A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints

Abstract

Background Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people. Methods Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2–5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. Results Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people’s functional status and needs (including for safe home environments), and to identify older people’s wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of ‘showing/doing with’ versus ‘doing for’ the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. Conclusion Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by ‘showing/doing with’ versus ‘doing for them’ when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge.

Factors Impacting User Engagement in Reablement: A Qualitative Study of User, Family Member and Practitioners’ Views

“…75,76 An interesting feature of reablement, and again different from many healthcare interventions, is much of the work to develop and sustain engagement is carried out by staff who are not professionally qualified. 10,77,78 In line with previous work, 63,79 our findings repeatedly highlight the nuanced and skilled way staff work with service users and, often, family members (something we explore further below). Such findings align with calls for greater recognition of the multirelational, complex, and skilled work carried out by non-qualified staff.…”

“…4 , 7 , 20 , 25 , 59 , 61 , 63 , 64 Finally, existing work indicates that reablement staff’s understanding of, and adherence to, reablement principles, communication and motivational skills, and duration of reablement visits may impact engagement. 8 , 10 , 13 , 20 , 21 , 26 , 30 , 59 , 64 , 65 …”

“…[1][2][3] Emerging in the mid-2000s, reablement represented a paradigmatic shift in the approach to the care and support of older people. 1,[3][4][5][6][7][8][9][10][11][12] The growing challenges of population ageing, and unsustainable demands on long-term care, have driven its implementation in many developed economies, though the way it has been operationalized varies. 1,5,[13][14][15] influence on intervention engagement.…”

Stakeholder perspectives on the preferred service ecosystem for senior citizens living at home: a qualitative interview study

“…In this context, value and benefits are based on senior citizens’ expectations and experiences of the service delivery process rather than outcomes alone [ 30 , 37 , 38 ]. This aligns with the global “what matters to you” movement and should form the basis of the service ecosystem development [ 24 , 25 , 27 , 39 ]. Additionally, health promotion and active ageing in age-friendly environments should be encouraged [ 29 , 40 – 43 ].…”