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 & Dementia: Applying Research (P2)
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With Dr Claire O'Connor - Dementia Research - results of the research program from UNSW and why reablement MUST be considered and used to achieve positive outcomes for clients living with dementia - also, the perspective of Allied Health professionals and methods for non-clinicians.
Discover more reablement resources at keepable.com.au
Introduction
SPEAKER_00Hello and welcome to this episode of the Reablement Podcast, where Keep Able are talking to a range of people who have experience using reablement and we're going to talk about how it can be incorporated into your work with older people and why it works. I'm Alison Vella from Keep Able. In this episode, we are talking again to Dr. Claire O'Connor, Senior Research Fellow from the University of New South Wales. Claire has recently done a whole lot of research on this very topic, so I'm very excited to have you here and get some ideas and thoughts from you, Claire. Thank you very much. Happy to be here. Is there anything else you want to say for your introduction? Have I missed any important key points there for you?
SPEAKER_01I think just that I am an occupational therapist by background and I'm working at the University of New South Wales and also have conjoint appointments at Neuroscience Research Australia and Hammondcare as well. My research is really looking at how we can translate and move the evidence around rehab and reablement for people living with dementia into practice to supporting people as best we can.
SPEAKER_00Fantastic because it is such a specific type of work and type of approach that people need to consider, isn't it?
SPEAKER_01It is a specific approach, but I guess it doesn't have to just be allied health practitioners or professionals who do this. I think taking a reablement approach to the way that we support people living with dementia, everyone can really do that. So we can all look at the person that we're working with and think about what people's abilities are and how we can support them in using their abilities. And everyone can do that.
SPEAKER_00Absolutely. Assess the actual person and go from there.
What are the main benefits
SPEAKER_00What are the main benefits do you feel?
SPEAKER_01So really it's about helping people to engage and participate in life as much as possible. So I mean, as human beings, we all need to be engaged and feel that we're doing things and achieving things. So it's about supporting people in maximizing their well-being. I mean, I could give you an example, is that at the end of the day, when I know I've got a laundry basket full of washing that I need to fold, I'm not looking forward to doing that. But I do it anyway because it needs doing. And at the end of the time that I've done it and I've got all that laundry folded up and I stack it back into the basket or folded, I feel pretty accomplished after that and it makes me feel good. That's the same for people living with dementia as well. So it's about looking at how we can support people to participate in life using the skills and abilities that they have.
Applying the research
SPEAKER_00Fantastic. Love that approach. Tell me about the research that you've been doing and what it tells us about using reablement for clients living with dementia.
SPEAKER_01I mean, we've been doing research over the past few years, looking at the evidence says about supporting people with reablement. And it's really about looking at what people's strengths and abilities are and supporting people collaboratively with the person to look at what they want to do and supporting people to do the things that they want to do. So the research really shows that there's a range of ways that we can do that, and it's not just one approach. So we can look at people's physical abilities, we can look at people's thinking or cognitive abilities, and also socially how we can support people to participate in life that way as well. And so the research really shows that there's a range of benefits that can happen from engaging in reablement with people living with dementia that really covers a whole range of areas depending on how
Example for a support worker
SPEAKER_01we support people.
SPEAKER_00Have you got any examples that you might have heard of and what it could look like, say for a support worker working with a client in their home?
SPEAKER_01Yeah, absolutely. As I said, it's about recognizing what someone's abilities are. So even though someone might not be able to do things in the same way that they used to be able to, everyone has abilities to some extent. And so it's about trying to recognize that and then support people to use the abilities that they got to participate. Going back to that laundry example. So if you've got someone who maybe can't do a whole load of laundry, maybe they can hang it out. Or maybe they can't go outside and hang it out, maybe they can sit down and fold the washing. Or if they can't fold a whole basket of washing, maybe they can sort the socks, or maybe they can fold the towels. So it's you break activities down into steps and look at which parts of that activity that the person is still able to do. You know, if you're there to support someone in meal times to have their lunch or to help them with dinner, what aspects of that meal is that person able to assist with? So instead of just cooking the whole meal and presenting it to the person, perhaps they could help with chopping up some of the vegetables or stirring some of the pots. So we really don't want to just do things for the person when the person is able to do parts of that activity themselves. So it's really about trying to recognize that everyone has abilities and how can we support those people to use their abilities.
SPEAKER_00It's a great concept, isn't it? Thinking about task analysis. What's the task? Let's break that down and see what we can make workable. Exactly.
Why it's not a one off approach
SPEAKER_00Exactly right. What would you say about it being a one-off approach?
SPEAKER_01Do you feel that it is? I feel like uh if someone is engaging in a reablement program with an allied health team, that is usually for a defined period of time. But outside of that, we should always be looking for opportunities to support people using, I guess, a reablement approach in terms of uh what I just spoke about, in terms of recognizing what people's abilities are and supporting them to do as much as possible in terms of the activities that they're doing every day. Even with the reablement programs, I don't think that even is just a what should be a one-off thing either, because people's abilities change and their needs change as well. And so we should be re-approaching that when needed to be able to sort of continue to support people over time. But definitely not necessarily a one-off approach. And we should always be looking at how we can support people to use their abilities and engage in the activities that they want to in life.
Reablement process for non clinicians
SPEAKER_00And can you talk about what the purposes and the process is for using reablement for non-clinicians, what it can look like for clients living with dementia?
SPEAKER_01Yeah, so I mean, the purpose is to support people to do what they want to do and to support people to participate in life and engage in the activities that they need to engage in. Um, how we can do it is really about recognizing what people's abilities are and what their strengths are, and making sure that we leverage that to support people to do what they want to do. It's about building rapport with clients living with dementia, and it's about communicating really clearly, whether that be the words that we use and the way that we use our words, whether we use visual communication, whether we use prompts by setting activities up for people so they can see what we're asking of them. There's a whole range of different ways that we can support people through sort of using a reablement approach to be able to help them to do the things that they want to do.
SPEAKER_00You've given some
Alternative ideas
SPEAKER_00great simple steps and strategies. Are there any other ideas that you'd like to give us that the wider audience might be appreciative of?
SPEAKER_01I think I probably have touched on a lot of them. So it's really be about looking at an activity that the person might want to engage in and how can you break that down into steps and then look at what steps that person is able to do. It's about setting up activities for people so people understand what we're asking them to participate in. It's about reducing clutter and simplifying the environment. So I guess if you want someone to do uh maybe chop some carrots at the dining room table, I would be removing everything else off the dining room table except for the chopping board and the carrots and the knife. So that reduces all that other distraction that might make it difficult for the person to do the activity that you're asking them to do. And it's about just having simple communication and using cues in different ways depending on what the needs of the person. I touched before on using visual cues or perhaps touching someone's hand or using verbal cues to support someone throughout the activity to support them in the ways that they need to be able to engage in the activities that they want to do.
SPEAKER_00Wonderful and some really great strategies and just simple ideas about stepping back and look at it for yourself and how can I make this as clear and simple as I can for the person.
SPEAKER_01Really, I would say look at what the person's interests are. If the person is not able to communicate that to you themselves, maybe if they have family, I would be asking the family what that person used to enjoy doing, what they currently enjoy doing, and I'd be looking at trying to frame up some activities to engage them in around that and looking at their environment and what supports they've got to be able to support them in different ways to engage in various activities. But as I said before, it doesn't have to be something like painting or something that's going to, you would think, would be particularly a leisure-based activity, although leisure activities are great, but also just looking at the day-to-day activities, also how can we involve people and engage them and help them to participate in the house and contribute to the household.
Goals for clients from non clinicians
SPEAKER_00Do you have any examples of what goals for clients by non-clinicians might look like?
SPEAKER_01I would just be remembering that everyone has abilities and everyone should be supported to participate in life and do activities that they want to do. People, just human beings, need to feel like we're doing things in life. No one wants to sit around and do nothing. So how can we support people to be able to be active and contribute in life? So I'd be thinking about that really creatively when working with clients living with dementia. So I know that, you know, if you're going in there and you've been brought in to shower a person, for example, thinking about, okay, what what aspects of this activity can the person do? Maybe they just need support with getting into the shower. And then maybe once they're in there, they can wash themselves if we do standby assistance and just use verbal prompts to say, you know, pick up the soap now, wash under your arms. It just depends on what those persons' needs are. So instead of just doing it for them, uh, how can we support that person to contribute to that activity as much as possible?
What is important for aged care workers to consider
SPEAKER_00So, what is important for aged care workers to consider?
SPEAKER_01I think it's just so important that we recognize that we should be supporting people to do things for themselves as much as they can and not trying to do everything for someone just because we think that that person needs help with something. So I think we just need to take a moment sometimes just to think, well, this person does have some abilities. What are those abilities? And how can we help them or support them where they need it? And then how can we sort of help that person uh use their strengths and the abilities that they've got? So we don't want to take things away from people because it's that, you know, use it or lose it approach, isn't it? So we really want to support people to use it as much as possible to support them to be able to maintain it for as long as possible.
SPEAKER_00Yes, whether it's about improving or maintaining that quality of life, that's what it's all about. That's right.
What language to use to empower
SPEAKER_00That's right. What about the language that you use with people when you are trying to empower them and build on their capacity or at least maintain their capacity? What sort of language do you think is important for clients living with dementia?
SPEAKER_01Okay, that's a good question. I think it uh varies depending on the person that you're working with. And I think sometimes it can be difficult to encourage someone to participate in an activity. I think sometimes if someone has dementia, it might be easier to say, oh no, I don't want to do that. If something seems a little bit uncertain or they're not sure what you're asking them, they might say no, thank you, if you offer them an activity. So the way that we communicate with someone and present an activity to someone is very important and can make a big difference about whether or not that person engages in that activity. So sometimes it's about framing it in a way that you're, I guess not just asking someone, hey, do you want to do this? It's about framing it in a way that's saying, Oh, come and do this activity. You know, you're sort of encouraging them to do it or asking them for their help. Say, oh, I really need your help with something. Do you think you'd be able to help me with this washing? So it's about framing it in a way that you are being encouraging and showing that person that you think that they can do this activity and it would really help you and really can contribute to the household if that person is able to do that activity for you. So I think we need to be a little bit creative sometimes. And sometimes the person might say no when they don't understand yet what we're asking them to do. So if we set up the activity, maybe that visual cue of someone seeing what we're asking them can sometimes help them as well. So we just need to be set up activities in the best way as possible and communicate it as clearly as possible so the person has a chance to understand what we're asking.
SPEAKER_00And having possible different strategies up your sleeve as well. Because if you work with someone long term and you can see this method is not actually working, having other ideas to try as well.
SPEAKER_01Oh, flexibility is so important. And, you know, listen to the person and you will be able to understand. I mean, it's, you know, someone might actually not want to do something, and it's very important that we listen to that as well and then find a different activity. So I'm not saying that we should be not listening to people. I think we should be listening to people, but some encouraging people as much as possible because sometimes people might just be saying no because they're not sure what we're asking, and it's easier to say no. So I just think it's very important to listen to people and support them and encourage them. And if someone doesn't want to do a certain activity, then be flexible and pivot and find a different activity that that person might want to do.
SPEAKER_00Because you might even see their response in their body language or facial expression or something else as well, if they can't verbalize what it is that they're feeling.
SPEAKER_01Exactly. Exactly. And that's, you know, where different type of prompting, different types of prompting is useful as well. So sometimes someone putting something into someone's hand might help them to recognize that you're asking them to interact with something. Sometimes, yeah, some people might need the actual touch cue to help them to engage in something. So we need to be really creative and flexible and really listen to that person. And yeah, you're right. And look at the way that the person is communicating to you as well.
SPEAKER_00That's great.
Using visual cues
SPEAKER_00Do you find that using other visual things like signage and that sort of thing in some circumstances can be a really great method?
SPEAKER_01Yeah, I mean, it's everyone's different and depending on what sort of signage you're talking about. But maybe if someone needs a sign to find the toilet, for example, that could be really useful. Or if someone is able to unpack the dishwasher but can't remember where everything goes, then perhaps some labels on the drawers or the cupboards might help that person to be able to unpack the dishwasher by themselves, or put in the laundry away, but they've unable to remember what goes where, then labels on the cupboards and the drawers in the bedrooms could help.
SPEAKER_00And are there any simple ideas or simple language that support workers might use with a carer or family member of the person living with dementia? If they sort of say, no, you just do that for them, and that's why you're here, how can we explain to
Language to use with a family member/care worker
SPEAKER_00them why we are trying to include them?
SPEAKER_01It's just important to be able to communicate that everyone needs to be able to do things in life and we need to be able to support people to do things to so they feel good. And maybe we can just put it down to, you know, we all feel good after we've done the chores that we needed to do that we didn't want to do, but we feel good afterwards and we feel a sense of accomplishment knowing that we've done those things. So I guess just trying to break it down to things that we all feel as humans so people can understand that people is no different for people living with dementia, and we just need to support them to also be able to have those feelings of accomplishment by having participated and contributed in the ways
Positive feedback example
SPEAKER_01that they're able to.
SPEAKER_00Yes. So have you had any feedback at all from an aged care worker or a client or a carer of someone living with dementia that may have experienced a really positive reablement opportunity?
SPEAKER_01I can think of a family carer who I was working with once who was really struggling to support her husband in the shower, and she was showering him for him. And then we uh worked together on communication and how she could communicate with him while doing that activity, basically to slow down and not try and rush through the activity and then use visual cues and just give him the time to respond, keep herself calm while doing that activity. That all made a really big difference to that carer, and she specifically tried all those strategies and came back and said, you know what, it just made such a difference. And then he was able to participate in the activity himself a lot more once he was in terms of getting undressed and getting into the shower and participating in the shower. He was actually able to do a lot more of it once he was given the time and once the communication was slowed down and he wasn't being rushed through the activity. And she just commented that it was better for him and it was better for her as well, and they both had a better experience, basically.
SPEAKER_00Thanks for sharing that example. That's so good. So
Social interaction example
SPEAKER_00talking about the benefits of social interactions for our clients, have you got any examples of where you have seen that be really beneficial before?
SPEAKER_01Yes, for sure. So I was working with a client once who had been supported to get back in the garden. It was something that he used to love doing. And one of the things that we worked on was getting him back out in the garden and supporting him to put together a veggie garden, and it became something that he loved going out and doing, and he used to water his garden and get out there and check on it daily. He actually had some communication challenges, and so family and friends who visited often found it difficult to communicate with him and didn't know how to talk to him. So having this garden actually became a really nice talking point. He was able to show the visitors his garden and then people would be able to really engage in really nice conversations with him about the garden and gardening, and it was just a really nice connection point where he was able to sort of reconnect with family and friends about that, and so it was a really nice outcome from that activity.
SPEAKER_00It's fantastic to hear of all the research and everything you are doing at the moment, Claire. I'm hoping that we get the chance to collaborate a little bit more in the future. But thank you so much for being here and joining us today. Thank you very much for the opportunity. And for our listeners, please jump onto our website at keepable.com.au for all our resources on wellness and reablement.
