As Australia prepares to implement the Support at Home program, aged care providers and policymakers have a rare opportunity to reimagine what care at home could—and should—look like. At the heart of this reform lies an important but often misunderstood concept: restorative care.

For individuals living with dementia, restorative care is frequently equated with “support” rather than rehabilitation. This reflects a long-standing and flawed assumption that rehabilitation is only appropriate for conditions where improvement or recovery is expected. But emerging evidence challenges this notion and suggests that rehabilitation not only has a place in dementia care—it’s essential.

Rethinking Rehabilitation in the Context of Dementia

The traditional exclusion of people with dementia from rehabilitation programs has been driven by clinical uncertainty and systemic bias. Yet recent research provides a compelling case for change.

A systematic review by Forsgren et al. (2021) found that multidimensional reablement programs—including physical therapy, cognitive interventions, assistive technology, and caregiver support—can significantly improve functional outcomes for people with dementia in home settings.

Similarly, a major randomised controlled trial by Clare et al. (2017) demonstrated that individualised cognitive rehabilitation interventions helped people with early-stage dementia maintain independence in everyday tasks and improve their sense of self-efficacy.

Even in post-acute care, rehabilitation has shown promise. A study by Sivananthan & McGrail (2016) found that people with dementia benefited substantially from inpatient rehabilitation following hip fractures, with improvements comparable to those seen in people without dementia.

These findings reinforce a critical message: rehabilitation should not be denied based on diagnosis alone.

Support at Home: A Window of Opportunity

The upcoming Support at Home program, set to replace the current CHSP and HCP systems, brings a renewed focus on restorative care and functional independence. While this is a welcome shift, there is a risk that individuals living with dementia may be inadvertently excluded from receiving structured, therapeutic support—simply because their condition is progressive.

The World Health Organization’s 2019 guidelines on dementia risk reduction emphasise the importance of physical activity, cognitive stimulation, and social engagementin maintaining function and quality of life. These are all hallmarks of good rehabilitation—and can be delivered effectively in the home setting.

To align with both global best practice and national reform goals, Support at Home must embrace a rehabilitation-inclusive model for people with dementia.

Bridging the Gap: Rehabilitation vs Reablement

Part of the challenge lies in the ongoing terminology confusion across aged care policy and service delivery. Terms like reablement, rehabilitation, and restorative care are often used interchangeably, yet they carry distinct meanings:

• Rehabilitation: A goal-directed process aimed at optimising function, often involving clinical disciplines like physiotherapy, occupational therapy, and speech pathology.
• Reablement: A time-limited, often less clinical approach focused on regaining skills and confidence after a decline in function.
• Restorative care: An umbrella term often used to describe a mix of support strategies aimed at maintaining or improving function.

In dementia care, these terms are frequently omitted or diluted within “holistic” care approaches. While person-centred care is rightly prioritised, this should not preclude the use of structured, evidence-informed rehabilitation strategies. In fact, rehabilitation—when tailored to individual goals—is inherently person-centred.

What Does Dementia Rehabilitation at Home Look Like?

A dementia-inclusive rehabilitation model within the Support at Home framework could include:

Component	Description
Cognitive Rehabilitation	Personalised strategies to support memory, attention, communication, and daily routines.
Physical and Occupational Therapy	Falls prevention, strength and mobility training, and enabling engagement in daily activities.
Assistive Technology and Home Modifications	Use of visual cues, adaptive devices, and safety enhancements to support independence.
Multidisciplinary Collaboration	Coordination between GPs, allied health professionals, care managers, and carers.
Post-Acute Rehabilitation Access	Inclusion in rehab pathways following hospitalisation or health events, regardless of cognitive status.
Caregiver Training and Support	Equipping informal carers with strategies to reinforce rehabilitation at home.

---

Why It Matters: Clinical, Economic, and Human Reasons

Implementing rehabilitation principles into dementia care at home is not only clinically sound—it’s economically prudent. Supporting people to maintain function can delay or avoid premature entry into residential care, reduce hospitalisations, and improve overall wellbeing.

For care providers, it’s also a chance to enhance service quality and outcomes, especially under a model where funding will increasingly align with demonstrated impact.

Most importantly, it reflects a commitment to dignity, autonomy, and respect for people living with dementia. It acknowledges their capacity to participate in their own care and pursue meaningful goals, even in the face of cognitive decline.

Conclusion: A Call to Action

As the Support at Home reforms take shape, it is essential that rehabilitation for people with dementia is not overlooked.

We have the research.
We have the policy momentum.
What’s needed now is a shift in mindset—from viewing dementia as a barrier to rehabilitation, to recognising it as a condition that requires and benefits from it.

By embedding rehabilitation into restorative home care packages, we can support people with dementia to live not just longer—but better.