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 Gill Lewin
In this episode, Hilary O’Connell has invited Gill Lewin, a member of the Australian Government Council of Elders, and adjunct professor at Curtin University.
Together they discuss the research and evidence behind reablement and short-term restorative care, and how it can help older people increase their quality of life and enable them to live more independent lives.
“Reablement most importantly is a model about helping people be what they want to be, the best person they are.” Gill says.
Hilary and Gill also discuss how the reablement approach is highly individual and structured to support each client’s personal goals, by looking at all aspects of a client’s current life, and what they aspire to do moving forward.
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, also known as restorative care. 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 Jill Lewin, who is a member of the Australian Government Council of Elders and is an adjunct professor at the Enable Institute, Faculty of Health Sciences at Curtin University in Perth. Jill is an international expert, aged care research, restorative care services, and reablement. While Jill's personal research interest has always been models of care that promote independence, she has conducted and published both quantitative and qualitative research on a diverse range of topics relevant to community-based care. Jill's research currently has more than 11,000 mentions in published papers. So I'd like to welcome Jill and first of all, thank you for talking with me today. And is there anything else you'd like to add to that introduction at all?
SPEAKER_00:Thank you, Hilary. No, I don't think there's anything I want to add, thank you.
SPEAKER_01:All right, well, we can get started then. So I'm going to run over just a number of questions for you about reablement and get your opinions on them. What does short-term reablement mean to you?
SPEAKER_00:Basically, it means helping people to be their best selves. And that is in all areas of their life. So it can include function as well as quality of life or sort of emotionally or whatever.
SPEAKER_01:And how do you think reablement, short-term reablement can help older people? What does the evidence say?
SPEAKER_00:The evidence is, of course, very mixed, and that's partly because of the whole issue related to research and what types of research is considered to provide the strongest evidence. But putting that aside, the evidence of those papers that are randomized controlled trials and provide the strongest evidence indicate that reablement or restorative care can in uh for some people help them improve their daily function, help them improve their mobility, help them improve their quality of life, and basically whatever goals that they have set themselves. And that's the issue about research, because reablement, most importantly, is a model about helping people be what they want to be, the best person they are, and everybody's different. So that that means that the approach needs to be individualized. And if one person it might be that they want to be able to walk to the local coffee shop, then the the sort of their their goal obviously relates to mobility and the strategies or interventions that um they are offered to help with that relate to building strength and balance and mobility and helping them be able to do that. But somebody else, their um main goal might be that they can uh make themselves a cup of tea, and then it involves looking at the difficulties they're experiencing and um the working how they can learn to do it perhaps differently from how they've done it before, but they can manage with their current capabilities.
SPEAKER_01:So very much down to it being say individualized to that person for it to actually mean anything to them.
SPEAKER_00:Oh, uh absolutely it has to, and which which relates again, as I said, to I think the main issue in terms of the mixed research evidence, because the the research approaches require one to look at to use the same outcome measures for everybody. But if everybody's working on different aspects of their own function or well-being, then not all outcome measures are relevant to them. And so you wouldn't expect that they would make gains across the board if they've only been working on mobility or only been working on a making a cup of tea. So uh yeah, it it very much relates to it being an individualized approach.
SPEAKER_01:I remember many, many years ago, and this is probably 20, 25 years ago, working with a lady. Um, and when I asked her what her goals were within reablement, her her priority goal was to be able to feed her little dog. And she didn't really want, I mean, she she she wanted to be able to wash and dress herself and walk better and all of those sorts of things, but they were secondary to her in comparison to actually being able to um feed her dog. Um, and so we went, we that's what we did with her. We sort of taught her how to do that, we provided equipment, different sort of solutions for her, and then also built up some of her quad strength and her upper limb strength, enabled her to do that, and then she was happy to move on and look at other areas of her life. Um, but you don't always have the luxury of of being able to do that.
SPEAKER_00:Of being able to move on to other areas of the their life, yeah, absolutely, because one of the things is that it a reablement program is usually only funded for a short period of time. And as you say, it's often a matter of sort of helping somebody realize that they can do things again and that they can strategize around it so that once they've sort of achieved that that first thing that they thought was most important, then suddenly they think, oh, well, you know, now I'd like to be able to do this and that and yeah, go further. Exactly.
SPEAKER_01:And you've touched on this a little bit already. What do you think reablement looks like when working with an older person? If you look back to some of the work that you've done, what does it look like?
SPEAKER_00:Um, one of the absolutely essential parts is the initial assessment, which involves um I think preferably the um one of the team that's going to work with her, um, or her or him, um, sort of working through all the person's strengths as well as their weaknesses and identifying what those goals are. So without that gaining a full understanding of where a person is at, as well as the goals that they want to get to, then you have no basis from which you can work and develop um or give the person ideas about um how you can work. So another aspect of that is that it's very much a dual process. The older person is involved, very involved, and they need to really get on board with the whole idea. And I'm a strong believer that that can be assisted by having other family members or other people who are important to them involved in the whole process, so that that person can then encourage and reinforce the new behaviors as the older person acquires them. So it's individualized, it's based on a very thorough assessment, it demands the development of a very good working relationship between the team member who's doing the work and the older person. It's facilitated hugely, I think, by having other people involved and it needs to be um fairly intensive, especially as we've already said, it's only funded for a short term. So that one needs to be able to get the person involved in um working towards their goal from the very beginning and quite intensively. So those are some of the important components that I see. And as I also said, as everybody is individual and has individual goals, then it's very important that the whole of the person is considered, that they that they're encouraged to think about their whole life, not just you know, whether they can do the the washing up, because that might not be so important to them. But sort of getting out and socializing might be the critical thing that they want to achieve. Many of the sort of functional aspects of their life they can understand are critical that they can do by themselves in order to be able to go out and socialise, because you can't catch a bus on time if you can't get yourself out of bed and showered or ready and dressed and um can walk to the bus stop.
SPEAKER_01:Yeah, you can't do when you can't do things when you want to do those things if you're relying on someone else coming in helping you. Totally. And if you're sort of thinking about some of the reablement programs, the services you've been involved in, what do you think of the we've talked about the principles, those key elements. What about the key uh evidence-based interventions that would be sort of uh uh you would say would be best practice within a reablement program?
SPEAKER_00:They're they're sort of again multifaceted. The evidence seems to indicate that people are more motivated in terms of personal care than they are in terms of home care. So that it's important that the sort of service is able to offer the supports and the strategies around building the strength and balance required to shower yourself or walk to the shops. So the whether you call them sort of physio-related skills, that's important. But then for learning how to make a cup of tea differently, um, you know, it's occupational therapists who have the original training in terms of task analysis and redesign according to somebody's capabilities, and also looking at um equipment. But if it's somebody's health and they want to learn to self-manage their diabetes better or whatever, then um some of the skills and knowledge related to nursing can be very important. But rather than have lots of different people go into the house, what we found when we first did a pilot of the HIC project was that the older person got a bit confused and didn't really like having multiple people coming in and working with them on different things, that it was really important that there was just one person who was the the sort of main person that who was developing the program and working with them, but that program needed to include different aspects from all different sort of health professional skill sets. So I think that you know the interdisciplinary or intradisciplinary approach is absolutely critical.
SPEAKER_01:So the sort of the OT can learn from the physio, physio can learn from the OT and nurse, etc. And we all will learn that everybody can learn a little bit about what each does and actually then apply that at that at a certain point.
SPEAKER_00:Absolutely, but I mean I do think with that approach it's essential that you have the um regular contact with your other health professionals so that if things aren't going as you hoped, you you have the sort of expert in that field, if you like, that you can discuss it with. And sometimes it's necessary to ask whether they will come and um do an assessment because basically it's not working out, and you think that um you know you you need more a higher or more specialist um approach.
SPEAKER_01:Absolutely, absolutely. All right, have you got a couple of examples? People always want to sort of hear some really positive examples of when reablement has worked and and then when it hasn't worked, and what might make things some successful and what's unsuccessful, what are the contributing factors? So an example or two of posit of when it's worked and when it hasn't, in your experience.
SPEAKER_00:Yeah. Um I could give you an example of a time that it it did work, which the the program that we were running at the time was actually called social um reablement. And um it was a program to especially help people whose the issues that they wanted to work on related to getting out of the house and doing things socially. Well, it wasn't social. This woman's husband was um in hospital, and he had been the main um driver for many years, and she found that when he was in hospital and it was going to be a long-term hospitalization, she felt that she couldn't drive to the hospital to see him, and it she lived quite a long way away, and it was taking her hours to go on public transport. So what she um asked for was some assistance in regaining confidence with the driving, and um, so a program was worked out, and it was uh somebody who'd been trained in reablement but was a volunteer. What they did was they had a sort of progressive program where at first the the volunteer sat with the this woman and they gradually increased the distance that she could drive and the sort of different situations in which she would drive. Then it was um a matter of uh sort of driving part of the way by herself. So the volunteer would start off with her and then um get out, you know, a suburb before the hospital, so that the woman had to do the parking and getting herself in. And yeah, so and it it was hugely successful. Successful, gosh. Yeah, yeah.
SPEAKER_01:That's an interesting example. I haven't heard that one before, but so important from a uh you know, community access perspective, as you say, uh, and to be able to visit her husband in hospital. What about um any unsuccessful examples?
SPEAKER_00:Uh I think the trouble, Hillary, is everybody only gave me the ones that were the positive ones, that's fair enough.
SPEAKER_01:What what if you without an example, what what do you think might be some of the contributing factors to something being unsuccessful? Would that be perhaps um sometimes the motivational levels of the person or they're just not quite ready for it, or the staff approach?
SPEAKER_00:Um you know yes, I think all of those can contribute, but I think right from the the very beginning, there has to be, if if not a positive attitude towards believing that um one can actually still learn as an older person and still change, that the sort of the attitude that they can't is at least still malleable and open to information and encouragement. Whereas there seem to be some people whose attitude is is really so entrenched that it's very hard for to sort of get over that. And in in some ways, yeah, I mean I've sort of think that until at least that somebody is admitting to themselves that maybe um life could be different if they did certain things, then I'm I'm not sure it's even worth beginning. I think that you have to be at least open to it, and then the reablement team can sort of look for the low-hanging fruit to quite quickly help the person see that yes, indeed, you know, they they can make changes and their their life could be different and a bit better.
SPEAKER_01:Yeah. So the small those small changes can make a big difference to someone's way of thinking, can't they? Yeah, huge. What would you like to see short-term reablement look like in the new support at home program?
SPEAKER_00:Um, I'd like I'd like to see that it was how everybody began. Well, I think that for it it ought to be the way everybody sort of started the services. And I was going to say started their service career, but for me, what I think that we were able to show in our research was that in fact it cuts short a career for many people. If it's something where somebody is successful and they then don't need the home support service that they originally thought they did, you know, that benefit can last for a number of years before other things take over and perhaps they come back. All right.
SPEAKER_01:Well, I think I think that's a really good place to conclude our conversation. Um, I think we've covered a number of topics. It's sort of around reablement, how it can help people retain their independence, where support staff and allied health play a key role. It's a lovely example of how working with this way works and maybe some of the factors that um can make reablement unsuccessful. And I I love your viewpoint on where um you think reablement should sit within the new support at home program. Thank you, Jill, for joining me today. And for those of you listening, I hope you've enjoyed the conversations. And to find out more about reablements, please do visit our Keepable site at keepable.com.au. Thank you, Jill, for your time today.
SPEAKER_00:Thank you, Hilary. You're welcome.
