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LTSS Choices: Promoting Choices through Restorative Services: International Innovations

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People require long-term services and supports (LTSS) when they have difficulty performing daily living activities due to age, disability, illness or injury. Evidence-based services that improve functional independence can help people choose to live in their own homes and stay engaged with their families and friends in their own communities. 

This report highlights a multidisciplinary intervention that strengthens a person’s ability to function called restorative services (sometimes called reablement or restorative care). It explores the evidence of the impact of restorative services and reviews roughly 20 years of evidence related to the efficacy of these services by summarizing international and country-specific studies. It concludes with recommendations for policy makers. 

Definition of Restorative Services

Restorative services differ from traditional home care in that they reorient services toward promoting independence, rather than treating disease and creating dependency. While the definition of restorative services varies among the countries that have tested and implemented these services, there are some common shared themes. Generally, restorative services involve person-centered, goal-oriented services for older people at risk of functional decline, often after an accident or illness. Restorative services are intensive, time limited, and multidisciplinary. They can include exercise and training, behavioral change, self-management and healthy aging training, equipment, and environmental modifications. Services generally last 4 to 12 weeks. 

Improved Function and Decreased Service Use

Multiple studies find that restorative services improve individuals’ abilities and decrease service use. Participants’ function improved and their dependence on others decreased. Restorative services also improved health-related quality of life. Improvements are durable because restorative services are more effective than usual care in improving function at 9 to 12 months and decrease the number of people who need higher levels of personal care. These recent reviews indicate that service utilization decreased for those who received restorative services. A study from Australia, for example, demonstrates lower use of home care, nursing homes, and emergency departments

Reducing Costs

Beyond improving individuals’ lives, restorative services reduce the use of LTSS and other health care services and have a high probability of reducing costs when compared with standard home care. In more recent studies, home care and health care costs were lower among restorative services participants than those receiving standard home care only. Ten of thirteen relevant studies found restorative services to be cost-effective when compared with inpatient rehabilitation, home care, day hospital rehabilitation, or a waiting list control. Studies in the United States and United Kingdom indicate that restorative care is no more expensive than regular home care and reduced use of institutions. Aids, equipment, and environmental modifications also led to recoupment of the costs of services over the life of the client.

Conclusion

Integrating restorative services into health and LTSS systems in the U.S. is important for at least two reasons. One is that 30 percent to 60 percent of hospitalized older adults develop a new dependency in daily activities and only 68 percent recover to their previous level of functioning six months after discharge. Another reason is that home care often does not focus enough on promoting a healthy lifestyle, daily routines, social support, exercise, autonomy, and control. As a result, older adults can become mired in an avoidable dependent role. Restorative care can give older adults more choice over their lives and has the potential to improve health-related quality of life, function, and independence. 

Suggested citation: 

Reinhard, Susan C., and Jane A. Tilly. Promoting Choices through Restorative Services: International Innovations. Washington, DC: AARP Public Policy Institute. December 9, 2021.  https://doi.org/10.26419/ppi.00158.001

 

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