Quote from the 2018 Nous Group Report – Wellness and Reablement – Summary of consultations across the Home Care Sector
A short history on the development of Wellness and Reablement within the Home and Community Care Sector
Australia has for over twenty years been seeking to develop, deliver and embed both targeted reablement programs and more generic wellness and reabling service delivery approaches as a key focus of home and community care.
We have complied a short history to show the journey undertaken across Australia since 1999 until the present time, 2021. Some of this information has been extracted directly from the Unpacking Reablement work undertaken by the Australian Association of Gerontology (AAG) in 2019 and supplemented with additional information and links.
Please note: this section is focused primarily on the delivery of wellness and reablement service delivery work practices by home and community care providers, therefore the history of wellness and reablement as part of the home support assessment process by the Regional Assessment Services (RAS) and Aged Care Assessment Services (ACAT) is not detailed.
The role of the assessment services is clearly stipulated in the My Aged Care Assessment Manual 2018 stating that wellness and reablement processes need to be embedded in the assessment and support process and that both RAS and ACAT assessors will work with the client to establish a support plan that reflects the client’s strengths and abilities, areas of difficulty, and the support that will best meet their needs and goals. This includes the consideration of formal and informal services as well as reablement pathways.
This short history includes:
- Organisation specific programs (such as the Home Independence Program and The Personal Enablement Program) developed by Silver Chain in Western Australia (WA) and operated from 2004 – 2018
- State based responses (such as the WA HACC Wellness Approach and the Victorian Active Service Model)
- Australian Government reports and reviews recommending the introduction and embedding of wellness and reablement, such as the 2011 Productivity Commission Inquiry Report Caring for Older Australians, the 2017 Legislated Review of Aged Care Report (Tune Report) and the 2021 Royal Commission into Aged Care Quality and Safety
- Australian Government initiatives and resources providing direction to the aged care sector such as the 2015 Living well at Home – CHSP Good Practice Guide, 2020 – 2022 Commonwealth Home Support Program Manual and the 2020 Wellness and Reablement Digital Site
Wellness and Reablement as significant paradigm shifts are a win-win. A win for older people by supporting individuals to remain as able, independent and engaged as possible in their community and a win-win for government and society as it can free up resources for those who require regular and longer support.
Why Wellness and Reablement is important
To support the ageing population, there is growing evidence that we need to improve health and wellbeing across all ages. Early intervention and an adoption of preventative approaches are vital. This enables people to plan ahead, so they can minimise functional decline and their future need for care. (WHO, World report on ageing and health, 2015). Click here for more from WHO on ageing.
For organisations that provide aged care services, there is an expressed intent to maintain and enable the functional ability of those who are in receipt of support, but in practice, the objective can raise significant challenges to ensure there are opportunities provided to all clients. For this to occur organisations need to make sure that every interaction with a client whether, in person, via technology, or the written word has an enabling focus.
Response to the Wellness and Reablement approach for many organisations has gone beyond reform and change management to become embedded within the organisation’s culture. This takes determination and a belief across all parts of the business – from support workers to volunteers to board members. This approach incorporates the belief that every consumer has a right to opportunities that fulfill their physical, mental and spiritual potential, no matter where they are on life’s journey. An organisation’s shared beliefs and values will impact the client’s ability to achieve good outcomes and remain living in their place of choice but it also is dependent on the lens through which each individual views the clients they are supporting.
Do they see the client as an individual who needs ‘help’ which is their role to provide or do they view the client as someone with the potential to make gains in their ability, no matter how small that gain is, with their support? A fundamental ageist response from staff when working with clients receiving aged care services is one of the biggest challenges to embedding wellness and reablement successfully within service delivery.
For further reading related to Ageism and the negative impact of ageist beliefs on older people please see the articles and links below. Plus discover how ageist you are and how it may impact on your work practices.
Imagine a world without ageism. Watch this enlightening video from Every AGE Counts on Ageism.
Find out where you sit
A recent WHO report found that every second person holds ageist attitudes. Ageism against older people is stereotyping, discrimination, and mistreatment based solely on a person’s age. Take this fun two-minute quiz to find out where you sit on the ageism spectrum.
There are benefits of wellness and reablement for organisations
There have been significant benefits highlighted by organisations who have embedded wellness and reablement into their service delivery, these benefits are not only across the whole of organisation but can have a broader impact across the communities connected by clients and their families.
- When staff are well informed of the support objectives, are supported to actively work alongside clients and assist them to achieve their support goals, and are empowered and involved to assist with problem-solving for both the client and the organisation their job satisfaction increases.
- Where organisations have adopted a model underpinned by a short-term reablement focus the opportunity is presented to provide support to a greater number of clients with the prospect to broaden an organisations’s client base.
- Client’s and their families who have been supported to achieve their support goals, currently requiring no support, are more likely to seek any further assistance needed from the same organisation.
- In organisations that have adopted a model underpinned by wellness and reablement by placing the client at the centre of all decision making compliance with the Aged Care Quality Standards is supported.
Does your organisation have examples demonstrating the benefits of implementing wellness and reablement which you would like to share? This could include stories of improved staff job satisfaction, more efficient use of resources, a broadened client base as a result of more dynamic short-term targeted support and improved client outcomes and satisfaction.
If you would like to leave any comments or feedback on KeepAble, or let us know of some of your experiences with wellness and reablement, please contribute in our Contact Us/Feedback form below.
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Resources for Homecare Providers
- Where are you on wellness and reablement delivery?The maturity of Wellness and Reablement approaches varies between providers. Consumers, assessors and providers are all at different stages of their journey. See what our guide says about the actions at each level.
- Preparing your annual wellness and reablement reportCompiling your annual wellness and reablement report requires preparation and ensuring you have collected the right data.
- It’s time to get serious about goal settingFor those accessing aged care supports, setting goals and planning towards achieving them provides the person a voice, making them and what they wish to achieve the focal point of the support being provided.
- Rethinking Group Social SupportMany of the individuals who join group social activities within CHSP social centres have previously created and belonged to a ‘social life‘ of their choice which may have been comprised of a social network of one other person or have been a network of many.
- Group Social Support – It starts with a conversationInitial conversations undertaken with clients need to explore how they previously socialised, what prevents them from returning to previous activities, how long has it been, and how do they envisage their social network to look in the future.
- Guide to writing support plansA support plan provides guidance to clients and support staff so they can work together to achieve the clients’ goals.
- Assistive Technology Essentials (Part one)The aim of this guide is to build awareness and knowledge amongst Commonwealth Home Support Programme
(CHSP) service providers and the broader aged care sector of the benefits of Assistive Technology (AT) and the role it plays as part of a wellness and reablement service delivery approach with improved outcomes for older people.
- Support workers guide to equipment (Assistive Technology)Learn how low level assistive technology can help maximise independence, especially for homecare clients.
- Measuring client outcomesAt the very core of embedding a culture of wellness and reablement is a shift for organisations in how they measure success.
- Essential steps for successful coachingWe review some steps so you can provide an effective coaching session to support workers within your organisation.
- Making choices, finding solutionsThis guide has been developed so people can make informed decisions when choosing assistive technology and home modification solutions.
Register with KeepAble for more useful resources as they’re developed.
Articles from wellness and reablement leaders
FAQ’s from organisations
People want to live independently in their homes for as long as possible. Wellness and reablement approaches encourage people to continue completing their daily activities and maintain the skills required to live independently. Likewise, wellness and reablement approaches can also help older people regain skills after a setback, through a short-term targeted approach. Activities can be related to the physical, emotional or cultural needs of clients.
The wellness and reablement report template for the 2018-2019 year required data relating to: – the development of support plans – acceptance and frequency that short-term support was recommended by assessment agencies; – proportion of service delivered on a short term or episodic basis and examples; – proportion and examples of clients who developed new skills/capabilities concerning physical, cognitive, and social connections; – challenges with implementation of reablement approach. An annual desktop review of Wellness and Reablement practices was announced in the 2020-2022 CHSP Manual as an additional reporting requirement.
Support plans are an important communication tool between the client and CHSP staff. To ensure they are effective, service providers should: – review the client’s assessment outcomes and support plan; – break down the broader goals in their support plan into achievable steps and strategies that will assist the client to reach their goals; – review and update a client’s needs change.
Organisations have reported the following benefits:
● increased job satisfaction from supporting people to achieve their goals;
● more fulfilling role through completing tasks that the client is unable to do.
● repeat business as clients is more likely to request your organisation due to past experiences.
It is important to understand why a client’s family is not keen to implement a reablement support plan. Often, family members are worried about the risks involved if their loved one wishes to continue completing their daily activities. They must understand the approach of giving the client every opportunity to be as independent as possible in their daily tasks. When appropriate, families need to be reassured that risks have been minimised and the following will occur:
● staff will work alongside the client and provide encouragement and assistance where required;
● functional assessments and modifications to how a task is performed, strengthening programmes, aids, and equipment which increase capacity to complete tasks.
● environmental assessments and modifications to minimise risks involved in performing tasks.
You must discuss and understand what the client sees as being disrespectful about the wellness and reablement approach. The philosophy which underpins the wellness and reablement approach expand across all cultures. For example, if a person continues to do the everyday activities they are able to do, or they work on rebuilding their abilities after a setback, in turn they will enhance their ability to remain living independently for longer. Both wellness and reablement are focused on an individual’s goals and abilities which aligns with being inclusive of the diversity of older people according to their needs.
An effective way to guide and enhance the skills of support staff is to work alongside them and provide coaching while they are working with clients in the community. Providing real-time guidance and feedback can improve the experience of the worker and increase the potential for the client to achieve their goals.
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