QUESTION: WHAT IS THE STATE OF IN-HOME COMMUNITY BASED REHABILITATION SERVICES IN AUSTRALIAINSIGHTSThe In-home community based rehabilitation service main purpose in Australia is to deliver basic training and services to disable people in their homes within the community, including all services necessary to improve the participation and functioning of daily lives.The Community Based Rehabilitation is sponsored by various state governments, private not-for-profit providers and private providers and it also offers different type of services, and various insurance covers.FINDINGSHello, thanks for asking Wonder for an analysis of In-home community based rehabilitation in Australia. Firstly, community based rehabilitation is a process that seeks to prepare and provide education and training for rehabilitation clients, community members, families and community sector to take on suitable roles in the delivery of health and rehabilitation service to attain improved and suitable client outcomes. In simple terms, CBR refers to the delivery of basic services to disabled people within their community, including all services necessary to improve the participation and functioning in daily life. While In-home rehabilitation is a substitute for inpatient rehabilitation. It provides people who have been in hospital with access to rehabilitation therapies and nursing in their home, instead of hospital setting. The increase in awareness among health care professionals, wider community and funding providers of the value of rehabilitation for persons facing limitation as a consequence of illness, injury, surgery or the aging process has resulted in rehabilitation programs located in Australia communities. In these community programs, it is common for health care professionals to provide rehabilitation services in the client home. However, this model of service delivery is not suitable for most rural and remote Australia communities due to the difficulty associated with distance, low population densities and lack of workforce. But they have been various suggested proposed project that could help resolve the difficulties faced in rural communities. For example a ‘network community-based rehabilitation coalitions’ approach encourages individuals and communities to contribute to the rehabilitation of themselves and others and avoid over-reliance on volunteers. TYPES OF IN-HOUSE REHABILITATION SERVICESThe types of services offered for In-home rehabilitation are:Rehabilitation and Geriatric Medicine Specialist assessment and reviewNursingAllied health including:PhysiotherapyOccupational therapySpeech pathologyDieteticsSocial workExercise physiologyAllied Health Assistant.The main focus of this research is on Physiotherapy community based Rehabilitation. Physiotherapy is defined as the treatment of illness, injury, or deformity by physical methods such as massage, exercise, and heat treatment rather than drug or surgery. With the rapid aging of the population of Australia, physiotherapists play a more vital role supporting older Australians to stay healthy and active. Most of the aged care sectors are adequately funded, so all residence can access the physiotherapy they need to maintain their optimal function. It is also important to note that the Allied Health Professions Australia (AHPA) is a national voice for allied health professionals. They play essential roles in proving rehabilitation services in rehabilitation facilities, hospitals, home, and other community settings. Their team includes physiotherapists and exercise physiologist, which assist in strength training and improving balance, mobility and limb function.ORGANISATIONS PROVIDING IN-HOME CBR IN AUSTRALIAOrganisations providers of In-home CBR comprise a mix of government (commonwealth and state) and private sector providers. Current funding arrangements has led to a mix publicly and privately-provided service for clients. The State Health Funded CBR Services in Australia is:Aged Care Assessment Teams (ACAT): Aged care system caters for Australians aged 65 and over (and indigenous Australian aged 50 and over) that can no longer live without support in their own home. Care is provided for people’s home, in the community and in residential aged care facilities by wide variety of providers. The teams may consist of registered nurses, physiotherapist, and occupational therapist.Transition Care Teams: It is applicable to all metropolitan public hospital/health services in Western Australia, especially staff of the Aged care Assessment Teams, social workers and staff involved in discharge planning. The teams may consist of enrolled nurses, physiotherapist, and speech pathologists and dietitians.Community Adult Rehabilitation Services (CARS): Generally targeted at older populations, those with strokes and other neurological conditions. The teams may consist of physiotherapist, and occupational therapist and psychologists.Commonwealth Home Support Programme (CHSP): Provide support for frail and older people. Teams are nurses, physiotherapy and counsellors.Private not-for-profit providersBluecare, Spiritus and Angllicare, provide domiciliary nursing, personal care in the home of eligible clients. They are usually funded by Home and Community Care (HACC). Private providersThere are many private rehabilitation providers, they provide the same In-home support but with special perks. We have the Australian Unity hospital, SA Health, and Calvary rehabilitation hospital etc.INSURANCE COVER FOR IN-HOME REHABILITATION Insurance plays a vital role in the In-home CBR. Rehabilitation can be funded or provided by other insurers and Government entities such as work compensation insurers, private health insurers, Medicare, Compulsory Third Party motor vehicle insurers and the National Disability Insurance Scheme (NDIS). The provision of rehabilitation by those entities is regulated to ensure the rehabilitation requirements are funded appropriately and are reasonable in all the circumstances. I will briefly explain how each insurance cover works below:Workers compensation insurer: Is a statutorily compulsory for all employers in every state and territory in Australia to have this insurance. It provides protection for workers when they suffer any illness flowing from activities at work. It only covers rehabilitation resulting from work injuries.Medicare: This health insurance scheme guarantee all Australians (and some oversees visitors) access to varieties of health and hospital services at little or no cost. The Medicare benefits allows for physical therapy, and occupational therapy service to be provided for purposes of symptom control or to enable the individual to maintain basic functional skills. The commonwealth’s Medicare legislation in Australia also guarantees public patient free treatment in all public hospitals. However, Medicare does not over dental, ambulance service and some allied health.Private Health Insurance: Medicare will only cover the rehabilitation cost you incur as an inpatient in a public hospital so one needs a private health insurance. Once person takes out an extras cover policy he/she can receive benefits that pay towards some or all the cost of out-of-hospital rehabilitation treatment. Private health insurer can cover additional service that Medicare does not, such as physiotherapy and also give more choices in health care, for instance the ability to choose a specialist and surgeons. About 47% of Australian population has private health insurance and the assurance provided by Medicare (Australian Government Department of Health 2018). Examples of Private health insurance that covers rehabilitation are AHM Health insurance, HCF, and NIB etc.Compulsory Third Party Insurance: The insurance covers your liability and the liability of anyone else that drives your vehicle for injuries you may have caused or the road user in a motor accident. Therefore, it covers rehabilitation cost arising from motor accident. In Queensland Australia is very compulsory for all vehicles to have CTP insurance. Examples of third party insurance are RACQ, Allianz and Suncorp etc.National Disability Insurance Scheme: The scheme was enacted in 2013 and is expected to be in full operation in 2020. There are around 4.3 million Australians who have a disability. Once it is fully rolled out NDIS will provide for about 460,000 Australian under 65, who have permanent and significant disability with funding support and services. CONCLUSIONThe research finding suggests that the Australia government plays vital roles in supporting and funding In-house Community Based Rehabilitation Services for Australians, especially in the aged care sector. 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