Becoming an enabler of everyday activity: Health professionals in home care services experiences of working with reablement

Abstract

Background Reablement services aim at improving participation in everyday activities at home and in the local community for older adults, focusing on the older adults' resources and goal for participation. Reablement services have been implemented in a number of municipalities in Scandinavia. To our knowledge, there are a few studies focusing on home care service providers experience working within the frame of reablement. Aim To provide knowledge regarding how home care service providers working with reablement in the home care setting describe their experiences. Methods The study had a qualitative design and included five focus group discussions with 25 healthcare professionals working in community health care in two municipalities. The data were analysed using a grounded theory approach. Result The analysis illustrated how the participants experienced both engagement and challenges working with reablement. This was identified by the two categories: creating sustainable change and negotiating the line between helping and enabling. The first described how increased focus on enabling participation among the service recipients created sustainable changes for the older adults and was considered a positive change for both the recipients and the health professionals. The latter showed how the participants found working with reablement as a process of negotiation. This was what the health professionals found most challenging with reablement. Conclusion Working within the frame of reablement offered the service providers, a framework for being more flexible in meeting the fluctuating needs of the older adults. This was done by increasingly utilise ones' clinical skills and changing from providing passive care to working on increasing the older persons' participation in everyday activities. Working with reablement also created challenges. This was related to the health professionals perceived expectations of what some of the older adults expected home care to be and caused ambivalence. Implications for practice Nurses and healthcare workers should focus on older adults' resources and goals in order to give services that enhance participation in daily activities.

Enabling and constraining successful reablement: Individual and neighbourhood factors

“…Similarly, our finding that people older than 90 were less likely to benefit from reablement is probably also the result of poor health and the natural limits on health improvements at an older age. This is not to say older people do not profit from reablement but it may be unrealistic to expect full self-care and, as studies have suggested, reablement for the very frail and disabled may often need to be accompanied by at least some level of home-care in order for it to be effective, especially over the long term [31,33,37]. Moreover, some level of informal care is likely to continue to aid independence for many reablement clients and, although this was not included in the management data and is thus an unknowable for our analysis, informal support has been shown by some studies [34,37] to be an important component of successful reablement.…”

“…Nonetheless, particular regressive health problems and disabilities mean that reablement is bound to be quite restricted for some groups. Similarly, it can be assumed that high initial care-need (as measured here by having care needs greater than 13 hours) will be unlikely to be wholly ameliorated through reablement and that some clients will continue to require some level of traditional home care alongside reablement [31,33,37].…”

“…Studies indicate that successful reablement tends to dwindle over time [13,14,35], and it makes sense that, as people age, their needs change and reablement programmes thus need to be dynamic [29]. Yet it has also been posed that successful reablement and, long-term success in particular, are likely to be influenced by social conditions largely outside of an individual's control, but which are rarely considered in reablement policy or evaluation [31,34,36,37]. These conditions include levels of informal social support for clients and broader neighbourhood and environmental conditions that may or may not aid independence.…”

Adult children’s experiences of family occupations following ageing parents’ functional decline

“…The study was conducted in four Norwegian municipalities providing reablement to older adults. Reablement is a form of rehabilitation service targeting older adults living at home who have been experiencing a decline in functioning (Liaaen & Vik, 2019), often after an accident or illness (Aspinal et al, 2016). Reablement is provided by healthcare professionals working in the community (e.g., occupational therapists, physiotherapists, nurses, and home-carers) and consists of training in everyday occupations to regain independence and the ability to stay in one's own home for a longer period of time (Glendinning et al, 2010;Langeland et al, 2015;Tuntland et al, 2019).…”

Discourses of service recipients in the context of reablement in Norway

“…Moreover, multiprofessional teams are established that include, for example, an occupational therapist, physiotherapist, healthcare worker, social worker, social educator, and nurse. In the multiprofessional teams, the occupational therapist has a central role and becomes involved in the implementation of reablement [13]. These changes result in new demands made on service providers who engage in reablement, including a new way of working and a new mindset that, in this case, involves a perspective and an approach that allow more user involvement [14].…”