Harnessing the Power of Exercise in Aged Care:
Insights from Exercise Physiologist Dr Tim Henwood

Interview Transcript

WRK4CE
Please give us a bit of insight on your background? Touch on some of the highlights; what you've done, especially around Healthcare.

 

Tim Henwood
So I started my career as a sports and exercise scientist. Very early in the days of exercise physiology, and had a passion for learning more about the field of older adults. So, then went in through postgraduate pathways to do an honours, and PhD, which then led to working as the healthy, ageing research fellow with what used to be the University of Queensland and Blue Care Research Centre.

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After a long and very promising academic career, looking specifically at how adults responded to exercise and most specifically resistance training, I then went down the pathway of some consultancy to help aged care providers realise the value of allied health is a better pathway than just care alone for keeping people independent and within their own home. That consultancy brought me down to Adelaide, where for nearly 7 years I was the Group Manager For Health and Wellness, with Southern Cross Care, in South Australia, NT and Victoria.

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During that time, I took what was a very average aged care service, and built it up to be probably one of the better services nationally for multidisciplinary health and wellness, engagement for older adults in the aged care system, and that reached across. We had allied health and therapy respite. We did telehealth, social engagement. We did a lot of research, and we also did a variety of other multidisciplinary programs across all those settings, short term restorative care, and the transition care program, and the reputation of that service was so strong.

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In the last couple of years, I spoke to the Royal Commission to help them understand the value of allied health and exercise as a pathway for wellbeing. I’ve also been doing work with the ‘support at home’ group, trying to help them realise what Allied would look like in the coming support at home reform after working with one provider. Now, I'm hoping as a consultant to be able to help other providers with that vision as well. There's a lot of interest out there. I think people are seeing, particularly with the baby boomers coming through, that having a reasonable allied health therapy exercise pathway can have value to track people into a business, but also can help reduce a lot of the issues that older adults have in relation to independence, and providers have, in relation to staffing the care needs of older adults to keep them independent.

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WRK4CE
So you’ve got a great foundation in academia and you’ve made the transition to working in industry. With that in mind, what are some of the aspects of your academic research into exercise that you have seen translate into real benefits for older people?

 

Tim Henwood
I think the biggest thing is the realisation of how much evidence is out there. And I think, typically what happens is a lot of Aged Care Providers are so caught up with the now; trying to deliver the best services they can, and they're looking at things like the Commission recommendations and trying to stay abreast of those things. They don't get the chance to look at evidence, absorb the evidence and finally match the evidence to their vision.

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The evidence is not often well matched to service delivery anyway, because evidence comes from very rigid methodologies.

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These control groups might eliminate people with dementia or cardiovascular disease, and often the parallels just aren't there between good research and good care. So, from my perspective, I was able to then take those elements of evidence, and slowly but surely embed them in the health and wellness service. As we went on we added more evidence, rather than just saying “This works, do it this way”.

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I think the biggest thing was having an understanding of the methodological process. Everything has to go through a certain amount of steps. There was also incredible value in building up a service that cuts across all those services as well. So, I didn't just stop having our health and therapy in the health and wellness space. We also embedded it into the respite services because we knew that just because people had dementia didn't mean they couldn't benefit from exercise. It didn't mean they might need dietetics. It didn't mean they might need an occupational therapy review in the home. So, having that ability to cross over across all those environments again, looking at that evidence based practice, allowed us to really build up quite a high quality standalone service.

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WRK4CE
And with that wealth of evidence you built up, I want you to take on a hypothetical situation. I'm running a small aged care facility, where we don't have the capability to develop these programs, so we’re engaging you as a consultant. What factors do I need to consider when putting together exercise programs for older adults?

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Tim Henwood
I think that one of the biggest things, and it's lacking across all health services, is health literacy. We were often so focused on delivering good quality care that matches against the commission standards, that a lot of people lose that vision of everything else that sits around it. 

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So, rather than going into somebody's home and just doing the domestic assistance, you need to consider how much social engagement are you doing with the client? How much time are you observing the client? Is the client using furniture to walk? Is the client struggling to get out of their chair? Having that improved health literacy amongst care staff can quite often lead to earlier identification of people's needs, and if you can identify them earlier, you can intervene earlier.

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That might mean working with an agency, it might mean partnering with an allied health team local to your area. But if you intervene early, you’ll see a reduction in the risk of falls, the risk of squalor and the risk of social withdrawal, along with all the other things that come with physical decline. So health literacy is quite often overlooked across the whole of the organisation, and I think people could do a lot better. 

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WRK4CE 
You mentioned a couple of times now, social isolation or disconnection? It's very well known that moving your physical body does wonders for your physical health, but is there a good foundation of evidence showing a positive effect on mental health of older adults?

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Tim Henwood
Yes, very much so. What we were showing in Southern Cross Care was evidence to this. People turned up to group exercise because they wanted to see people who are in that group exercise class, that social engagement for those people was the driver of them being there. The exercise is just something they knew they had to do, so they were going through the motions with the exercise, but the engagement of being there with those people was the real incentive.

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There's some great examples around, there's an organisation up in Brisbane called Burnie Brae. They are built around a community centre. People there are doing everything from line dancing, ping pong, going to the gym and doing volunteer activities. But, the big thing that brings them all together is the social engagement, because they're catching up with people they know, and they enjoy the company of. I helped them start quite a good exercise program many, many years ago, which still booms today. But again, most of it's built on the fact that the client can go there, get a cup of coffee, go to the book library, pick up a book, take it home, using their transport service. So, it's this big hub where people are getting all those unmet needs fulfilled that they don't just get in their own home environment.

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WRK4CE
So, it's not just that you have to build something in isolation, where residents do physical activity, it needs to be a part of the greater ecosystem of care?

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Tim Henwood 
Yes, that's the ideal circle. There's a lot of missed opportunities in retirement villages these days; where so many people are locked away in their units, even though they're living with 100 other people who are in exactly the same boat as they are. And that's because there's no clubhouses. There's no bus trips. There's no opportunity to get to know your neighbours. So they don't go.

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However, I think there's a lot more proactive retirement living going on these days where people are setting up happy hours, social engagement environments, community hubs, gymnasium swimming pools that are actually driving people to this. That way they become more engaged in their own communities.

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WRK4CE
So, I can see a really clear model where I, as a provider who has their own facility, I have a captive audience and can make this possible. Have you seen home care organisations do this too? Whether it's in partnership with a gym or an aquatic centre, or something like that, where they are taking their home care clients into a collaborative exercise environment?

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Tim Henwood
I haven't seen a good model yet. There's definitely a lot of talk about it. We talked a lot about it when I was in the Group Manager role at Southern Cross.

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I think there are a lot of people caught up in the complexity of home care. It's not just scheduled domestic assistance and personal care, it's managing the bookings, managing the invoicing, changing the bookings, keeping the runs right to the staff and making sure you've actually got staff that day. There's so many balls in the air running a good home care service that I think the other stuff can be forgotten.

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But this is why I go back to the health literacy piece. If the care goes around to somebody's house and that older person is struggling to get out of their chair or using their furniture to walk, they've seen this dwindle in this person for the last 5 weeks. They're getting worse and worse. Then, I think they can identify it early. You can really start making inroads into prevention of it getting any worse.

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WRK4CE
That sounds to me like a training piece or a skill requirement for carers or RNs, or whoever is delivering the service in home care so that they can better identify the symptoms that lead to future problems.

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Tim Henwood
Yes, early identification. It goes right back to the beginning as well. We've got a health system which is reacting to everything that they need to react to. But they're not planning care. We've got a lot of health providers who are treating people through private health. 

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There are better and emerging care models out there. I think we're starting to see it; the baby boomers are just around the corner and they will demand and want better care. I think the average aged care provider is fed up with going into their own retirement villages and seeing four different service providers, little cars parked around their villages indicating to them that their home care service could be better because it's not attracting the client base.

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WRK4CE
So, I just want to touch on something you mentioned; the baby boomers. Everyone in the industry is seeing this wave coming in very soon. One of the things we've researched and seen is that the baby boomers look very different to what the previous generation, both culturally and linguistically. Which reflects Australia being a society built on migration. Have you seen in your research, or your work at Southern Cross Care, how different cultures of older adults experience exercise, or their willingness to engage in exercise?

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Tim Henwood
Yeah, very much. I was making jokes about this the other day. Years ago, I did some work with the Greek society in Brisbane and the preference was 45 min of exercise. The ladies would exercise hard, but then they ate afterwards for 2 hours, and that was their social engagement. They all brought pans of food. You couldn't leave the room until you ate afterwards with them. Very similarly, I just had a conversation with Bene Aged Care, one of the Italian providers, and it's very much the social engagement that comes after the exercise is incredibly important.

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We've seen it in a lot of our Gyms. We mentioned the Burnie Brae experience before, and we tried to marry our gymnasium as much as we could to coffee shops with Southern Cross Care, and had quite a little bit of buy-in from people who would do their workouts and go and socialise afterwards.

I think in those cultures, the really big cultural groups, such as Greek and Italian migrants, exercise is secondary to the social engagement that they experience afterwards.

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WRK4CE
Interesting. Obviously, the next wave of aged care clients will be that heavy European migration, and the next generation will look slightly different, and the next generation looks slightly different. It’s going to be interesting for providers to try and come up with solutions because a ubiquitous approach of doing your 45 min of walking isn't going to work that well.

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Tim Henwood
I don't know if you’ve ever been to China, but the parks are full of people doing Tai Chi. Self motivated, all ages at different times of the day. And in Japan, there are these big morning exercise groups where people stand around a little speaker that booms out an exercise regime, and people follow it in the hundreds. In Singapore, there are a lot of adult playgrounds everywhere. On the surface they look like a playground, but they’re filled with balance beams and mobility challenges, strength challenges and things like that that are quite well utilised by the local older population.

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WRK4CE
I spent a fair bit of time living in India in the last decade, and for older Indian’s the primary thing is walking in the park. It’s a tough place to get outdoors at times, especially in the summer. When they could get out, we would see people in the park walking, doing some yoga, doing body weight exercises. This is all done very early before they have breakfast, because that's just culturally how they do it. And for every country it will be different.

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Tim Henwood
Yeah. And I, I think that's it. I was talking to somebody about it today, we're having a conversation about how the primary place of residency is protected. Australia has all these 80 year old ladies living in 5 bedroom mansions who are on the pension.

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I'm sort of caught between a rock and a hard place as to how I feel that scenario should go, but I do think as well. One of the things we don't do is have great conversations about what next? We never talk about the ageing process. We never talk about what happens when this house becomes too hard for me to live in. What happens if I get dementia? All those sorts of things. It's only just recently the advance care directives have started to become mandatory. So, many people still don't have them, but they're all a driver to conversations about ‘what next’?

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We're in a boat where we need to have those ‘what next’ conversations? Like, we've just said, about people from certain Asian cultures. And a great percentage of the Europeans actually care for their elderly differently, bring them into their homes, incorporate them into their families, and they play a role within those families until they can't care for themselves anymore. And I think in doing that, those older adults then feel a greater commitment to stay as healthy as they can, so that they can play that role in the family.

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Whereas, the amount of people I see who expect to turn 65 or 70 years of age and get somebody to clean the house, because that's what happened to mum. And mum did it because her mom got somebody around to help with domestic assistance. We're a little bit skewed in our thinking.

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WRK4CE
You're talking about baby boomers. The conversation I often hear is that baby boomers have different expectations and higher expectations of service. I imagine that's something that needs to be brought into consideration when building these programs that they're gonna expect more and not be happy to be sitting around all day.

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Tim Henwood
Very much. Baby boomers are a lot more empowered. One of the things that we have a hard time with is getting older adults to engage with exercise. I think a big help is with everyone having phones and the internet. This has led to apps targeting this space, where people can exercise at home through an app, either on their phone or through their computer and this is using AI to generate the programs for them.

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So, there's the joy of that sort of stuff as well. But the other end of the scale is, they're also gonna come through with higher levels of education and greater capacity to get information which will also then drive decisions. I'm going to that retirement village because it's got this sort of gym, or I'm going to go with that provider, because they've got a particular health program. 

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WRK4CE
Talking about exercise becoming a driver for future clients/residents being interested in specific homes, if I'm an aged care provider, what are the potential things that I need to see at my residential facility to make it more appealing than somewhere else.

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Tim Henwood
Not just flashy gyms and pools and stuff like that, but actual dedication that you want them to be utilised, and it won’t just be down to the self-motivation of the resident.

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They actually have an allied health set-up where they do assessments. So that you get the right program, those sorts of things. So, a dedication to actually doing what's gonna benefit the client rather than just giving them something that they need to self-motivate.

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But also, for the average age care provider. I think we really need to think about: we've been doing it like this for so long, what would be a better way to do it going forward? If you look at aged care, some of the figures and the service deliverables - They've been the same for 15 years.

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We need innovation. We need people to think outside the box. And I know I know funding is tight, and the government and the average Australian just does not value aged care as it should be valued.

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To do something different. We need to take chances and actually look at what's working elsewhere. And how can we change what we are doing?

 

WRK4CE
Ok. I have an anecdotal experience of my mother in law who has aged and overtime has picked up some injuries which has limited her movement. She still gets out and has started using an app based exercise regime on her ipad. It’s one of the things that really appeals to her, she can do it in her home but there is an engaging community of people on the app. So, she still feels like she’s exercising with other people, even though it’s all on the app.

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So the obvious question with that in mind is, how do you build that? How do you get that level of engagement, and how important is that level of engagement?

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Tim Henwood
It’s variety. Some people love that, some people hate that. Some people want to be regime driven. Some want something different every day. Some people want to be challenged. Some people don't want to break a sweat. And then there’s everybody in between. You need to strive towards having vibrancy as well as personal touch. It's very hard to get that in an app.

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But we've got a whole new generation of people who are much more adept at working in that space. You know the guys who are in their twenties and thirties, who have 550 friends on Facebook, 5 of which they've ever met in real life. That’s the internet generation who are engaging with people from all over the world. They don't really need to have a level of social contact with exercise. But the current generation, they need that social contact to feel important.

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The next generation will be a little bit more proactive about being self motivated, the next generation, again, more proactive about being self motivated. But again, I think this is the joy of the apps that we see coming through. So many apps are doing carer solutions or dementia solutions, but they're all a little bit different, because everybody wants something which is a little bit different as well. So, there is a great opportunity to land on something which is perfect for you, and therefore there's a great opportunity for massive amounts of variety in that space.

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WRK4CE
So, the take away I'm getting from you is there has to be flexibility built into these programs. But more importantly there has to be personality. It’s not a completely rigid system that's just gonna be able to be plugged into any facility. We have to bring a system in place that gives the individuals delivering the care and the exercise program the ability to have their own personality come through in that program to engage participants and participate more.

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Tim Henwood
Yeah, I think that's the truth. We go back to the social stuff we were saying before. So just like it needs the social component, it needs an individual component. We need to be looking at everybody individually and going you're obviously a bit more anxious, or you've got a very outgoing personality. How do we take these things into account? Exercise programs can be very generic. And I think that's where that personal touch becomes very important. Because even though you've given 5 people in the room exactly the same program, you're engaging each person differently based on their personality and their needs.

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That becomes a little bit harder when you're using app based activities, unless you're doing lots of work in the background. 

 

WRK4CE
To recap. We've talked about the need for exercise in aged care, the benefits of it, both physically and mental. We’ve talked about the wealth of evidence that supports this and some of the things people can do to build it into the day-to-day delivery of care rather than having it be a standalone thing. You also mentioned having structures for people to engage and enjoy it as part of their routine.

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If I'm a provider who's got nothing in this area, what do I need to think about first of all?

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Tim Henwood
Even having simple conversations with people like me, who can help you work out where your starting point is, and what might be the best direction. Whether your vision is to have your own team and your own facilities. Or whether there is an opportunity to connect with a local agency. There's tons of providers out there. But there's not a lot of providers out there I would trust with my older mother or father.

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Making sure you're connecting to the right agencies to get that health and wellness pathway started. And even then, are there many providers out there who are really embracing technology? There's a variety of app opportunities to engage. Then you've just got that piece to do where you're helping your clients engage through technology. And that sounds really hard, but it's just the same process over and over again with every person.

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The first one is the hardest, the second one's a little bit easier by the time you've done 10 people, it's a walk in the park. 

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WRK4CE
Okay, interesting. It doesn't matter how many conversations you have in this space. So often it comes back to that question of “what would I do if this was my mother or father”?

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Tim Henwood
Yes, especially if you started talking about the benefits and the early identifiers that we discussed earlier - the evidence is just undeniable. Then, if you started talking about reform! I spent a lot of time recently trying to write Linkedin posts and trying to get the attention of the likes of Janet Andersons and Annika Wells of the world, because the barriers don't just sit with the Government, the Home Care provider or the client. Everybody has a little bit of ownership in not getting on to good allied health therapy and exercise pathways.

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I think we need that to change. I think baby boomers will offer a great opportunity for change. But we've also talked about getting providers to think outside the box; like the Royal Commission, which classified our health and therapy as a specialty service. That's how rare it is in aged care, but it is the true answer for mobilising everybody, staying on their feet, everybody getting up their front stairs, everybody resisting, falls in their living room.

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The government knows the value, but it just doesn't know how to make it work as a funding mechanism. 

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It's a big catch-22. Then we could start talking about the health service like the hospital system, which is currently clogged up with folks waiting to get into residential/home care. They're pushed out and then back in a week. Why is it a revolving door? Because they're treating the symptoms and not treating care. They're not putting care and prevention into place.

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WRK4CE
You've talked about the Royal Commission a couple of times. And you provided input into that Royal Commission. What has come out of the Royal Commission with respect to exercise in aged care. And if the answer is not a lot, what should have been in there in your mind?

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Tim Henwood
I think the message is slowly but surely dripping down. They always say that evidence takes 15 years to translate, to practise. But we're 40 years down the track now, there's over 17,000 publications stating the benefits of exercise for older adults. So, I'm not not hanging any hopes on evidence translating into action.

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The Royal Commission very much acknowledged the value of allied health and therapy. It suggested that that should be part of every home care provider's care plan. But so many providers are just not set up to deliver it. And it doesn't come down to “We're gonna start delivering it. Let's get on with it.” It's not as easy as saying this should happen, and then it happens. I think it'll take time, I think there is a process in place like in the reform space. The Government is very much looking at carrying through the short-term restorative care program to become a restorative care program in support at home.

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It should happen as early as July 2025. So that'll be a 12 week program that people can be referred to, they get 12 weeks of intensive allied health and therapy, which should make them functionally better afterwards, and they should also get a period of health literacy which will help them self-manage afterwards as well. So that's happening.

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The new quality standards that we've just had come through, where they never talked about independence or allied health, or therapy, or exercise previously, have now got a lot of that wording in it. So there is that movement. But there's a bit of an issue with how that needs to be delivered, because recently they did the request for feedback on the guidelines for the quality standards and the statement around allied health and therapy is that all clients should be offered re-able and given reablement if they choose to take it. That last little statement gives everybody hope. It's that tick box that goes offered, refused, offered, refused. 

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WRK4CE
In an environment where things are tight, financially. If there is an option to not deliver something that will cost a lot more money, unfortunately, some people will choose to skip it.

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Tim Henwood
I think there is a movement, and I've had a lot of discussions with the Government. The governing body for allied health professionals has also had a lot of discussions with the Government. I think the Government is probably fed up with hearing “You'll save money in the long run”. It'll positively impact the health system. 

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I think we go back to those baby boomers, this empowered group of people who will come through and go, my friends going to the gym, they can get off the toilet, they can get down, play with their grandkids. I want to go to a home care provider who offers that level of allied health and therapy.

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Referring back to the variety aspect, you’ll get some people who want to go to the gym and work hard, some people who want to do group exercise with chairs and balance and light balls and things like that. But you'll need to have those programs available.

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One of the greatest things I think that could happen is the government could actually set a benchmark. I'm gonna give you $10,000 to bring this person back to a high level of functional well-being after those 12 weeks. You need to show me that they've had a change, otherwise you don't get paid.

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Like the health system is rewarded for when they discharge somebody from hospital. It doesn't matter when that person comes back to hospital, or what level of health they leave hospital with. There's a lot of people out there doing their best. There's no denying it. The way the Commission set up the quality standards and the indicators. It is set up to make people do a better job. But that better job is based around good care. And if I give you care that allows you to reduce your well-being, am I really caring for you the best I can?

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WRK4CE
Right? It's a great question to ask at a foundational level. 

 

Thanks Tim.