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 Angie Slater
In this episode, Hilary O’Connell is joined by Angie Slater, Director of Home Care and Retirement Living at Juniper.
Together they discuss how reablement assists older people’s physical, mental, and social health and wellbeing, and how this model is working with each individual client to support their individual goals.
When describing reablement, Angie says: “You have to really understand what is motivating and meaningful to someone. To be able to see what people’s short-term goals and aspirations may be. What is stopping them from achieving them currently?…
…I think the biggest thing about this approach is that it’s incredibly empowering for older people. It puts choice and control in their hands.”
Hilary and Angie also discuss how reablement can help people reduce the fear of falling, build their confidence and reclaim their independence, control, and quality of life.
Discover more reablement resources at keepable.com.au
Hello 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'd like to welcome Angie Slater. Angie has both a nursing and a social work background in the UK and is the Director of Home Care and Retirement Living at Juniper, a home care, residential, and retirement living provider in West Australia. Angie has extensive experience within the not-for-profit health community care setting and is a strong advocate of the adoption of a reablement philosophy in our health and social care practice. Welcome Angie, and thank you for joining me today to talk about all things reablement. Before we get started, is there anything else you'd like to add to my introduction?
SPEAKER_00:Thank you. Thank you for the welcome. I think the only thing I would add to that that I'm very, very proud of, is the being able to lead a national trial on a reablement approach in the RAS space in 2019. That was being able to be a mentor to mentors in other locations throughout Australia and apply a reablement approach to initial assessments, people entering the My H care system. So very proud of that to share that love nationally, and I am very passionate about reablement for sure.
SPEAKER_01:I do remember that project, in fact, and there was a report written at the end, wasn't there?
SPEAKER_00:Yes, there was. Yes, very good.
SPEAKER_01:All right, well, let's let's get going. Um I've got a number of questions to ask you. Uh all about reablements, which as you say, I know you're very passionate about. So, and what does short-term reablement mean to you?
SPEAKER_00:It means, first of all, I think it's connection with the individual. You've got to really understand what is motivating and meaningful to someone to be able to see what people's short-term goals and aspirations may be, what's stopping them achieving those currently, and being able to develop short-term time-limited interventions in order to support people to achieve those goals through a short period of time, so six to eight weeks is a um time frame that I've used, and being able to celebrate successes along the journey incorporates some coaching principles with um with people to recognize the progress they are making. I think that's a really important piece to where people start, where they how they're progressing and where they end up, because that has the potential to make them again confident to go on and set new goals and aspirations and achieve new things. So that's certainly been in my experience what I've observed when people achieve goals and in a time-limited re-ablement phase, they often go on to set, you know, kind of higher, um, more challenging goals and want to achieve them and are motivated to do so. So that's why it's an awesome way to work.
SPEAKER_01:Right. Okay. And how do you think it can help older people?
SPEAKER_00:I think the biggest thing about this approach is it's incredibly empowering for older people. It puts strength in your hand, puts choice and control in their hands. It um allows them to think about what their strengths are, what that what their um holistic support mechanism looks like, what um good looks like for them, what a good day looks like for them, what a not so good day looks like and how they go about that, how they problem solve. It allows them to be at the center of decision making, of being able to make clear decisions, being able to articulate those, and I think improve their health literacy overall, um, around the impacts of any specific conditions or limitations. I think it it um allows them to see sometimes actually how they've problem solve them themselves, they just don't realize they have. Um to maybe needing some guidance on trying things alternatively or different ways, still been able to do it, but in a different way.
SPEAKER_01:But what about from an outcome perspective? Do you think it can help improve confidence, um, improve their activities of daily living, their strength and balance, that sort of thing?
SPEAKER_00:Oh, I think all of those things. I think I think being able to prove your confidence, your uh reduce things like uh fears of falling, um, I think quality of life indicators, so that you know what um matters to them in their life and how they feel about their life and how how much in control they feel around how they're managing things like pain or um other things, I think there's it it it actually does have an amazing impact on them holistically, which is which is the why it's so nice, because it doesn't just take uh physical, it actually brings in psychosocial and it brings in other people, carers, you know, it brings so quality of life is not just them, but they're how they're have their relationships with other people. So I think social citizenship is the other thing. Like being able to get out into your community and provide connection to your community, go to the shots, have that, think some of those things that some of us take for granted, but suddenly having those things stop when you realize the value of those things. And it, you know, I think I think the world can become quite a small around you if you don't feel confident to go out your door. So yeah, I think absolutely agree with you.
SPEAKER_01:I know I know we've both seen some amazing results from reablement people who, you know, haven't been able to walk very well, haven't been able to share themselves independently in dress, and over a six to eight week period can get them back to not always quite as they were before, but pretty good. Okay. So what do you think, what does reablement include or look like when you're working with an older person? And that might include the sort of staff that you um have involved as well.
SPEAKER_00:I think um it uh includes staff with an inquiring mind. So I often say to staff that I've worked with, it's you'll feel like the three-year-old that keeps asking why. Why? When did that happen? Um, because you need to understand a bit where they have come from, how they've got to why they're here, and where they want to get to. Um and to do that, sometimes you do need to think about um starting, you know, revivements about you need to put a little bit more um investment and support up front, and then you aim to reduce that over time. So I think if um you start to think about Allied Health in particular, which I'm a big strong advocate of, you know, come have someone come out when you've notified that you can see that this person's um strength and balance is clearly deteriorated, they're no longer able to get off a chair well or in and out of bed or whatever it may be. Being able to get a physio to come be involved at that earlier stage and to get people to get people to think about the impact of that reduced strength on things about around the home, getting out in the community, accessing a public toilet even in the community. I might not do that now because I don't, you know, I don't feel confident. I might not be able to get up, and that's quite scary. So I think the what's really important with a revivalment approach is the allied health component. I actually feel very strongly about the physio and OT involvement in that too. Um and I think for support workers, I think it's a more empowering way to work because you get to see people achieve things as opposed to kind of it could feel different when you're not supporting a person to achieve an outcome. So I I'm very I think staff involved in my experience have shared that it's such a nice way to work because you feel like you're part of that person achieving something, which is very rewarding.
SPEAKER_01:Right. So picking up just on the support staff side of things, what do you think of the say three key things that they need to think about? And I I'm thinking along the lines of how does a support worker step back from stepping in in some ways? It's very hard when you're a support worker who wants to support people, and in some ways we we want them not to support people in quite the way that they've used been used to doing. So, how do what do you sort of think some of the support workers' three things that they might need to consider?
SPEAKER_00:I think what what support looks like is a good question. So being able to stand back and watch how that person's doing that, remembering that they're doing things when you're not in the home with them, too. So being on well, how would you do this if I wasn't here? How would you go about doing it? It's actually a way of you being able to see and support the person to problem solve, support the person to see um how they go how they would do that. And also, I think it it's important, the stepping back is important for for them, but it's it's important for the support worker because then you can do something about what you observe potentially. So if you start to see someone as you know, kind of wall surfing, or you know, you you can see that, but it's it's it's a okay, I've I've seen that, what am I going to do with it? So it's a light bulb moment of I need to escalate that. So you've seen something which appears unsafe, and that's why I think the education of support workers is really important. Um, and then you know, they've got to know who to escalate that too. And hopefully then people are getting that allied health intervention sooner than they would have done. Because I think historically we've kind of waited for falls to occur and then we've asked for the and it, of course, that's a much harder rehab phase then. So um, you know, I think that's a big thing. I think being able to connect, as I said at the beginning, around um, you're not going to talk about you're not going to talk about your goals, aspirations, and what you want to be able to do with someone that you can't talk to. And I actually had a um a staff member share with me recently who'd been a support worker and then went on to do allied health training. And she'd said to me that it's really interesting to go from the kind of doing for working with someone to stepping back. And she said at one client naturally turned around and said, Hey, don't do that for me. I can do it myself. I feel like a child if you do that. So she it was really interesting because she said it was that that made and I said, Well, what I find interesting about that is she articulated that, which is which is great. That's how she felt. But there'll be lots of clients that might not feel confident enough to say they felt like that, but they still may feel like that. So that's why it's important to work with the person and what they can do. Because I think leaving a home, knowing that the person can get around their home safely, can get themselves something to eat, something to drink, they can they can get around the area of their home. Walking away from knowing someone's confidence do that by themselves is a nice way to work. Leaving thinking thinking a person's not safe, not so nice.
SPEAKER_01:Absolutely, absolutely. I know I I've always had uh a saying uh which I've sort of often said to a number of support workers that I've worked with, if I'm in that if someone's home, is what I'm doing here taking anything away from this person's independence? Or is it actually adding to it? And if you're asking that question just as about as you're about to step in and do something for someone, am I taking their independence away or am I helping them in this way? Yeah, and I think it's a bit of a bar uh a bar around that.
SPEAKER_00:Yeah, and I think a good example of that is something as simple as bringing the post in for them when you come in. Well, you've now maybe taken the one form of exercise outside the house they would have done that day. So it's well-meaning from someone's uh perspective, but at the same time, you are potentially taking away um that that ability for them. And potentially a conversation with their neighbour, um negotiating different, you know, ground outside, all sorts of things around that that um you know isn't what perhaps any primary thoughts, but when you do start to think like that, it's a better way to work.
SPEAKER_01:Better way to work. And it is it is hard if you're in a rush as well, from working perspective, it is hard to sort of be, but if you can start to get those things in your in your head, it's uh it's this approach starts to build. Do you have and you've you mentioned a couple of things? Do you have an example of when short-term reablement has worked and when it hasn't? And then what made it successful or unsuccessful? So a couple of nice examples.
SPEAKER_00:Yeah, I went to see um a gentleman, one that always springs to mind to me, um, being from the UK and how people love their socks in Australia, which always blows my mind. Um I went to see a gentleman that was living, so he was living with cancer and a few comorbidities that had been occurring, and he had some um, he had quite life-limiting um conditions, and so therefore his goals were really quite there in the forefront of things he wanted to be able to achieve. Uh, one being been able to get to his letterbox for his 80th birthday, and it was quite a steep driveway. How was he going to be able to do that? But the other thing was he was ex-military, and not being able to put his socks on himself to him was really degrading. With his wife assisting with that, was her seeing her on the floor for him was offsetting him on a daily basis. So you kind of that wasn't, I guess, what was flagged, that's the point I'd make as well. That wasn't even flagged as a concern and the in the referral. It was by connecting with him and understanding what had changed in this world that this came about around the socks. So, you know, I sat with him and and got him to show me what he'd been trying to do, what was stopping him from doing it. And then um, just as something as simple, so we had a sock applicator and I had one in the car, as I did in those days, and kind of um put it in and said, How about we have a try? I'll do it next to you, you have a go. Um, showed him how to use it. He sat next to him, we both put socks on at the same time, and he he he did it and he kept practicing, and and I said, you know, keep keep having a go, like keep trying with this. And he couldn't believe he could put his socks on in a few seconds. He was just blown away by that. Um and it and that he rang me 10 days later to say, This has changed my world. And I, you know, who'd think that something as small as a sock applicator would do that? But that's the that's the thing we might think that because we're not living with that impact. But when when you you feel like you do that you can't have pushing control and dependence over those everyday tasks, of course, you feel frustrated, you can feel upset, you can affect your relationship. And he was on a real positive high. And then it was a bit of coordination working with the hospital um team. He'd just come out of hospital to see if we could make that goal happen around getting him to his letterbox. So we we did um some work to get a rail installed so he could um the OTs went out to see him, and that's what they determined was was gonna help him. And then he just they worked on practicing increasing the distance over a few weeks so that he could, and he got his goal of getting to the letterbox for his ATF to get his cards. So I think, you know, and I use that I've used that story a few times because I think there's a little bit of a misconception that people with life-limiting um impacts don't have goals, and that's absolutely not the case. In fact, they're more in the forefront of what they want to achieve. So um that sticks in my mind particularly.
SPEAKER_01:Well, that's a fantastic story. I I it's not a similar story, but it's about the small things that make a difference. When I years ago went to see a lady who um had a number of um difficulties, I have to sort of say. But all she really wanted from her goal perspective as re-abent was to be able to feed her little dog. Because she couldn't get down to the ground any longer or lower down to be able to get and put the food bowls down and that sort of thing, and the little dog couldn't jump up, you know, all of those sorts of things. But we worked out a solution in the end, and she was similar, rang me and said, was crying, saying, I can now feed my dog. Because we designed a long handled tray that she could lower to the floor, the dog could jump on this tiny little dog, then she could raise that up, feed, and put the put it back down again. Made such a difference to her life.
SPEAKER_00:Yeah.
SPEAKER_01:What about unsuccessful? When when hasn't it worked and why didn't it work? From your experience, when doesn't it really work? Reopen.
SPEAKER_00:A b a big um part of my role over the years has been mentorship of others um trialling and adopting that approach to their practice. And a few times I've seen where it's been unsuccessful is is where um we haven't got to understand or the goals or how realistic they are, whether they're achievable in the time frame that we have. And I guess thinking a big thing for me is also professional boundaries. So where I've seen it be unsuccessful is where it hasn't been referred on as early as it should have been, to those professional um disciplines. And you know, you but you can't come in with a supercape. It's not about, it's not about you've been able to save the world. Um and you know, the reality is um people will choose, as they always have throughout their life, whether they want to engage or not engage with ideas from other people. And you can't always change that overnight. So as much as a worker may really want something to be successful and they think they can see the outcome being um successful, in my experience, the examples that I've seen when I've been out with other staff and how that how that hasn't kind of worked, it's been around how it was talked about. If we have missed the buy-in for the individual, there's got to be a purpose and a reason to get up in the morning. Things wherever it is that makes you smile, it doesn't matter what it is. I think if you can't pull that out from the person, you can't connect and you can't pull that out, I don't I think you it's not gonna work. Because you've got to you've got to you've got to pass, you've got to link into past passions and interests. Um, you've got to be able to understand how we got to the point we're at. And I just think there's such a skill set in the in the question, the ability to ask those questions, but to also allow someone free space to say, I don't actually know, I know what I want to achieve, but I really don't know how to get there. And being able to have the experience to help them put a plan together of those little leapfrog steps in order to achieve the goals. I think if you can't do that, then you don't get the great outcomes.
SPEAKER_01:I certainly think the ability to have those conversations is is crucial, isn't it?
SPEAKER_00:Yeah.
SPEAKER_01:So if you had any advice for an organization preparing to to deliver short-term reablement, what would you say? You've gone into a new organization or another organization says, Angie, how did you how do you set up reablement service? What are the three things you'd always think of?
SPEAKER_00:Do you know for me, I think it's a value alignment to strength-based approaches and how we treat staff the same as we treat our clients. You know, same, it's it's the same same. Do we help, do we want to build capability in our people? Then we build capability in our clients. Like for me, it's it is an organizational-wide feel for that value alignment. And and I think for me, that's why I've you know been aligned to organizations that have had that, because um it's a very, it tends to be, and particularly for allied health people, they're very they choose allied health roles because they are attuned to wanting to improve the person first, or do you know have that have that um philosophy, life's philosophy, values have impacted in a way which makes you um have that sense of belief that something can be achieved. And I think um an organization to truly do well with this approach, they also need to believe in it themselves, and they need to see believe in the outcomes, they need to be able to articulate it to their staff and to and to their customers of the organization, and they need to um live and breathe it. Leaders need to live and breathe it because then it's easier for you to have conversations with your staff. You can talk about different opportunities and how you can do things differently. We should be innovative. If you're an innovative organization, you're doing all the principles of reablement of how else can you do this? How else can we achieve this? You know, this is to me, it's very same same. Um, we can't go wrong if we if we treat people all the same.
SPEAKER_01:Yeah, and it and it's it's also it's never just well, we're done now. It's a continuous ever growing learning.
SPEAKER_00:Yes. Always learning. Yeah.
SPEAKER_01:That I think that sounds like a great place to conclude our conversation. Um we've covered a number of topics, so including how reablement can help people retain their independence, how support staff play a key role in this, and some really good examples of how when working this way works and when it isn't quite so successful. I'd like to thank thank you again. Thank you again to Angie Slater for joining me today. And for those of you listening, I hope you've enjoyed the conversation. To find out more about reablent, please visit our Keepable site at keepable.com.au. Thank you again to Angie.
SPEAKER_00:Thank you, Louis.
