From Quality of Life to Quality of Death

As Australia prepares for the new Aged Care Act and strengthened Aged Care Quality Standards from 1 July 2025, reablement and wellness are emerging as guiding principles in aged care reform. These approaches are about more than just maintaining function – they reflect a commitment to supporting older Australians to live with purpose, independence, and dignity.

Allied health professionals are ideally placed to support this vision. Their work spans prevention, recovery, and quality-of-life interventions. Yet, turning this vision into practice will require both systemic support and new ways of working.

Aligning Vision with Funding

In residential aged care, challenges persist. Under the Australian National Aged Care Classification (AN-ACC) model, there are currently no designated care minutes for allied health, creating uncertainty around the delivery of reablement services.

In the community, where most older Australians receive support, the upcoming Support at Home program introduces short-term funding streams. While promising in design, the practicalities of navigating these changes remain complex. Providers face questions about budgets, referral pathways, and how to coordinate care that adapts to individual needs over time.

Understanding the New Care Pathways

From 1 July 2025, Support at Home Program will introduce three broad service areas:

• Everyday Living Assistance: domestic support and meals
• Support for Independence: personal care and social connection
• Clinical Care: including nursing and allied health services

Alongside these are three short-term funded supports:

• Restorative Care (up to 12 weeks) to promote recovery and independence
• Assistive Technology and Home Modifications [AT-HM] scheme
• End-of-Life Pathway for those with < 3 months or less to live wishing to remain at home in their final months

It will be essential for allied health providers to advocate for their role in these funded routes for care and be able to scale practice to deliver the services to a growing number of older adults. Allied health providers that offer a range of services and disciplines might also want to consider how they could bundle different types of care across the classifications and promote this to referrers.

What Do We Mean by ‘Reablement’?

As aged care continues to evolve, having a shared understanding of ‘reablement’ is essential. It is not just a term, but a philosophy that shapes how we deliver and fund care.

In a recent paper led by physiotherapist and researcher Dr Claire Gough, a team from the Caring Futures Institute at Flinders University explored this very issue.  ¹Their work, part of a Department of Health and Aged Care–funded project to develop the Restorative Care Clinical Guidelines, highlights the importance of clarity and consistency in how we define reablement in practice.

According to the updated guidance for the strengthened Aged Care Quality Standards, reablement is defined as:

“A process directed by the older person to support restoration of function or adapt to some loss of day-to-day function and regain confidence and capacity for daily activities. It may promote independence, capacity or social and community connections.”

This definition places the older person at the centre. It recognises that reablement isn’t just about restoring physical function, it is also about rebuilding confidence, capacity, and connection.

Importantly, reablement is not a standalone service. It is intended to underpin all aged care delivery, regardless of the funding stream or care setting. The new standards make this clear. Outcome 5.4 states that clinical care must involve assessment, prevention, planning, treatment, and review always with the goal of minimising harm and optimising function and quality of life.²

For allied health professionals, this calls for a shift in how we frame our work. It invites us to speak more openly about the broader value we bring, not just in clinical outcomes, but in helping people achieve what matters most to them. This becomes especially important when supporting older adults with complex needs, or those approaching the end of life, where quality of life may be the most meaningful outcome we can help deliver.

Reablement Through to End of Life

Palliative care and end-of-life care has been well recognised as a core part of aged care. In this space, allied health plays a vital role in supporting reablement activities helping to sustain quality of life even as the focus gently shifts toward quality of death.

As health declines, allied health interventions can shift focus towards comfort, dignity, and maintaining quality of life. The new standards recognise this, stating that care at the end of life must align with an individual’s values and preferences.³

Recent research highlights the positive impact of allied health in aged care- particularly in mobility, sleep, balance, and daily living.⁴  Even among people living with dementia, reablement supports wellbeing and function.⁵  These outcomes speak to the enduring value of allied health across the full continuum of ageing.

Practical implications of delivering reablement

Delivering reablement well means delivering truly person-centred care: supporting individuals to achieve personal goals and maintain independence, even as health declines. This approach sits at the heart of allied health, yet it requires time, continuity, and strong communication across multidisciplinary teams.

Despite its value, current funding models present practical barriers. Allied Health Professions Australia (AHPA) has raised concerns that clinicians may not be adequately reimbursed for the direct and indirect work required to deliver reablement effectively. The restorative care pathway, limited to 12 weeks, may not provide enough time for meaningful or sustained impact. While the introduction of the end of life pathway is a welcome step, it still leaves a significant gap between restoration and end-of-life – one where many older adults continue to need skilled support.

Ongoing allied health involvement will likely depend on effective coordination of multiple funding streams, including Support at Home packages, Medicare plans, and private health coverage. Without this, continuity of care remains a challenge.

Conclusion

While the intent behind the current reform changes is strong, realising them will depend on workforce readiness. Person-centred care takes time. It also relies on effective interdisciplinary communication, continuity across care pathways, and the ability to respond to changing health and social needs.

Yet, current funding models often undervalue the indirect and relational aspects of allied health practice. Time-limited interventions like the restorative care pathway, though valuable, may not provide the continuity needed for those with progressive conditions. The end-of-life pathway is a step forward, but many older people will require support during the months, and sometimes years, between active recovery and life’s final stages.

To bridge these gaps, allied health services must be flexible, well-integrated, and equipped with tools to demonstrate their impact.

This is where the ELDAC Allied Health Toolkit can help. Developed as part of the End of Life Directions for Aged Care (ELDAC) project, the toolkit is designed to support allied health professionals working in aged care to deliver best practice in end-of-life care. Funded by the Australian Government Department of Health and Aged Care, ELDAC offers practical, evidence-based resources to guide clinicians through the complexities of aged care reform. To ensure the toolkit continues to meet workforce needs, ELDAC welcomes feedback, collaboration, and engagement from clinicians and services across Australia.


¹Gough C, Damarell RA, Dizon J, Ross PDS, Tieman J. Rehabilitation, reablement, and restorative care approaches in the aged care sector: a scoping review of systematic reviews. BMC Geriatr. 2025 Jan 20;25(1):44. doi: 10.1186/s12877-025-05680-8. PMID: 39833726; PMCID: PMC11749624.

²Aged Care Quality and Safety Commission. (2025). Strengthened Aged Care Quality Standards – February 2025. https://www.health.gov.au/sites/default/files/2025-02/strengthened-aged-care-quality-standards-february-2025.pdf

³Aged Care Quality and Safety Commission. (2025). Strengthened Aged Care Quality Standards – February 2025. https://www.health.gov.au/sites/default/files/2025-02/strengthened-aged-care-quality-standards-february-2025.pdf

⁴Farrer O, Tieman J. What Evidence Exists to Support Palliative Allied Health Practice in Aged Care: A Scoping Review. Healthcare (Basel). 2024;12(19).

⁵Poulos CJ, Bayer A, Beaupre L, Clare L, Poulos RG, Wang RH, Zuidema S, McGilton KS. A comprehensive approach to reablement in dementia. Alzheimers Dement (N Y). 2017 Jul 27;3(3):450-458. doi: 10.1016/j.trci.2017.06.005. PMID: 29067351; PMCID: PMC5654482.