Keep Able Reablement Podcasts
Keep Able is your go to authority on Wellness and Reablement. Our various podcasts cover discussions on real world issues and examples from people in the at home aged care support sector, specifically for CHSP providers.
Keep Able Reablement Podcasts
Reablement Conversations: with Nicola Seafield
In this episode, Hilary O’Connell has invited Nicola Seafield, Allied Health and Short-Term Restorative Care Program team lead at MercyCare.
Together they discuss what short-term reablement means in practice, how to implement this model daily, and the positive outcomes it brings in terms of building clients’ confidence and empowering them to change their current circumstances.
“It is an opportunity to work with a client to improve their quality of life, find out what is important to them functionally, emotionally and spiritually so we can deliver a positive outcome.” Nicola says when describing reablement.
Discover more reablement resources at keepable.com.au
Well, good morning, and welcome to ILA's Conversations About Reablement, where we talk to people from different backgrounds and roles across aging and aged care and get their perspectives on reablement. My name is Hilary O'Connell, and I'm the principal advisor of healthy aging and reablement here at ILA. Today I would like to welcome Nicola Seafield. Nicola is the Allied Health and Short-Term Restorative Care Programme team lead at MercyCare here in West Australia. Nicola has been working as an OT for 14 years and started her career in an acute hospital covering a range of areas, including trauma, orthopedics, care of the elderly, rapid response, AE, and before moving to the general medicine and surgical wards. Nicola relocated to Australia eight years ago and has worked in the AIDS care setting since arriving, working in CHSP and residential aged care space before moving into short-term restorative care and home care packages. Nicola enjoys meeting clients in their own space rather than the hospital setting. This provides a level of empowerment and confidence to discuss their stories and finding out what is most important to them. She thinks every situation is different and what is most important to the client isn't always what you think it might be. Nicola is passionate about the reablement approach and the collaborative work with the client to strive for their goals. So I'd really like to welcome Nicola and thank you for joining me today to talk about all things reablement. Now before we get started, Nicola, is there anything else you'd like to add to my introduction?
SPEAKER_00:No, I think you've got it covered. Thank you for having me.
SPEAKER_01:Right. All right, let's get going. So I'm going to ask Nicola a series of questions and then we're going to have a little chat about things. So Nicola, what does short-term reablement mean to you?
SPEAKER_00:Okay, well, theoretically it's a program where a person can learn or relearn new skills to improve their strength and their ability to live independently in their own home. But as a therapist, for me, it's an opportunity to work with a client to improve their quality of life, uh, find out what's important to them functionally, emotionally, and spiritually. So it can deliver a positive outcome. The reablements space or the short-term reablement, it's a short burst of intervention and it's provided collaboratively involving the OT, physio, nursing, dietitian, and GPs, maybe a few more. But it's all with the aim of achieving the goals that are set by the client over that short period of time. And that for me is what short-term reablement is. Lovely.
SPEAKER_01:All right. And you've worked both in the UK in their version of reablement, and now you're currently working more in what we call a short-term restorative care setting.
SPEAKER_00:Yeah, for sure. I mean, in the UK it was more like a rapid kind of response, but we would input into the reablement at home team. But now we definitely are much more involved in that whole process. Right, great. And how do you think short-term reablement helps older people? Well, we work with people to build the confidence, provide their education, empower them to change the current circumstances, mostly. Be that building strength and tolerance to walk a bit further, assistive technology home modifications to help them function at home more effectively. It can be a great platform, really, to boost their current abilities and prevent them from needing support workers or carers to come into their home and help them. When delivered well, a reablement program can help people have the confidence to get out in the community, continue to be active. I feel a lot of people, when we go out and speak to people, they feel like life gets much smaller as we age. And it doesn't always have to be like that.
SPEAKER_01:And out of interest, the sort of people that are coming to your service, what are some of the difficulties that they're having? Is it is it mostly within personal care or household daily activities, mobility, getting out and about, and things like that?
SPEAKER_00:A big mix and a combination of all. I think it's what generally alerts the referrer is the biggest one, is usually a big decline in mobility because that's visual, that's something that people can see. Sometimes we get into sort of the nitty-gritty of it, and then we find that it's personal care that's can be an issue that hasn't maybe been disclosed. But the big red flag is generally the functional ability that people can see or their memory loss. That's always a big one with us as well. Okay.
SPEAKER_01:So when you're working with an older person and say their carer or family members, what does reablement look like? Take us through um a day on reablement working with someone.
SPEAKER_00:Okay. Again, it's that a collaborative approach to what everybody being involved. So in the beginning, at the very start, it's kind of making sure the client and their carer or family member, whoever that might be, are all well informed with the process, the plan, their expectations and any limitations of the program. So setting it out from the beginning. We're talking about an eight-week program usually. So as such, the goals have to be established to be achievable and realistic within that time frame. We let people know that it can be intensive. So they may have four sessions that week from various professionals, which can be intrusive sometimes if people aren't used to having people in their own home straight away. So we we kind of do the work to prep for that. Sometimes clients are just not used to that level of involvement. So we make sure that during the first session or the first meeting, that's something that we talk about. So it's something they're wanting to engage with. It's often a good time then that we'll discuss outcomes that we've had uh so we can gain some motivation, commitment to the programme. So it's always a good idea for the involvement of the family members through the process just to be kind of well, they can be instrumental in maintaining that motivation and advocating for the client if things aren't going quite a plan. Lovely.
SPEAKER_01:All right, so how important do you think it is to build someone's confidence and their strength and skill so they can actually get back to how they were?
SPEAKER_00:Well, massively important, massively important. Just by giving them that that start, that boost, us being involved and them seeing that they can reach target and reach the goals, does that in itself the education part of that is is huge as well. It's it's letting people know that they're if they're able to do it for themselves, that's great. We've managed to get there. If not, there's there's that safety net of maybe equipment, carer support, and that in terms gives people that level of confidence. No, that I might not need something now, but is there a for do? But I am capable of doing things for myself just now. Yeah, yeah, yeah.
SPEAKER_01:It's important to reinforce that, isn't it? I think certainly if people have been discharged from hospital or just because they are getting older and people can um be quite ageist and just make an assumption that you can no longer do things or no longer improve on your sort of your function and capacity and things like that. And it can, I think, put people in a spiral.
SPEAKER_00:Definitely. I think that's what's good about getting those close to that person if they're if there are somebody that is close to that person involved in it as well. Because sometimes us as family members or overcaring friends can actually get into that state where we think, oh, you know, we need to look after the person, or the person needs someone to look after them now, or we're fearful of this, which then in turn that psychological element rubs off on the person to make them think, oh, you know, people are telling me I can't, so maybe I shouldn't. Yes, yeah. And we just need to turn that on its head a little bit.
SPEAKER_01:The language is so important, isn't it? Oh, yeah, for sure. So tell me, you mentioned um equipment just now. Where where does uh city technology or equipment or home modifications fit? What sort of equipment or mods might you do to support someone?
SPEAKER_00:I mean, look, with equipment, mods, all of those things, they have a great place in what we do. First and foremost, we look at strength, balance, improving our overall function. But types of modifications that we've done through this program might well be minor bathroom modifications, reducing the hub height, providing basic equipment, sort of like shower stools, bathing, appropriate seating, appropriate walking aids if we need them, down to sort of memory, you know, we're using things like Google Hub, we're using things like adaptive phones, where so people can call that have been unable to do so. We're using safety devices around the home, you know. So if there is a fall, it can activate. If there is something starting to change, then the family would know about it. You know, if a person becomes more active at nighttime or we've got memory decline, then we can sort of figure those things out that little bit earlier. Depends on the person. Yes, absolutely. Absolutely.
SPEAKER_01:Uh, if you as what what do you think the three key things that support staff? So if you're working in a home care organization, uh the support staff, what don't you think they need to think about when they're working with someone as part of a reablement approach?
SPEAKER_00:Okay, so if we got support staff going in there, familiarize yourself with the plan at every visit. Don't assume you know it because you visit this person and you have done for the last six weeks or whatever. The plan might change as the client progresses through the program. Talk to the client, the professional is involved to clarify any changes that you know have been made and provide feedback, positive or negative. But yeah, provide lots of feedback. If time is an issue, let us know. Let the professionals know who's giving you the plan so we can adjust the plan or allow more time to complete the sessions, whichever we feel is most appropriate. Don't jump in and do for the client. Encourage them to do as much as they can for themselves and give positive reinforcement. If you see some great improvement, don't keep it to yourself. Write it in the notes, then tell me about it when you've come out. Tell the client during the session. Having the change noticed by someone else is just so empowering and motivating, and those words would mean everything. I'm glad you mentioned the uh doing with, not doing for type approach.
SPEAKER_01:Because I think if we can just keep it sometimes as simple as possible that I'm going in to support someone to do things for themselves, I'm gonna not try to step back and not do them for them.
SPEAKER_00:Yeah. It's difficult, I'm sure, for support workers, time elements can be difficult if you see a person, you know, taking longer. You kind of, our approach as caring professionals is to help, but it's kind of like stepping back and allowing them that that good stretch, allowing them to know that they can do it, trying the different techniques over again that we've taught them. So when when we pull out the program is finished, that they're able to do that. And that is the time when we, you know, that's the the time that we've got to make it happen. So kind of hands off, yeah, but eyes on. Absolutely.
SPEAKER_01:Absolutely. So, do you have do you have an example of when short-term reablement has worked and when it hasn't? So what made it successful or unsuccessful?
SPEAKER_00:Oh, yeah, for sure. Here at MercyCare, we've had so many great outcomes with our STRC program. We had a bilateral below amputee client, week one, being unsafe, standing just from his couch, and walking with supervision and two sticks to unage indoor mobility and significant improved balance halfway through the program. And then by the end of the program, he'd return to driving after we accessed some car modifications via the STRC funding, which was amazing. Another one springs to mind a client who loved gardening, but had a real nasty fall, went outside and as such, never went back into the garden. Had such a big impact on his confidence that he was going to go into full-time care. It was just so low because garden was his life. We had the physio do a strength and balance home exercise program, quite intensive, uh, which he did enjoy. And then the OT was involved in making the garden safer and more accessible. And at the end of the program, we had sort of, you know, he had some raised flower beds, he had, you know, he was planting herbs and vegetables in his garden, and away he goes. We during that process were able to identify some early changes to his memory, also. So we we give some intervention with regards to this, we give some technology to support with his memory, and that hadn't been picked up until the program as well. So yeah, he felt a lot more secure when we pulled out of there. Another one of my favorites. Oh amazing. I've got so many. You got me going okay now. I mean, one of my other favorites was a client we had, and she was pretty much bedbound. She was living in her bed, everything was around the bed at week one. Midway through, we got her walking into the lounge room. We got some appropriate seating for us, so she was engaging socially now. So she wasn't in the bedroom all day. She was sitting in the lounge room with Emily. And by the end of the program, she was sitting in the garden enjoying the weather. And her daughter sent us some amazing smiley pictures, which were just fantastic to see. And that was uh, it's fantastic outcomes.
SPEAKER_01:Really, what we need is more short-term reablement and restorative care programs, don't we?
SPEAKER_00:Oh, yeah, for sure. For sure.
SPEAKER_01:Everybody should be having these opportunities.
SPEAKER_00:Yeah, for sure. And those are just a couple that spring to mind.
SPEAKER_01:What about unsuccessful? When hasn't it worked? Is motivation a real key? The the you know, not only being having an a the the running a program, but also the motivation of the person themselves.
SPEAKER_00:Oh, sure. Yeah, yeah, we do get we do get that. When we just can't draw out the volition, motivation or participation from a client, for sure that does happen. It's not always often. Sometimes when we go in and we can we can discuss, but it does happen for sure. The client needs to be involved and work towards the goals in order for the program to work. You know, it's not about us coming in and doing these things for you, it's working with you. And sometimes there's a number of factors, the timing's just not right for them, and they aren't in that space to then make a change. Yeah, yeah. Can maybe happen if low mood's been an issue and it hasn't been addressed. Or sometimes when it's more our family, loving family that want to see the changes and are really pushing for the client to engage in the program. So it's kind of their goals more than the client. We do have that at times, and the time is just not there. Yeah. We have we have unfortunate circumstances where we've had to disengage because the client goes then into hospital for more than seven days, so then the funding of the program stops. Yeah, so we have things like that as well. Okay, that's great.
SPEAKER_01:Now, if you had any advice for an organization who was preparing to deliver, say, short-term reablement as opposed to say short-term restorative care, and that can get a bit confusing. What would you say? And I'm thinking more of the philosophy of the organization to some extent and the changes that an organization needs to consider to deliver reablement successfully.
SPEAKER_00:Look, I also think even the restorative care, it's all reablement focused. It should all be along the similar lines. For me, they they interact completely. Don't be quick to be equipment focused, would be my main advice. Always aim to improve the strength and function before compromising with equipment, is how I logically put it in my mind. Get the client engaged to work from the first meeting so they know what to expect. Yeah, get them engaged in the in what we're about to do, the whole process, and think outside of the box. We've had some great outcomes with relaxation therapy, music, hydrotherapy, some fantastic things that that then the client is able to go in and engage in themselves.
SPEAKER_01:What about the philosophy of staff, training for staff? Do you do much training for staff, sort of particularly home care staff?
SPEAKER_00:I mean, look, in with with our team, we we do speak to our support workers and we do provide those trainings and understanding around the client when we're involved and delivering a service. So the expectation is there. We we're a very close team, and I think that's the difference with us. We work very much as multidisciplinary, and that does involve our support workers, home care coordinators, people delivering the service. So we work very closely with the with our nursing, with physio, with LT, with our allied health assistants, support workers right across the board. So so yeah, uh, we have that kind of open door policy when things are changing. So we talk to each other quite regularly. So yeah, yeah, we do fundamentally we do. And I do believe that everybody wants to do well and do their best for the client. It's just sort of sometimes re you know, re-imagine that for the uh reablement model. Yeah. Yeah, yeah.
SPEAKER_01:And I agree with you. I think the actual communication between everybody is absolutely critical. So that the same message and the same language is being used to when you're working with someone to encourage them to sort of be part of the program and everybody's saying, coming at it from the same perspective.
SPEAKER_00:Definitely, definitely. We've got some great people that we can work with that who very much have the same mindset, just continuing to get the message across.
SPEAKER_01:Well, I think that's sad, getting getting the message across is certainly what you're doing today. And I can tell how passionate you are about reablement. So I think that would be a great place to conclude our conversation. We've covered a lot of topics, including how reablement can help people retain their independence, how support staff and allied health play a key role in this, and some great examples of when working this way works. I mean, I I love your story about the bilateral amputee and the and the gentleman in his gardening. So I thank you again to Nicola Seafield from MercyCare for joining me today. Um, and for those of you listening, I hope you've enjoyed the conversations we've been having. And to find out more about reablement, please visit our Keepable site at keepable.com.au. And thank you to Nicola.
SPEAKER_00:Thank you for having me.
