Exploring the experience of reablement

In this instalment of the Evidence Hub, we present the summarised key findings of this article detailing the reablement experiences of clients and their families.

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Introduction

This article presents:

• Qualitative evidence about the experiences of older people and their carers in reablement programmes
  
• Findings and recommendations from 19 studies and literature sources.

Key Findings – Five main themes emerged

1. The move towards wellness and reablement represents a significant change in delivery of community aged care services. This has also created disparity between what is offered by providers and expected by consumers. 
   
2. Developing meaningful client goals can be difficult but is essential for engaging consumers in reablement interventions.  
   
3. Clients often lack understanding about reablement interventions and the associated benefits. This negatively impacts participation in reablement.
   
4. Maintenance of health and wellbeing outcomes after the reablement period needs to be considered.  
   
5. Families/support networks want to be involved, but often feel overlooked.

Theme 1

The new approach to service delivery and managing client expectations

• Many consumers expected home support services to fully compensate for their functional losses (i.e. that support workers would do all tasks for them).
• When providers expected clients to do tasks with them (rather than staff doing for them), it often led to client negativity and poorer reablement outcomes.
• Conversely, research found that reablement was generally well received by older adults and their informal carers when they:
  • understood reablement and their role in the process
  • were fully consulted in developing their reablement goals

Theme 2

Setting meaningful goals

• Clients who had relevant, achievable goals reported that this was motivating and had a positive impact on their experience and outcomes.  
• However, many older people believed that goals were not negotiated at commencement of the reablement. In fact, many could not recall the goals that were set.  
• Others reported that their priorities and preferences were not considered. There was a feeling that often the goals were imposed. This resulted in decreased engagement in reablement.  
• Service users reported that “independence” was often very narrowly defined; mostly limited to self-care and home management tasks. 
• Clients reported there was often no consideration for social and leisure engagement. For many, this aspect of daily life was a priority that remained unaddressed.  
• Improved ability to complete household and self-care tasks enhanced overall confidence for many clients. This increased motivation to improve in other aspects of daily life when the opportunities were presented.

Theme 3

Intervention issues 

•  Many older people did not understand how the reablement interventions (e.g, exercises), related to their goals. This was demotivating. 
• Important areas for intervention were often overlooked. The authors stated: “Current reablement practices for older people appear to focus on physical health with limited attention on mental health” (Mulquiny and Oakman, 2021, p.e1480) 

Theme 4

The reablement period 

• Some clients and their carers thought the reablement service would continue indefinitely.  
• Some older people and their carers described the ending of the reablement as abrupt which resulted in stress and anxiety about their future. 
• Clients often stopped the exercises and activities when the reablement period ended due to lack of support or encouragement.   
• People who required ongoing support after reablement often returned to dependency models of care. 

Theme 5

Issues for carers 

• Carers often felt overlooked in the reablement process despite a desire to be involved. They indicated they could provide insights into the client’s situation that could be helpful in assessment, goal setting and intervention planning.  
• Engaging carers in the reablement process helped them to learn new support strategies from the reablement team. 
• Carers reported having more free time for themselves when their loved ones were more independent.  

Conclusions / Recommendations 

• Providers should ensure that reablement clients understand the principles and process of reablement. This will enhance motivation and participation. 

• Goals must be created collaboratively, addressing the client’s priorities. Goals may include social, leisure and/or community activities, not only self-care and household activities.  
• The reablement period must be clearly defined. A transition plan should be developed to minimise anxiety and help the client maintain gains when the reablement period ends.  

• When exercises and other reablement interventions are prescribed, the provider should explain how the benefits will translate into meaningful activities.  For example: 
  • Improving upper body strength can help to lift and cuddle grandchildren. 
  • Improving balance and endurance can improve safety and confidence to visit friends and family in the community.

You can review the full article here: ‘Exploring the experience of reablement: A systematic review and qualitative evidence synthesis of older people’s and carers’ views’.