HOW IN-HOME COMMUNITY-BASED REHABILITATION WORKS IN AUSTRALIA
COMMUNITY-BASED
REHABILITATION IN AUSTRALIA-IN HOME SERVICES
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| Picture credited to OneSourceCare |
INTRODUCTION
Australia is a country
that provides a real paradigm for Community Based Rehabilitation (CBR)
services. Through policies, regulations, and enacted laws, the country at all
levels of government see the need for CBR as an efficient support-healthcare
alternative for her citizens (Source 1). As defined by the World HealthOrganization (W.H.O.), CBR is "a strategy within community development for
rehabilitation, equalization of opportunities, and social inclusion for all
children and adults with disabilities."(Source 2) Disability, in the
context of this paper, is viewed from the medical model which describes
disability as a variation from the physical norm that can disadvantage the
person physically vis-a-vis the quality of life. According to this view, barriers
experienced by people with disabilities arise from individual functional
limitations resulting from disability, as opposed to the idea that social
factors limit individuals (Source 2). Based on this, extra medical intervention
through a rehabilitation process is an important aspect of the recovery of a
person who had undergone surgery or recuperating from an illness or injury or
passing through the aging process.
Rehabilitation in this
sense refers to rehabilitation services provided by relevant health professionals
in the community context (Source 2). This means patients undergo their
rehabilitation process at the convenience of their homes instead of
medically-based rehabilitation institutions like hospitals. This indicates a
variation from a community-centered rehabilitation process. According to Geddes
and Chamberlain (Source 2), outpatients of this nature typically fall into four
categories: i) early discharge supported
with rehabilitation; ii) additional post-discharge rehabilitation; iii)
inpatient rehabilitation substitution, and iv) long term programs focusing on
maintenance of function. Irrespective of these categories, the results this rehabilitation process aims
to achieve is to integrate people back into the community, their social life or
their work environments either by helping them assume back their physical
functionalities or helping them adjust to a new form of functionality.
The highlights of this
paper are to provide an analysis of IN-HOME community-based rehabilitation
services (with a focus on physiotherapy) in Australia by examining the
following:
- The types of
organizations providing in-home rehabilitation;
- The types of services
offered for in-home rehabilitation;
- The role of insurance
(what services are covered, etc.); and
- Other insights that
shed light on the current state of the industry.
Physiotherapists are
critically in high demand in Australia for patients who may have suffered from
injuries ranging from sports-related to chronic health conditions. However,
physiotherapists are required by law to be registered under the National
Physiotherapy Board of Australia. Members of the Australian Physiotherapy
Association must also complete continuing professional development (Source 3).
Instances that could trigger consultation with a physiotherapist include pain
management, stroke and other neurological illnesses such as Parkinson's disease
or multiple sclerosis, musculoskeletal and sports injuries, occupational
health, osteoporosis, cancer, palliative care, and lymphoedema, amongst others.
Because situations like this require patients to undergo a period of healing
and monitoring, health care professionals, funding providers, and the wider
community have increasingly become aware of the value of rehabilitation for
individuals experiencing functional limitations (Source 4) as a consequence of
the highlighted conditions above. This has resulted in rehabilitation programs
located in communities that are supported by traditional hospital-based
services. In these community programs, it is common for health care
professionals to provide rehabilitation interventions in the client's home.
In-Home services have significantly increased as allied health practitioners
working in private practice may provide follow up rehabilitation support (Source 4).
TYPES
OF ORGANIZATIONS PROVIDING IN-HOME REHABILITATION
As mentioned earlier,
allied health professionals provide rehabilitation services in hospitals,
rehabilitation facilities and increasingly in the home, or other community
settings (Source 4). But these professionals operate under one organization or
the other to fulfill this need.
The
Government through relevant schemes: Medicare is the
national government health insurance policy for her citizens. Its funding can
help people meet the cost of accessing in-house community-based allied health
services through CBR programs such as the Home-Based Rehabilitation Program
anchored by the Royal Rehab Support Network (Source 5). Funding for in-home
rehabilitation services is also available through state-based government
agencies that provide workers compensation such as Workcover Queensland (Source 6) and Workcover West Australia (Source 4). If a person may require
rehabilitation following an accident injury, they may also be covered for the
cost of in-home services through State and Territory accident schemes such as
the Transport Accident Commission in Victoria (Source 4).
Larger
Hospitals: Larger hospitals provide healthcare services to
people that range from emergency medical care, inpatient care, intermediate and
acute care, aged care, allied health, to primary and community care. They can
be regarded as first responders to qualify a patient for in-house
rehabilitation services. Since larger hospitals have many professional
departments and staff, in-house rehabilitation can be easily recommended with
assigned allied health staff to monitor the process. You can find some of these
larger hospitals via this link: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/hospitals+and+health+services++country+south+australia/a+to+z+of+country+hospitals+and+health+services
Private
Clinics: Private clinics have planned procedures,
consultations or tests that are carried out by specialists on patients.
Although this usually takes place in hospitals, outpatient services may be
provided for in-home rehabilitation. For a list of some outpatient clinics,
follow this link: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/hospitals+and+health+services+metropolitan+adelaide/flinders+medical+centre/services+and+clinics+at+flinders+medical+centre/flinders+medical+centre+clinics
Primary
Healthcare Services: In 2015, the Australian Government
established 31 Primary Health Networks (PHNs) across the country primarily to
improve patients' care by making healthcare more effective, efficient, and
accessible. As a result, in-home allied health services may also be available
through community health services or local programs funded by the PHNs (Source 7). Some of the regional local health networks are as listed: Barossa Hills
Fleurieu Local Health Network, Eyre and Far North Local Health Network,
Flinders and Upper North Local Health Network, Limestone Coast Local Health
Network, Riverland Mallee Coorong Local Health Network, and Yorke and Northern
Local Health Network.
CBR
Outreach: CBR emphasizes the importance of "conceiving
health promotion programs through a negotiated partnership with the communities
whose cooperation and participation the health promotion practitioner seeks
(Source 8). With CBR in many communities, rehabilitation assistants such as
allied health practitioners and enrolled nurses are picked to work under the
direct (or in-direct supervision of health professionals such as physiotherapists,
occupational therapists, etc. to provide in-home rehabilitation services to
patients (Source 4). Examples of NGO service providers under this category are
Calvary Community Care, Home Support Services, Pop-Up Community Care, and Royal
District Nursing Service (Source 9).
Independent
Healthcare Providers: According to the recent statistics
available on Crunchbase.com, about 701 companies are listed under the Health
Care Category in Australia and only 6% of these lots are public organizations,
and 1% is non-profit. Although many of the companies listed under this category
are into diverse healthcare services, a few provide in-home rehabilitation
services either by themselves or in collaboration with other organizations. For
comprehensive details on each of these providers, see: https://www.crunchbase.com/hub/australia-health-care-companies#section-overview
Insurance
Companies: Generally, insurance companies play major roles in
healthcare provision all over the world and Australia is no different. Both
national and state governments have state-owned insurance schemes that cater
for in-house rehabilitation. Private insurance companies also take lead on
this, working in partnership with many hospitals and healthcare companies.
THE
TYPES OF SERVICES OFFERED FOR IN-HOME REHABILITATION
Types of services
offered for in-home rehabilitation include the following services:
• Rehabilitation and
Geriatric Medicine Specialist assessment and review
• Nursing
• Allied Health
including:
• Physiotherapy
• Occupational Therapy
• Speech Pathology
• Dietetics
• Social Work
• Exercise Physiology
• Allied Health
Assistant
• Personal care
assistance where this is an identified rehabilitation goal
• Short term equipment
loan.
• Rehabilitation in the
home services also incorporate access to telerehabilitation services (Source 9)
THE
ROLE OF INSURANCE
Health insurance
companies in Australia have seen the need to include home-based physical
therapy on a long-term insurance policy. What this translates to is that
in-home rehabilitation services can be accessed from private health funds.
Although the Medicare system makes provision for certain benefits under the
scheme and provides one of the best public health systems in the world, more
than 50% 0f Australians have private health insurance. This is because private
health insurance provides increased choice, convenience, and flexibility. For
instance, private health insurance makes choices for time, hospital, doctor,
and privacy.
Private health
insurance also provides cover for services generally not included under
Medicare like dental, optical, physiotherapy, chiropractic, remedial massage
and acupuncture. Many people use their private health cover to get access to
services they may not otherwise be able to afford, such as in-home
rehabilitation services. More so, the Australian Government has introduced
several different measures over the years—including a rebate, a loading, and a
surcharge—all aimed at encouraging more people to go private.
There are basically two
types of private health insurance in Australia – (i) Hospital Insurance which
covers all or some of the costs of hospital treatment as a private patient (in
both public and private hospitals) including doctor's charges and hospital
accommodation; and (ii) Extras Insurance which covers treatments generally not
available under Medicare, including dental, optical, physiotherapy,
chiropractic and acupuncture. An individual is allowed to purchase the hospital
only insurance or the extras only insurance or combined hospital plus extras
cover.
As mentioned earlier,
the Australian Government provides incentives and surcharges which were
designed to encourage more people to buy private health insurance. To read more
on health insurance policies, rebates, surcharges, and other what-have-you
incentives offered by the Government, go to https://www.australianunity.com.au/health-insurance/about
CONCLUSION
We have examined the
in-home rehabilitation services and the dramatis persona involved. In-home
services can be described as a unit of community-based rehabilitation which has
essentially been effective and efficient over time.
Due to the power of
choice enabled by private health networks, community-based services, and
healthcare affordability, patients nowadays prefer outpatient services because
of environmental familiarity, privacy, and comfort rather than spending extra 2
– 6 weeks or more bedridden in hospitals for their rehabilitation.
Although many
institutions as highlighted above are now providers of in-home rehabilitation
services, the industry is growing with the capacity of patients to afford these
services. The Australian Government has provided an atmosphere to make private
healthcare providers thrive to be able to render quality health services to
citizens. People are encouraged to take up private health insurance policies
and this forms the bedrock in the affordability of services rendered by
independent healthcare providers.
SOURCES:
Source Title: Private Health Insurance: a quick guide –
Parliament of Australia
Publication Date:
08/04/2017
Relevancy: Because of
legislation concerning Home-Care Services.
Credibility: It is a
Government website.
Source Title: A Sustainable Approach to Community-Based
Rehabilitation in Rural and Remote
Australia
Publication Date:
06/01/2014
Relevancy: It talks
about CBR in rural and remote Australia.
Credibility: Authors
are renowned scholars in their disciplines from credible institutions and the
site is a credible database for research works.
Source Title: Rehabilitative Care – Allied Health
Professions Australia
Publication Date:
07/10/2019
Relevancy: It takes a
look at allied health professionals in Australia.
Credibility: The body
is the recognized national voice for allied health professions in Australia and
is the body that the Federal Government and other national organizations turn
to when they seek a collective view of allied health.
Source Title: Rehabilitative Care – Key Areas
Publication Date:
07/10/2019
Relevancy: It takes a
look at allied health professionals in Australia.
Credibility: The body
is the recognized national voice for allied health professions in Australia and
is the body that the Federal Government and other national organizations turn
to when they seek a collective view of allied health.
Source Title: Home-Based Rehabilitation Program
Publication Date:
06/20/2015
Relevancy: It provides
a home-based rehabilitation program in Australia.
Credibility: The body
is a recognized program by the Australian Government and its source of funding
is from Medicare.
Source Title: Return to Work One Step at a Time
Publication Date:
01/11/2019
Relevancy: It outlines
workers' rehabilitation process after suffering injuries at work.
Credibility: It is a
Government website.
7. URL: http://www.phrp.com.au/issues/january-2016-volume-26-issue-1/the-new-australian-primary-health-networks-how-will-they-integrate-public-health-and-primary-care/
Source Title: How will they Integrate Public Health and
Primary Care
Publication Date:
01/26/2016
Relevancy: It provides
an article on the testimonial of a worker's rehabilitation process after
suffering injuries at work.
Credibility: It is a
testimonial with verifiable details of the source.
Source Title: Inclusion of Home-based Rehabilitation
Services in the Long-Term Care Insurance – Review on the Home-based Physical
Therapy in the OECD
Publication Date:
12/11/2011
Relevancy: It talks
about the inclusion of home-based rehabilitation services in long-term care
insurance.
Credibility: Authors
are renowned scholars in their disciplines from credible institutions and the
site is a credible database for research works.
9. URL: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/rehabilitation+services/rehabilitation+in+the+home
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/rehabilitation+services/rehabilitation+in+the+home
Source Title: Rehabilitation in the Home
Publication Date:
06/11/2019
Relevancy: It talks
about health services provided in the home from several metropolitan hospitals
across South Australia.
Credibility: It is a
Government site
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