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Putting the clients of home help in control

In the last two decades, there has been a sea change in how older people are assisted to stay living in their own homes. From a focus on ‘doing things for people’, the approach is to assist people to maximise their ability to do it for themselves. This is called restorative home support, or RHS.

In its Operational Policy Framework 2010/11, the Ministry of Health required DHBs to include a restorative model of support in their services. Reviewing home-based support services for older people in 2011, the Office of the Auditor-General described the intent of the RHS model of care as improving the independence of older people or maintaining their level of function for as long as possible.

Better living for older people isn’t the only driver here – money spent keeping people active and safe in their homes means money saved on provision of residential services, presentations at emergency departments, and hospital inpatient admissions.

The vision of the New Zealand Healthy Ageing Strategy is that older people ‘live well, age well and have a respectful end of life in age-friendly communities’. Its framework for achieving this includes enabling ‘high quality acute and restorative care, for effective rehabilitation, recovery and restoration after acute events’. The Ministry of Health, in its 2019 – 2022 update of the strategy, lists improving acute and restorative care as a priority.

In its 2013 proposal for implementing an RHS model, Waitemata DHB made explicit the role of the client and family in the process – the ‘goal-based care plans’ should be ‘developed by the client and their family/whānau and the care manager, employed by the provider’.

The Southern DHB sings from the same songbook when it says that its Aged Care Needs Assessment and Service Co-ordination aims to maximise a person's independence. ‘The service will be person-centred and goal-oriented, seeking to build on the individual person’s strengths’ as it identifies the level of support an individual needs in the home and community.

Just as there were with the previous model for home help, the move to restorative home support has brought some fierce battles over resources but this is not the fault of the model, rather of its implementation. At its heart, RHS focuses on individuals making the most of what abilities they have. It aims to give a person choice and a say in what happens next. When people have choice they feel much more in control of their situation, and being in control makes people feel better too.

If you are eligible for RHS, the more you and your family or whānau engage in formulating your support plan, the more it will reflect your choices.

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