Citizen's jury regarding rehabilitation in residential care following hip fracture: Methods, process and verdict

A citizens’ jury is a way for policy decision makers to hear from the public regarding a specific issue. Jurors from a broad cross-section of the public are given the opportunity to learn about an issue and deliberate together to agree upon and make recommendations regarding specific questions. Thus a citizens’ jury yields citizen input from a group that is both representative of the community and is informed about the issue. This citizens’ jury was conducted by Flinders University, Division of Rehabilitation, Aged and Extended Care to investigate approaches to providing care following a hip fracture for older people and people with dementia who live in residential care. Providing publicly funded rehabilitation services to people who live in nursing homes is controversial. There is a high and growing demand for rehabilitation services and there is uncertainty about “the return on investment” of providing these services to people living in nursing homes with limited life spans. On the other hand, without rehabilitation these very frail older people may find it difficult to recover their ability to walk. It has been argued that once a decision has been made “to fix the hip” by operating, the older person should be offered various levels of support for recovery (including rehabilitation) to ensure an effective treatment outcome. Approaching the operation and rehabilitation as one episode is not the current funding approach in Australia at present, so a decision is needed about whether it is reasonable to allocate resources from rehabilitation to people who live in nursing homes and have broken their hips but have short expected life spans. Given that the decision involves community values (allocation of resources, end of life care and care of people with dementia) thirteen members of the public participated in the citizens’ jury on 25 and 26 of June 2016. The collective recommendations to the two questions addressed by the citizens’ jury and the policy implications are summarised below.