Innovation: Everyday rehabilitation
Denmark
AAI Domain: Independent, healthy and secure living (access to health care services, physical activity, independent living)
When older people enter hospital after a health emergency and stay there for even just a few days then all too often they can lose some of their ability to live independently when they are discharged. Assuming that the older person responds well to medical treatment and can go back to living in their own home many will need some form of social care services to help them to cope. This process can be costly to the individual and the public purse depending on the prevailing social welfare system so there is a strong incentive to develop socially innovative approaches that improve the health and well-being of older people and reduce the costs of providing social care services for a prolonged period of time.
The Danish municipality of Fredericia in the eastern part of the Jutland peninsula has a population of around 50,000 people and faced the prospect of a significant increase in the number of older people, particularly over the age of 80 years, with an associated increase in the costs of providing care. To address this challenge the municipality decided in 2008 to pilot the ‘Home Rehabilitation’ project as part of a larger programme, ‘As long as possible in one’s own life’, to facilitate active ageing among older people aged 65 years and over who had been in hospital.
This was part of a wider commitment to active ageing for older people based on prevention, rehabilitation, technology and social networks to maintain everyday life for as long as possible. The intention was a paradigm change from providing home care services when older people were in need of care to a more pro-active approach based on early intervention and rehabilitation.
The Home Rehabilitation project was established as a multi-disciplinary team consisting of 15 care trainers, three occupational therapists. two nurses and two staff to visit and assess people’s needs. They assessed older people aged 65 years and older in their home environment promptly after their discharge from hospital and provided an intensive training programme to rehabilitate them. This typically involved a four week programme with 72 hours of support for activation so that older people could perform the routine tasks of daily living in contrast to providing a lower level of home care services for a prolonged period.
This rehabilitation programme included serious gaming using the Nintendo Wii, electronic pill boxes for medication as well as helping older people to help themselves. The spending on the Home Rehabilitation team was recouped within two months of operation as older people responded positively to the challenges of rehabilitation and had a much reduced need for home care services. An evaluation of the programme found that 85% of older people reported an improved quality of life and the team delivering the programme also reported greater job satisfaction.
The programme was initially funded through a National Board of Health grant for the development of older people’s care but the success of the programme, which was recognised with the award of the Danish Innovation Prize in 2010, has lead to it being mainstreamed and rolled out in other municipalities.
In relation to active ageing, the Home Rehabilitation project and the ‘As long as possible in one’s own life’ programme improved access to health care services with an emphasis on rehabilitation and prevention of further loss of capacity. The process of rehabilitation is based on encouraging physical activity and exercise to restore and improve physical capabilities and the use of serious gaming technology was innovative at the time in the Danish context. The aim of the project was to promote independent living among older people after they had experienced a period of time in hospital and it has generally been very successful at achieving this aim.