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 Dr Elissa Burton
In this episode, Hilary O’Connell and Dr. Elissa Burton, Associate Professor at Curtin University, School of Allied Health, discuss how reablement and restorative short-term care improve clients’ quality of lives.
This model gives clients the opportunity to work out ways to improve mental and physical function, rebuild skills they’ve lost, and equip them with support so they can reach their goals and live independently at home for as long as possible.
“I’ve done a lot of work with older people in their 90’s and even their 100’s, which are looking at physical activity programs, strength and balance training, and they’ve seen great improvements, over an 8–12 week period.” Dr. Burton says. Hilary and Dr. Burton also discuss the upcoming Home Support Program, and why a successful reablement and restorative care program starts with the assessor and service provider.
Discover more reablement resources at keepable.com.au
Okay. So Hello everyone. Hello and welcome to ILA's Conversations About Reablement, where we talk to people from different backgrounds and roles across age care and get their perspectives on reablement, also known as restorative care. Today I'd like to welcome Dr. Alyssa Burton, who is an associate professor at Curtin University School of Allied Health. Alyssa is an experienced academic who has spent 15 years exploring healthy aging, particularly with older people receiving home care services. She has over 75 peer-reviewed publications focusing on areas such as restorative care services, reablement, barriers and facilitators to participating in strength and balance training, force prevention, and carer support. Alyssa currently co-leads the Australian arm of the International Reable Network, which includes 35 plus reablement researchers from over 10 countries and works with an exceptional group of researchers and policymakers in Ireland bringing physical activity to home care services. So please welcome Alyssa. And thank you, Alyssa. First of all, I'd uh like to thank you for uh talking with me today. Is there anything else you'd like to add to um that introduction at all? No, it's lovely to be here with you, Hilary. Thanks for inviting me. Pleasure, pleasure. Great, all right. Well, if not, then let's get started. What I'm going to be doing is um asking uh Alyssa a number of questions and getting some of her responses and perceptions around restorative care and reablement so that I can share with everyone. So, Alyssa, one of the first questions we'd like to ask is what to you is short-term reablement or restorative care?
SPEAKER_00:Thanks, Hilary. I actually see reablement or I'll probably speak mainly about restorative care because I think it's a little clearer in my mind exactly what restorative care is, whereas many people have different definitions on reablement and what they view that is, whether it's a service, an approach, um, different things like that. So, with regards to restorative care, I see it as a service that is short term, but it's an opportunity to help an older person maintain or rebuild skills that they may have lost in the previous years. And when we speak with older people and all of my research is about older people, their main goal once they're retiring is to live in their home for as long as they choose. So I see restorative care as a tool to be used to help them to actually achieve that goal. Um I think health literacy is incredibly important. Many people who receive home care services and their family don't necessarily understand what's required to be able to stay living in your home for as long as you choose. And restorative care services can really provide an optimal pathway to help with that. Um, and I think it's a really good opportunity to provide more information and education as well as providing a service short term.
SPEAKER_01:Right, lovely. That's that's a great way of looking at it as well. I mean, as you sort of say, so many people say that they wish to remain in their own home for as long as possible. And any services and supports that we can provide that enable them to do that and be as independent as possible is the is the way forward.
SPEAKER_00:Yep.
SPEAKER_01:Lovely. All right, so from following on from that, how can short-term readmold or restorative care help people? You've sort of partially answered that before, but that's what other sort of things, and in what way can it help people?
SPEAKER_00:Well, often what happens when the older person um feels like they're maybe not coping with things at home, it might be due to an injury or an illness. They may have had a fall, they may have had short-term stay in hospital, things are just becoming a little bit more difficult around the house. So then they ask for an assessment. Uh, and if they were to get a restorative care service, they'd have someone go into the home and actually find out what their immediate goals are. But I think also on top of that, once again, and I'll probably continue to harp on this for the duration of the interview, it's all about helping them to achieve that ultimate goal of living independently. So, yes, providing those short-term short-term assistance. So it may be providing some domestic assistance for a little bit of time. It could be providing some assistive technology and actually teaching them how to actually use that, but it's also working out ways to improve their function, mental function, physical function, so that they can continue and hopefully get back to where they were before they had that injury or illness, and then even improve. I've done a lot of work with older people in their 90s and even their hundreds, which are looking at physical activity programs, strength and balance training, and they've seen great improvements over an eight to 12 week period. And if they continue that, then they can have those gains for years and years. So, and there's no reason why they can't achieve that long-term goal of independent living.
SPEAKER_01:Great. Thank you for that. Now I know that your your one of your focuses is uh physical activity, building strength and balance. When you think about a restorative care program, um, what does it usually include? And you you partly mentioned that just now. You mentioned assistive technology, you mentioned sort of strength and balance. But if you looked at a typical uh restorative care program that was evidence-based, what are some of the characteristics or what are some of the sort of um types of interventions that would be most typical? And I appreciate that you had mentioned strength and balance and things like that.
SPEAKER_00:Strength and balance is incredibly important because home care clients or those looking to receive home care services fall twice as often as those who are not receiving services. So, and we know the detrimental effects of falls. So immediately we should be looking at a strength and balance program to avoid those falls in the first place. But if they're having some difficulties around the house, it may not be uh particularly friendly for an older person and what their requirements are. There could be some uh changes that need to be made in that way, but they may need assistance from a nurse or a multidisciplinary team just for a short period of time, could be due to a wound. Uh, so they might need some assistance with that. They might be having some problems with their cooking. So, what are some of the techniques that we can do to work around that? So, if they had bad arthritis in their hands or something like that, they may not be getting enough protein in their diet. And so they're looking at getting closer to that frailty or sarcopenia. And we know both activity plus also what they're eating is really important in that way. And a lot of that is education. So it's around person-centered. We need to find out what they want uh and what they need, uh, and then providing the education to help them to be able to do that themselves, or some techniques in which we can help them along the way, but them not stopping doing things completely.
SPEAKER_01:Yeah. So you're sort of talking about things like um, say, uh physiotherapist might sort of say, look, a good strength and balance program is good for you, force prevention, exercise physiology maybe gets involved, but also perhaps an occupational therapist or support worker helping someone relearn how to do something, sort of change the activity that they're doing and doing it in a different way so they can manage to do a little bit of it themselves independently and slowly improve that. Yep. And you might bring in assisted technology at some stage as well to sort of help the person manage that activity as well.
SPEAKER_00:Yep. Great way to kind of overall bring it together. And that's where that multidisciplinary team comes in. And it's not just allied health people, it's also the support workers too. They can play a really big part because often within the restorative care service, they will be seeing that older person a lot more than the allied health team.
SPEAKER_01:Absolutely, yes. And that they're the people who are consistent and people are actually working on helping that person improve over time. Yep. Great. Thank you for that. Do you? I know you sort of worked in um or certainly researched um restorative care services and reablements. Do you have any sort of um ideas on um what works and what hasn't worked, and what perhaps has made a reablement program or restorative care successful or unsuccessful? And an example of that if you've got one?
SPEAKER_00:Yeah, um, I think the staff play a huge role in that, uh, from the assessor to people who are actually going in and providing the services. I think it's really important to build a rapport with that older person and actually listen to them. Not hear what you think they're saying, but hear what they're actually saying, because we're all in a very big hurry in life and just trying to get through, tick a lot of boxes, uh, and often it's missed. A good example was a recent research project that I was working on, and it was actually with people living with dementia and their carers. Wasn't specifically a restorative care service, but the way one of my research officers, who's an extremely experienced physiotherapist, the way she handled the person that she was working with and how they work together, I saw as a true restorative care service. So it was actually a six-week research project working with a person with dementia and teaching them how to use a walking aid. So it was either a walking stick or a four-wheelie walker because their mobility had reduced to the point where they weren't even wanting to leave the house. So often with a four-wheelie walker, you um give it to the person, you might give them one session of learning how to do that, and then off they go, they're expected to remember everything and know how to do everything safely. Well, our program was four weeks of four sessions over six weeks. And in the first session, she did a lot of research assessments, which is typical of any research project. But she also asked the gentleman, why did he want to learn how to use a four-wheelie walker? And what was his purpose for that? And his whole purpose was I want to be able to walk my dog around the block because I've done that for years and years and years, and I can't do it any longer. So in the first week, she taught him how to use the four wheelie walker. Second week, it was learning how to go out of the house, put the brakes on, get up to the driveway. Third week, it was pulling the dog over. Where are we going to put the lead around the four-wheelie walker? Let's just try out in the patio a few sessions of walking with the dog. Thankfully, the dog wasn't a puppy because puppies go a little crazy. The dog was nice and mature and knew the exact um sort of pace to walk at with the person living with dementia. And so by week six, this gentleman was walking the block with his dog. His wife, who was his carer, got half an hour to just chill out and be by herself. The dog knew the way home. So it didn't matter if they went a different way. He knew exactly where we were going. And they felt like they got their life back. So within a span of six weeks, yes, we had achieved what we wanted to in our research project, was which was to teach a person living with dementia how to use a walking aid. But for me, his quality of life has just gone through the roof, and that's restorative care. And so we had a huge win on that one. And the way his wife uh reported it was we've been getting health services for three years. You've done more in six weeks than we've had in three years. And that is what restorative care can do. And I was lucky enough that the physio working on the project has a huge amount of expertise, has worked in home care services for a number of years, and understands restorative care really well and could incorporate that into the research project. And I was highly positive about the way she went about it because we're all about improving people's quality of life.
SPEAKER_01:Yeah, I agree, agree. I think sometimes, um, as you say, restorative care is thin or the focus is on improving someone's physical function and the normal activities of sort of daily living, which clearly has to be part of the focus, but that um social and emotional and mental health side of things, and then the impact on quality of life is is absolutely critical because that's what's what's what's important to the actual person. Yeah. Um, I've had as an occupational therapist, I've I've had similar stories, and some of the goals that people have set have been, you know, I'd like to be able to walk the dog, I'd like to be able to go to the park with my grandkids and either play with them or watch them play, or you know, Hilary, I'd just really just like to be able to get to the local shop and buy my paper because that on the way there I talk to people and I talk to the shopkeeper, and that makes a difference to my life. And those very simple things in some ways are just so important to people. Yeah. Yeah. What about when it might be unsuccessful and what you thought might be any contributing factors to it not being as successful as it could have been?
SPEAKER_00:Yeah, I think it works on both sides. Like when you talk to the staff, staff will say uh having older people who are not motivated to help themselves, as they put it, uh they don't want to do exercise. They don't want to do X, Y, and Z. So it makes it very difficult. So perhaps we need to look at how we actually put those strategies forward. It's not about the actual exercise, it's about, well, do you want to stay living independently? If you have a decline in function, how are you going to get onto the toilet and off the toilet independently? How are you going to shower yourself and dress yourself when dressing requires a fair bit of balance? Um, even if you are sitting on the bed, it still requires a fair bit of balance and getting in and out of the shower safely and stuff like that. So I think it's how we actually word it. Uh, but at the same time, staff in some instances don't help themselves either, because I've spoken to a number of staff, and it's that person's too old, they're not able to do it, um, they've had health issues, they've had a stroke, so there's nothing we can do. And I don't believe that's the case whatsoever. Um, I don't want the older person to be moving too much because if they fall on my watch, then the family will be really unhappy. So if the person falls and it's not on your watch, is that okay? And if if we're not helping the older person to try and remain living independently, is that okay? Like putting in domestic assistance is the easiest thing that we do in home care services. And it is the best thing to decline function. And is that okay? Personally, I don't see it as okay. Um, I I would like to think that when my parents are at that point that I'll be assisting them. My mum's already doing balance exercises because we talk a lot about it and the importance of it. And she really notices a difference when she goes on holidays and she's not doing them as regularly. Soon as she gets back home, bang, she's back into the balance exercises and she feels a difference. So it really is trying to put the conversation together so that you have that conversation with the older person and they get the understanding of why it's important.
SPEAKER_01:Yes, yeah.
SPEAKER_00:Yeah.
SPEAKER_01:Lovely.
SPEAKER_00:Rather than just telling them, I think just telling them to do X, Y, and Z is not going to work.
SPEAKER_01:It doesn't work. No, it's got to be relatable, doesn't it? It has to be relatable and it has to be relatable to something that they are uh that's important to them, that they value, uh, and and such like. So looking ahead slightly, the uh new support at home program, the new Commonwealth Support at Home program that um will commence from uh 2024, 2024, or July 2024. Uh any advice? What how what would you like to see that program look like in comparison to perhaps how it looks currently from a restorative care perspective?
SPEAKER_00:Yeah, probably in three different ways. When a person hasn't received any home care services at all, and they call my age care and they want to have an assessment. After that assessment, I would love to see them receive a restorative care service. That's the first thing that they receive so that they can get a really good understanding of what the best things are and the best ways to remain living independently. So, and being able to do the things that they love. What do all the people love? They love socializing, they love social connection and engagement with family and friends. And it's difficult to do that if you can't get out the front door. So it's working with them, and I guess as well as helping them, it's also helping to build their health literacy as well on what is required to remain living independently. So that's really important. So I'd love to see everyone who inquires about aged care and is suitable for aged care to receive restorative care as a starting point. Anyone who goes into hospital and has a hospital stay, in particular if their hospital stays kind of four days or more, uh, because we know that when we go into hospital, hospitals love to have us seated in the bed, which, if you're an ICU and stuff like that, it may be required. But in many ways, it's not necessarily required that we stay sitting in bed the whole time. And people lose physical function when they're in hospital. There's so much research to show that. So as soon as they come out of hospital, I would love for people to automatically receive a restorative care service. We're talking sort of eight to 12 weeks. So it's not a lifetime thing, it's short term. To give them a top-up to try and get them back to where they were before that injury or illness and before that time in hospital where they lost all that function due to being in bed all day, every day. Um, the other thing I would love to see, and this is definitely on the wish list, is people who are receiving long-term home care services once a year, I would love to see them get a very short assessment. And that assessment be a couple of functional assessments and a little bit of social uh connection assessment too. And for those people who are declining, I would love to see a short-term restorative care service be put in for once again, eight weeks, eight to twelve weeks, just to give them a top-up and try and avoid that decline that the long-term booster, so to speak.
SPEAKER_01:Yeah.
SPEAKER_00:Yeah, exactly. And if they haven't declined over that 12 months, I want them to be told, you're going great. Keep doing everything that you're doing. Your function and your ability to live independently is going really well. So keep going. You know, whereas people are just living, they have no idea whether they're declining or whether they're maintaining or whether they're improving. Like many people who go to the gym, you know, we go to the gym over and over and over again, and we don't necessarily have an assessment, so we have no idea whether we're improving or not.
SPEAKER_01:Yes, yes, I can understand that. Yes, I it's a great idea.
SPEAKER_00:Yeah, and I think um the support workers would be capable of doing the few small tests and then providing an alert on the aged care just for bang, this person needs a short-term restorative care service.
SPEAKER_01:Well, and this right now, we're coming to the end of our um conversation. Uh, if you anything else that you would like to um add to conclude?
SPEAKER_00:Uh I would like to say to the assessors in the home care world, when you go out and assess people and you go through the checklists that are required in your role, at the end, when you decide on their care plan, please ask yourself this question. Will the services I'm going to put in maintain or improve this person's function, mental, physical, social function, and mean that they can live in their home for longer? Or will it help them decline in their function? That's one question I would love assessors to ask themselves at the end of each assessment before they provide services. The other thing is I would like um staff members to have better health literacy themselves on the benefits and what is required to live independently for older people, and that it's possible at any age. I've got hundred-year-olds who have been part of my research projects, and age is just a number. Uh, it's more about their health status and what we can do for that particular health status as well, which is really important.
SPEAKER_01:Thank you. Well, I'd like to we've come to the end of our conversation. Um I'd like to very much thank uh Dr. Alyssa Burton for her time today and um wish you well for the rest of the day. Thank you very much. Thanks so much, Hilary. Have a good day.
