Embedding allied health in aged care: the EAHOP model

Description of impact

Quote from a family member: “Mum was pretty severely disabled when she moved in [to the nursing home], and to know that there were going to be people helping her out every single day with her rehab was just such a relief. It’s great on so many levels. The physical improvements have been fantastic, but the mental boost as well – being part of something bigger than us; the research that is going to ultimately improve the way that aged care is delivered in Australia.”

The problem

Around 190,000 Australians live in nursing homes with high needs in daily living, cognition, frailty and complex care, and over half of these people have dementia. The Royal Commission into Aged Care Quality and Safety (2018-2021) identified serious shortcomings in allied health access and quality in nursing homes in Australia. For example, the international benchmark for allied health care for older people living in residential care stands at 22 minutes per day, but reports suggest Australian providers averaged just four (4) to eight (8) minutes per day. Australians in residential care are missing out on essential diagnostic, therapeutic and rehabilitative care that help prevent illness, manage chronic conditions and recover from injuries – in terms of access to service providers, quality of service, and duration of service for adequate care. And reforms since the Royal Commission are inadvertently reducing allied health time even further. The research-led Enhancing Allied Health for Older People (EAHOP) model responds to this challenge by embedding a multidisciplinary allied health model in a nursing home to improve resident health and wellbeing, evaluate its effectiveness in practice, and explore how similar models can potentially be implemented around the country for better care of older Australians.

The approach

EAHOP embedded six senior allied health clinicians (dietitian, pharmacist, physiotherapist, occupational therapist, optometrist, speech pathologist), two allied health assistants, and a nurse team leader/clinical liaison manager into a nursing home here in Canberra. The model followed a framework for complex interventions and the Age Friendly Health Systems 4Ms Framework (Matters, Mentation, Medication, Mobility) – best practice approaches informed by research. Residents were screened and comprehensively assessed, and tailored care plans were co developed with a General Practitioner using a case conferencing model. These care plans included referrals to relevant allied health disciplines under EAHOP to manage and, in some cases, improve, health conditions and quality of life. Interventions ran up to 36 weeks, with allied health assistants working with clinicians across disciplines. 

The Sunbeam program is an example of a transdisciplinary program delivered under EAHOP involving progressive resistance and balance groups, where residents participated in sessions from a physiotherapist and an allied health assistant across different disciplines to improve their strength and balance and help prevent falls and injury.

 We employed a mixed-methods process evaluation for the pilot and found:
• Reach: 36 residents received assessments/interventions.
• Dose: Median 18.2 minutes per day of allied health per participant (IQR 12.4–26.6), much closer to international best practice, over a median 36 weeks; totalling 145,760 minutes.
• Fidelity (commitment of clinicians and carers to provide quality care):  Allied health assistants supported most Sunbeam groups and provided interprofessional sessions across multiple disciplines. Allied health clinicians were committed to delivering quality care to their patients and established strong relationships with residents. 
• Cost: AU$49.20 per day, per resident.

The team also conducted and analysed interviews with residents, families, intervention staff, and home leadership to gather valuable qualitative data about each group’s experiences and feedback on EAHOP. 

Supporting implementation of the model involved: 
• Orientation and training for service providers and nursing home staff; 
• Monthly meetings with care staff, project leads and other stakeholders; 
• Facilitating student placements to reduce costs and provide valuable practical experience for future allied health practitioners; and 
• Involving the EAHOP clinical liaison manager in project management, care coordination, education and relationship building.

Implementation and uptake of the research

Mechanisms & culture: embedding allied health clinicians within the nursing home enabled proactive, flexible care and fostered strong relationships with residents and staff, which proved to be the key driver of impact. The transdisciplinary assistants made service delivery more efficient and effective, coordinating and communicating between allied health clinicians and nursing home staff.  The EAHOP team were supported by leadership and included in the care team’s daily huddles, allowing them to integrate into the broader care team.

Scaling and future implementation: the team is exploring future opportunities to test the EAHOP model across multiple sites, explore sustainable business models to support multidisciplinary planning, and address funding and regulatory constraints for wider adoption. The nursing home involved in the initial study has continued with a modified strength and balance program, and cognitive stimulation therapy, with ongoing involvement from University of Canberra allied health students.

Outcomes and impacts for beneficiaries

Benefits for residents:
• Increased engagement in meaningful activities via individualised plans and relationship centred care. Residents reported feeling dignified and understood.
• Improved strength and mobility through Sunbeam programs and flexible therapy.
• Reduced unnecessary medications by aligning allied health and medical plans with pharmacists and GPs.
• Improved vision from optometry assessments and tailored interventions.
• Improved cognitive communication skills through speech pathology programs and tailored assistant delivered sessions.
• Improved nutritional intake from dietetic assessments, review of in-home foodservice and recommendations.

Quote from a resident: “Now, I can speak, I can sit upright, I can move – though it’s still a bit shaky – and I’ve even had cataract surgery. A lot has changed. I think I would’ve been very depressed without this program. You don’t realise how big those things are until you can’t do them anymore.”

Benefits for staff:
• Greater job satisfaction for delivery practitioners by supporting person‑centred care, building meaningful relationships with residents, and working to full scope.
• Improved care due to strong leadership support and integrating the EAHOP team into daily care team huddles.
• Improved teamwork through case conferencing and student involvement.
• Systems improvement in nursing home via audits by allied health clinicians (e.g., nutrition, pressure injury, equipment) and proposed process reviews.

Potential impacts of EAHOP with broader implementation:
Wellbeing impacts:
• Improved strength and mobility of aged care residents.
• Decreased falls risk, also decreasing injury rates and severity with falls prevention.
• Improved quality of life of aged care residents with increased strength and mobility.
• Improved vision outcomes and care for aged care residents with embedded optometry services.
• Improved relationships and connections for residents with speech pathology programs and sessions improving cognitive communication skills. 

Societal impacts:
• Improved job satisfaction and sense of fulfilment for delivery practitioners.
• Positive shift in perceptions of aged care and older people from relationship building between staff, residents, care providers and families. 

Economic impacts:
• Increased work opportunities for allied health professionals and assistants in aged care.
• Decreased costs of pharmacological care with reduction of unnecessary medications.
• Improved learning outcomes and quality of care by allied health students in aged care through practical experience. 

Evidence and support

An initial evaluation has been undertaken, which found the model delivered a median 18.2 minutes per day of allied health per participating resident – over four times the national median and closer to international best practice – costing AU$49.20 per day per resident. Fidelity was high across disciplines with GP case conferences were routinely completed.  Through 26 interviews with residents, families, EAHOP staff and home leadership, we found the program succeeded due to strong relationships, embedding allied health staff and good practice, and transdisciplinary assistants who could support residents across different services.

A full cost -effectiveness evaluation is currently being undertaken and will be published in 2026. Future projects scaling up the EAHOP pilot will continue to evaluate its effectiveness and impact