, whereas i other situatios, the perso will require support that is ogoig. May people eedig commuity care support have the potetial to gai tagible beefits by participatig i low levels of physical activity, improvig their diet, ad utritio, usig aids ad equipmet to maitai their fuctioig, participatig i activities that are meaigful to them, ad buildig or re buildig ad maitaiig social relatioships. 3.2 The evidece base A few key fidigs from the vast ad growig evidece base i support of a eablig approach are summarised below. There are risk factors for cardiovascular disease, such as high blood pressure, obesity, ad smokig, which have bee show to lead to premature death ad disability. There are also protective factors, such as exercise, diet ad utritio, which have bee show to improve health, persoal wellbeig ad quality of life (Broe, 2010). Brief commuity care itervetios that give a cliet the opportuity to regai their capacity to do thigs for themselves ca arrest physical deterioratio for a while ad improve persoal wellbeig (Aged Services Learig ad Research Cetre, Souther Cross Uiversity, 2009). Low level exercise such as shoppig, cookig, doig housework, laudry ad gardeig ca help improve fuctioig, build cofidece ad morale, ad improve persoal wellbeig (McWilliam et al, 2000). There is icreasig evidece that adoptig strategies for welless ca make a positive differece to people who are elderly ad frail (Stuck et al, 1999; Peel et al, 2005; Seemad & Crimmis, 2001). Improvemets i a perso s health ad fuctioal capacity are ecessary but ot sufficiet to achieve wellbeig. Measures to (re)coect people to their commuities ad social etworks are essetial (McMurray, 2007). I may cases, it is possible to reverse or slow dow deterioratio i fuctioig, improve capabilities, ad improve wellbeig with modest low cost itervetios such as ecouragig low level exercise, ad improvig diet ad utritio ad the use of assistive techology (eg aids ad equipmet such as caes ad walkers) (McWilliam et al, 2000). It is possible to improve idividual fuctioig by modifyig the home eviromet Towards a eablig approach i commuity care 9

12 eg by addig ramps, lowerig cabiets, ad removig rugs (O Coell, H. 2007). It is possible for frail older adults participatig i short term restorative care programs offerig multi discipliary itervetio, to improve their ability to perform activities of daily livig, reduce the likelihood they will fall ad ijure themselves, icrease feeligs of idepedece, autoomy, ad self efficacy, ad icrease ivolvemet i the maagemet of their health ad abilities icludig self care (Lewi et al, 2006; Ket et al, 2000; Tietti et al, 2002). Research over the last 10 years suggests that commuity care that places a emphasis o completig tasks (eg doig the shoppig, doig the laudry), ad geerally doig for may be uitetioally creatig depedecy ad workig agaist the goal of ehacig the idividual s autoomy ad idepedece (Rybur et al, 2007). Whe successfully targeted ad implemeted, a eablig approach that icludes short term restorative itervetio ca delay, reduce, or remove the eed for loger term ogoig support from the commuity care service system (Victoria Govermet Departmet of Huma Services, 2008). A eablig approach has the potetial to improve staff satisfactio (Victoria Govermet Departmet of Huma Services, 2008). I short, a eablig approach has the potetial to ehace idividual autoomy ad idepedece ad to improve persoal wellbeig ad quality of life. It also has the potetial to improve staff satisfactio ad to assist service providers to free up capacity to support more cliets. Appedix 1 provides additioal iformatio about key refereces that support a eablig approach. 3.3 The eed to effectively maage icreasig demad for services Today, at age 60 a Australia ma ca expect to live o average, to age 84; ad at age 60, a Australia woma ca expect to live, o average, to 88 years. Life expectacy for Aborigial ad Torres Strait Isladers is 15 years lower tha for o Idigeous Australias, ad the Australia Govermet has determied that: Closig the gap i life expectacy betwee Idigeous ad o Idigeous Australias is a matter of atioal priority. By 2021, almost oe i four Australia adults will be aged over 65 years. Over the ext 40 years, the 85 year ad over age group will quadruple i size (Productivity Commissio, 2010). The Natioal Health ad Hospitals Reform Commissio (NHHRC 2009) forecasts that the umber of aged care places will eed to at least double by 2030 to meet projected demad (Ibid). These are compellig reasos for us to adopt evidece based better practices ad to pilot ew models of sustaiable service delivery. 10 Towards a eablig approach i commuity care

13 3 3.4 Who will beefit from a eablig approach? Feedback from pilot projects i Victoria ad from demostratio projects i NSW suggests that, i additio to frail older people ad people with a disability, other groups will beefit from a eablig approach. These groups iclude carers, family members, staff, provider orgaisatios, local commuities, ad govermet at all levels. Eve if there is o potetial to restore or improve fuctio, people ca beefit from accessig services that use better practices associated with welless, active ageig, early itervetio ad prevetio, ad social iclusio. Idividuals beig supported to live at home ad i their commuity ca be ecouraged ad supported to actively participate i the developmet ad delivery of their services, eve if this is limited. A eablig approach is based o the idividual s goals. The perso directs the directio of eablig strategies, meaig they are more likely to be actively egaged ad feel that eablig is doe with them rather tha to them. For may idividuals this will ot be a short term itervetio; however a ogoig service ca help prevet uecessary deterioratio. It appears at this stage that a idividual s diagosis is ot a reliable idicator of success whe participatig i a eablig program. Positive results have bee reported by people with complex eeds, people receivig palliative care services, people i the old old (over 75 years) age group ad people with demetia i the early stages. Orgaisatios that are usig a eablig approach report that this approach is likely to get the best results i the followig circumstaces: whe both the recipiet of the service ad the provider of the service uderstad ad value the approach the perso has the capacity to make gais i their persoal wellbeig, fuctioig ad socialisatio family members ad carers support the approach the idividual is a willig participat the holistic eeds of the idividual are addressed staff are skilled i implemetig evidece based better practice the goals are developed with the perso ad they have meaig for that perso whe eablig itervetios are evidece based ad targeted to meet the idividual s eeds. Towards a eablig approach i commuity care 11

14 4 Supportig a eablig approach i NSW The Better Practice Project I October 2009, Ageig, Disability ad Home Care (ADHC) iitiated The Better Practice Project for HACC i NSW. This project aims to stregthe the capacity of commuity care to adopt evidece based better practices that will ehace the autoomy, idepedece ad quality of life of people requirig support to live at home ad i the commuity. The Better Practice Project has a eablig approach at its foudatio, ad has four compoets described i Sectios 4.1 to Mappig iovatio ad better practice iitiative I March 2010, a call for omiatios was issued, ivitig the HACC sector i NSW to omiate service providers adoptig better practices i service delivery that were aliged with a eablig approach. This resulted i developmet of A hadbook for commuity care services. This will be available from November 2010 olie > Doig busiess with us > Home ad Commuity Care Program. The hadbook icludes practice ideas, case studies, ad cliet ad carer stories from 50 services, large ad small, across NSW. This resource provides fact sheets ad essetial iformatio about available resources. 4.2 Awareess raisig educatio ADHC has partered with the Aged & Commuity Services Associatio of NSW ad ACT (ACS) to develop a awareess raisig program to be offered across NSW. The program is desiged for care coordiators, case maagers ad HACC developmet officers who wat to lear more about a eablig approach by participatig i a small iteractive program. The awareess raisig educatio program will be idepedetly evaluated ad the results of the evaluatio will iform decisios about future programs. 4.3 Demostratio projects Four demostratio projects are ow uderway, supportig idividuals who are eligible for HACC services, usig a eablig approach. The projects will ru for 12 moths util Jue 2011 ad are located i: 12 Clarece Valley i Norther NSW Sigleto i the Huter Regio Norther Sydey Easter Suburbs Sydey. These projects are offerig short term early itervetio ad support to approximately 400 older people who are willig ad iterested i participatig. Towards a eablig approach i commuity care

15 4 The demostratio projects will help us to lear more about: how a eablig approach ca help idividuals improve their fuctioig, their social etworks ad their persoal wellbeig the characteristics of people who beefit most from this approach the costs ad beefits of this approach the impact o staff, participatig service providers, ad the local commuity. Eable Me Demostratio Project, Norther Sydey 4.4 Idepedet project evaluatio Idepedet cosultats have bee egaged to evaluate the results of the demostratio projects, the mappig iitiative ad the awareess raisig educatio program. The cosultats will gather quarterly feedback o the demostratio projects, icludig cliet feedback, ad cliet ad carer stories. They will also gather feedback from staff ad service providers ad will facilitate shared learig from the projects durig the year. The outcome of the evaluatio will cotribute to iformig the directio of future service delivery. Towards a eablig approach i commuity care 13

16 5 Future 1 directios i commuity care I NSW, the HACC Program has etered a period of trasitio. Uder the Natioal Health ad Hospitals Network Agreemet edorsed by the Coucil of Australia Govermets (COAG), there will be a split of resposibilities for aged care ad disability programs. The Australia Govermet is to assume full resposibility for aged care services for people aged 65 years of age ad over (50 years of age ad over for Idigeous Australias) from 1 July As part of its commitmet to a smooth trasitio, the NSW Govermet is kee to support ad facilitate a state wide cosultative process with the commuity care sector. Aged ad Commuity Services Associatio of NSW ad ACT Ic (ACS) will play a active role i commuicatig the chages ad assist i buildig future sector capacity through cosultatio ad facilitated forums o trasitioal plaig. ADHC will make fidigs from The Better Practice Project available to the Australia Govermet ad will apply these fidigs i plaig ad developig commuity care services for people uder 65 years of age. ADHC will cotiue to egage the sector i how best to implemet a eablig approach as a viable support optio for people requirig support to live at home i their commuity. This process of chage is likely to take time. 14 Towards a eablig approach i commuity care

17 Next steps: How you ca be ivolved 6 If you wat to kow more or become ivolved i this excitig ew directio for commuity care the followig iformatio provides some optios. 1 Read about the evidece related to a eablig approach. Refer to the refereces ad appedix for details. 2 Participate i regular IMPACT forums facilitated by: Aged ad Commuity Services Associatio NSW ad ACT Ic (ACS) mail@agedservices.as.au Coucil of Social Service of NSW (NCOSS) ifo@coss.org.au 3 Lear from the practice ideas, case studies, ad cliet ad carer stories featured i A hadbook for commuity care services. It is available from November 2010 olie at > Doig busiess with us > Home ad Commuity Care Program. 4 Atted the awareess raisig educatio programs beig coducted by ACS ad suggest iterested co workers also atted. For iformatio about the awareess raisig educatio program cotact ACS via o mail@agedservices.as.au. 5 Participate i regioal forums ad etworkig evets that are focussig o this approach ad exchage iformatio ad ideas. 6 Share your eablig better practices ad achievemets with others by speakig at upcomig forums ad cofereces. 7 Atted the 2011 HACC ad Commuity Care Coferece beig ru by ACS to be held i Darlig Harbour, Sydey from 2 3 May Cotact ACS via o mail@agedservices.as.au. Towards a eablig approach i commuity care 15

18 Refereces Aged Services Learig ad Research Cetre, Souther Cross Uiversity (2009). Re ablemet of Older People i North Coast NSW. Souther Cross Uiversity. > Doig busiess with us > HACC O Coell, H. (2007). The WATCH Project: Welless Approach to Commuity Homecare. Commuity West Ic ad Wester Australia Departmet of Health, Home ad Commuity Care. Perth. Ageig, Disability & Home Care (2009). NSW Peel, N., Bartlett, H., & McClure, R. (2004). Healthy Guidelies for Home ad Commuity Care (HACC) Ageig: How is it defied ad measured. fuded services. Ageig, Disability & Home Care, Australasia Joural o Ageig, 23(3), Sydey. Productivity Commissio (2010). Carig for Older Broe. T. (2010) Key ote speaker address. Australias: Productivity Commissio Issues Paper. Preseted at the Natioal Aborigial ad Torres Caberra: Commowealth of Australia. Strait Islader Aged Care Forum. 4 5 August data/assets/pdf_file/0003/ 2010, Adelaide, South Australia /aged care issues.pdf Departmet of Families, Housig, Commuity Rybur, B., Wells, Y., Forema. P. (2007). The Services ad Idigeous Affairs (2009) Closig the Active Service Model: A coceptual ad empirical gap o Idigeous disadvatage: the challege for review of recet Australia ad Iteratioal Australia. Caberra: Commowealth of Australia. literature ( ). Australia Istitute for Primary Care. La Trobe Uiversity, Melboure. eral/documets/closig_the_gap/closig_the_ga Available September p.pdf Seema, T. E., & Crimmis, E. (2001). Social Impact NSW (2009). Who is Impact NSW? eviromet effects o health ad ageig: Itegrated epidemiologic ad demographic approaches ad perspectives. Auals of New Ket, J., Paye, C., Stewart, M. & Uell, J. (2000). York Academy of Scieces, 954, Exteral evaluatio of the home care reablemet pilot project. Cetre for Group Care ad Stuck, A. E., Walthert, J. M., Nikolaus, T., Bula, C. Commuity Care Studies: De Motfort Uiversity, J.,Hohma, C., & Beck, J. C. (1999). Risk factors Leicester. for fuctioal status declie i commuity livig elderly people: A systematic literature review. Lewi, G. & Vadermeule. S. (2009). A Social Sciece ad Medicie, 48(4), o radomised cotrolled trial of the Home Idepedece Program (HIP): a Australia Tietti, M., Baker, D., Gallo, W., Nada, A., restorative programme for older home care cliets Charpetier, P. & O'Leary, J. (2002). Evaluatio of i Health & Social Care i the Commuity Joural, restorative care versus usual care for older adults Cetre for Research o Ageig, Curti Uiversity of receivig a acute episode of home care i Techology ad Silver Chai, Perth. Joural of America Medicie Associatio, McMurray, A. (2007). Commuity health ad Coecticut. 287, welless: a socio ecological approach. Sydey: va Dam, T., Ellis, J., & Sherwi, J. (2008). Perso Elsevier Australia. Cetred Plaig: A review of the literature. Stregtheig perso cetred plaig i the McWilliam, C., Diehl Joes, W., Jutai, J., & Commuity Participatio program, Ageig, Tadrissi, S. (2000). Care delivery approaches ad Disability & Home Care, Sydey. Available Seiors idepedece. Caadia Joural of September Ageig, 19(1), Victoria Govermet Departmet of Huma NSW Departmet of Premier ad Cabiet (2008), Services (2008). Victoria HACC Towards 2030: Plaig for our chagig Active Service Model Discussio Paper. Victoria populatio. NSW Departmet of Premier ad Govermet Departmet of Huma Services. Cabiet, Sydey. Available September asm_discussio_paper.pdf 16 Towards a eablig approach i commuity care

19 Appedix Defiitios Active Ageig Active ageig is the process of optimisig opportuities for health, participatio ad security i order to ehace quality of life as people age. It applies to both idividuals ad populatio groups. Active ageig allows people to realise their potetial for physical, social, ad metal well beig throughout the life course ad to participate i society, while providig them with adequate protectio, security ad care. World Health Orgaisatio The Welless Approach The Welless Approach is a philosophical chage i the thikig behid the delivery of Home ad Commuity Care (HACC) services i Wester Australia (WA). It supports a move withi the WA HACC Program towards developig ad implemetig service models that have the potetial to build capacity by actively workig with the cliet to: prevet loss of idepedece by focusig o the retetio of existig skills ad where appropriate focus o regaiig skills ad a subsequet icreased level of idepedece ad well beig, as opposed to a cotiuig or icreasig depedece o services beig provided by others. CommuityWest Re ablemet This ew model, kow uder various terms, emphasises a capacity buildig restorative approach. Its pricipal aim is to maitai ad restore, to the extet possible, a older perso s capacity to live as idepedetly as possible. Most of the re ablemet type projects/programs reviewed which demostrated positive outcomes icluded similar essetial compoets or features, icludig goal settig; comprehesive assessmet; ad havig multi discipliary teams. Aged Services Learig ad Research Cetre, Souther Cross Uiversity (2009). > Doig busiess with us > HACC Perso cetred plaig Perso cetred plaig is a process for cotiual listeig ad learig, focusig o what is importat to someoe ow ad i the future, ad actig upo this i alliace with their family ad frieds. It is the foudatio of self directed support. Put simply, perso cetred plaig is a way of assistig people to work out what they wat, the support they require ad helpig them get it. Hele Saderso, Literature reviews evidece base i) Aged Services Learig ad Research Cetre, Souther Cross Uiversity (2009). Re ablemet of Older People i North Coast NSW. Souther Cross Uiversity. Available > Doig busiess with us > Completed research This report was fuded by ADHC s Norther Regio ad summarises the experiece of teams i the UK, New Zealad ad Wester Australia. The report provides a comprehesive overview of the Australia ad iteratioal peer reviewed ad grey literature, explorig: multi compoet re ablemet programs evidece based sigle compoet itervetios for re ablemet programs commo features/approaches i re ablemet programs (icludig the use of assistive techologies, physical therapy, mobility ad stregtheig exercises, social rehabilitatio, ad health educatio, icludig chroic disease self maagemet, cotiece promotio ad utritio) key issues for implemetatio of re ablemet programs. Towards a eablig approach i commuity care 17

20 Appedix ii) The research showed that the provisio of brief service itervetios that give a cliet the opportuity to regai their capacity to do thigs for themselves ca arrest physical deterioratio for a while ad improve persoal wellbeig. The paper also reflects a series of cosultatios with service providers o the NSW Far North Coast, with geeral cosesus reached amogst participats that the evidece clearly supports the beefits of adoptig a re ablemet approach for the provisio of HACC services. It was oted this requires a philosophical chage. va Dam, T., Ellis, J., & Sherwi, J. (2008). Perso Cetred Plaig: A review of the literature. Stregtheig perso cetred plaig i the Commuity Participatio program. Ageig, Disability & Home Care, Sydey. Available > Publicatios ad policies > People with a disability This is a review of Australia ad iteratioal literature about perso cetred plaig practices (PCP) ad approaches. Literature was reviewed with the itetio of illumiatig the features of PCP ad practices, the outcomes of PCP, ad the issues that eed to be cosidered i the developmet of perso cetred practices. The literature review demostrates that perso cetred approaches ca achieve sigificat outcomes for idividuals with disabilities. It also demostrates that it is a approach that requires fudametal chages i the way that service systems relate to people with disabilities. iii) Rybur, B., Wells, Y., Forema. P. (2007). The Active Service Model: A coceptual ad empirical review of recet Australia ad Iteratioal literature ( ). Australia Istitute for Primary Care. La Trobe Uiversity, Melboure. Available This literature review was commissioed by the Victoria Departmet of Huma Services i order to provide a evidece base to iform the developmet of the Active Service Model (ASM) withi the Victoria system. It comprises a comprehesive iteratioal review of the literature, icludig a review of coceptual ad theoretical uderpiigs, curret iteratioal practice ad empirical research utilisig a ASM type approach. iv) McWilliam, C., Diehl Joes, W., Jutai, J., & Tadrissi, S. (2000). Care delivery approaches ad Seiors idepedece. Caadia Joural of Ageig, 19(1), I this text, the authors highlight that adoptig strategies for welless wherever possible is advatageous for all types of prevetio, ad argue that it is ofte possible to rehabilitate or re eable occupatioal ad social fuctios i frail older adults with chroic illess. v) Fie, M. ad Thomso, C. (1995). Factors Affectig the Outcome of Commuity Care Service Itervetio A Literature Review, Departmet of Huma Services ad Health, Aged ad Commuity Care Divisio, Aged ad Commuity Care Developmet ad Evaluatio Reports, No. 20, AGPS, Caberra This paper highlights a study coducted i the Uited Kigdom by Davies, B., A. Bebbigto ad H. Charley (1990), Resources, Needs ad Outcomes i Commuity Based Care : A Evaluated Demostratio of a Log Term Care Model, Avebury, Aldershot. The study examied the impact of employig some simple targetig criteria, such as regular reassessmet o a populatio eligible to receive home care. The study foud that after regular six mothly reviews, a modest proportio were estimated to o loger require assistace ad were take off assistace. While some reapplied later ad were readmitted to services as their coditio idicated, the results of simply itroducig regular reassessmets of all cliets were show to be very sigificat. After five years, the cost of servig the populatio without reassessmet was approximately oe ad a half times that of assistig the populatio remaiig after regular reassessmet. The reassessmets demostrate that declie is ot ievitable ad depedece o services is ot a life setece. Reassessmets helped may cliets regai their idepedece. vi) World Health Orgaisatio (2002). Active Ageig: A Policy Framework. World Health Orgaisatio. Available 18 Towards a eablig approach i commuity care

21 This Policy Framework was developed to iform discussio ad the formulatio of actio plas that promote healthy ad active ageig. It was developed by WHO s Ageig ad Life Course Programme as a cotributio to the Secod Uited Natios World Assembly o Ageig, held i April 2002, i Madrid, Spai. Evaluatig practice i) Ket, J., Paye, C., Stewart, M. & Uell, J. (2000). Exteral evaluatio of the home care re ablemet pilot project. Cetre for Group Care ad Commuity Care Studies: De Motfort Uiversity, Leicester (Uited Kigdom). Available ii) iii) iv) This paper is a evaluatio of three Promotig Idepedece pilot projects i Leicestershire, Uited Kigdom. The itetio of the pilot projects was to eable people to remai livig i their ow homes as log as possible by providig itesive packages of support ad rehabilitatio. All pilot projects aimed to help people to look after themselves rather tha do for them. The report highlighted the importace of close ivolvemet ad support of multi discipliary colleagues with occupatioal therapy ad physiotherapy backgrouds, as well the eed for traiig ad developmet opportuities for home care staff. Lewi, G. & Vadermeule. S. (2009). A o radomised cotrolled trial of the Home Idepedece Program (HIP): a Australia restorative programme for older home care cliets i Health & Social Care i the Commuity Joural. Cetre for Research o Ageig, Curti Uiversity of Techology ad Silver Chai, Perth. Available HIP Cotrolled Trial article.pdf This study compared the outcomes for idividuals who participated i the Home Idepedece Program (HIP) with those of idividuals who received usual home care services. The (HIP) is a short term restorative programme targeted at older home care cliets. The results of this study supported the hypothesis that older idividuals referred for Homecare who did ot have a diagosis of demetia ad participated i programs to promote their idepedece had better idividual ad service outcomes tha similar idividuals who received usual Homecare. Tietti, M., Baker, D., Gallo, W., Nada, A., Charpetier, P. & O'Leary, J. (2002). Evaluatio of restorative care versus usual care for older adults receivig a acute episode of home care i Joural of America Medicie Associatio, Coecticut. 287, This study reviews potetial of restorative approaches towards home care for frail older adults, which aim to go beyod traditioal home care goals of maiteace ad support towards improvemets i fuctioal status ad quality of life. The authors cite a rage of positive outcomes, icludig improved quality of life ad fuctioal status ad reduced costs associated with a reductio i the ogoig use of home care services post itervetio. New Zealad Miistry of Health (2002). Assessmet of Services Promotig Idepedece & Recovery (ASPIRE) i Elders. Available fact sheet The primary aim of the Health of Older People Strategy (2002) i New Zealad was to develop a itegrated approach to health ad disability support services that is resposive to older people s varied ad chagig eeds. Ageig i place services that give older people the ability to make choices i later life about where to live, ad to receive the support eeded to do so are a key compoet of meetig the aims of the Strategy. The ASPIRE project was set up to evaluate the effectiveess of three of the more sigificat ageig i place programmes: the Coordiatio of Services for the Elderly (COSE), Christchurch the Promotig Idepedece Programme (PIP), Lower Hutt Commuity FIRST (Flexible Itegrated Restorative Support Team), Hamilto The results of these programmes foud that the three services reduced the risk of etry to residetial care ad caregiver stress levels did ot appear to rise, despite older people with high ad complex eeds remaiig i their ow homes (Kathy Specer, NZ Miistry of Health Towards a eablig approach i commuity care 19

22 Appedix v) Commowealth Departmet of Health ad Aged Care, (1999) Targetig i the Home ad Commuity Care Program, Aged ad Commuity Care Service Developmet ad Evaluatio Reports No. 37, Commowealth Departmet of Huma Services ad Health), AGPS, Caberra This study reviewed the effects of differet targetig strategies i the HACC Program, icludig targetig to improve fuctioig ad support idepedece i the commuity. The review foud that there are circumstaces i which early, basic ad geeral assistace has beeficial outcomes. These circumstaces ca be see as presetig widows of opportuity for secodary prevetio, that is, itervetios aimed at prevetig loss of fuctio ad deterioratio i idividuals who already have established disabilities. Three broad sets of circumstaces i which targetig to restore ad maitai fuctio applies ca be distiguished, icludig cliets eedig ogoig but low levels of assistace, post acute care ad supportig carers. The NSW cotext i) NSW IMPACT Forum IMPACT priciples ii) The five key priciples developed by the IMPACT Workig Group ad backgroud about IMPACT are available at: details.html NSW Departmet of Premier ad Cabiet (2008), Towards 2030: Plaig for our chagig populatio. NSW Departmet of Premier ad Cabiet, Sydey. Available > Publicatios ad policies > Towards 2030: Plaig for our chagig populatio The report itroduces the first NSW whole of govermet strategy to actively pla for demographic chage. The documet idetifies a rage of ways that NSW Govermet agecies ca respod to the ageig of the populatio, with a focus o early itervetio to support people to maximise their health ad quality of life as they move ito older age. Other Australia jurisdictios i) Victoria Govermet Departmet of Health (2008). Victoria HACC Active Service Model Semiar February , Available The Victoria HACC Active Service Model Semiar was a 1 day follow o evet to the Natioal Forum, icludig some of the Forum s keyote speakers, alog with presetatios ad evaluatio fidigs from a umber of HACC Active Service Model Pilot Projects. Nearly 700 people atteded the evet. Presetatios from the day are available at the website above. ii) Victoria Govermet Departmet of Huma Services (2008). Victoria HACC Active Service Model Discussio Paper. Victoria Govermet Departmet of Huma Services. Available The discussio paper provides a overview of the evidece base ad treds that have led to the developmet of the Active Service Model (ASM) iitiative, describes the priciples, objectives ad key compoets that uderlie the ASM, raises issues for implemetatio ad outlies possible actios that could be part of a implemetatio pla. iii) O Coell, H. (2007). The WATCH Project: Welless Approach to Commuity Homecare. Commuity West Ic ad Wester Australia Departmet of Health, Home ad Commuity Care. Perth. This resource provides a overview of the WATCH (Welless Approach to Commuity Home Care) project i Wester Australia, icludig its aims ad objectives, key workplace chages, essetial priciples. More iformatio o the Welless approach is available at 20 Towards a eablig approach i commuity care

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24 Ageig, Disability ad Home Care Departmet of Huma Services NSW Level 5, 83 Clarece Street Sydey NSW 2000 Ph TTY October Towards a eablig approach i commuity care