Effects, costs and feasibility of the ‘Stay Active at Home’ Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial

Metzelthin, Silke; Rooijackers, Teuni H.; Zijlstra, G. A. Rixt; Rossum, Erik van; Veenstra, Marja Y.; Koster, Annemarie; Evers, Silvia M. A. A.; Breukelen, Gerard J. P. van; Kempen, Gertrudis I. J. M.

doi:10.1186/s12877-018-0968-z

Cited by 13 publications

(24 citation statements)

References 70 publications

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“…For example, in New Zealand reablement is delivered by support workers and registered nurses with support from the wider inter-disciplinary team (King et al, 2012a(King et al, , 2012b, while in the Dutch 'Stay Active at Home' study, reablement is provided by home care teams (i.e. domestic support workers and nurses) (Metzelthin et al, 2017(Metzelthin et al, , 2018. In contrast, in Norway, reablement is strongly influenced by occupational therapists and is delivered by an inter-disciplinary team that also includes other disciplines such as nurses, social educators, physiotherapists, home-helpers and assistants (Langeland et al, 2015(Langeland et al, , 2019Tuntland et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Development of an internationally accepted definition of reablement: a Delphi study

et al. 2020

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With an ageing society, the demand for health and social care is increasing. Traditionally, staff provide care for their clients rather than with them. In contrast, reablement aims to support people to maximise their competences to manage their everyday life as independently as possible. There is considerable variation between and within countries regarding the conceptual understanding of the approach. This variation affects the ability to evaluate reablement approaches systematically, compare and aggregate findings from different studies, and hinders the development of a robust evidence. Therefore, a Delphi study was conducted in 2018/9 with the aim of reaching agreement on the characteristics, components, aims and target groups of reablement, leading towards an internationally accepted definition of reablement. The study consisted of four Web-based survey rounds. In total, 82 reablement experts from 11 countries participated, reaching agreement on five characteristics (e.g. person-centred), seven components (e.g. goal-oriented treatment plan) and five aims (e.g. increase clients’ independency). Furthermore, most experts agreed that reablement is an inclusive approach irrespective of the person's age, capacity, diagnosis or setting. Based on these features, a definition of reablement was developed, which was accepted by 79 per cent of participating experts. This study is a significant step towards providing conceptual clarity about reablement. Future research should focus on evaluating the implementation of agreed reablement components to inform practice, education and policy.

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Section: Discussionmentioning

confidence: 99%

Development of an internationally accepted definition of reablement: a Delphi study

et al. 2020

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“…The Dutch reablement training program ‘Stay Active at Home’ was recently designed to integrate reablement in the delivery of homecare services [ 15 , 16 ]. The program seeks to equip homecare staff (nurses, nurse assistants, nurse aides and domestic workers) with knowledge, attitude, skills, social and organizational support to implement reablement in daily homecare practice.…”

Section: Introductionmentioning

confidence: 99%

Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults

et al. 2021

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Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n = 4). Results The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. Trial registration ClinicalTrials.gov (Identifier NCT03293303). Registered 26 September 2017.

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“…In addition, societies that seek to limit LTC spending in the long run may consider alternative ways of achieving this, including reablement programs that limit the development functional limitations or restore abilities in older populations (cf. Lewin et al 2013;Tuntland et al 2015;Winkel et al 2015;Zingmark et al 2017Zingmark et al , 2019Metzelthin et al 2018).…”

Section: Resultsmentioning

confidence: 99%

Substitute services: a barrier to controlling long-term care expenditures

Kattenberg

Bakx

2020

Eur J Ageing

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In many developed countries, long-term care expenditures are a major source of concern, which has urged policy makers to reduce costs. However, long-term care financing is highly fragmented in most countries and hence reducing total costs might be complicated by spillover effects: spending reductions on one type of care may be offset elsewhere in the system if consumers shop around for substitutes. These spillovers may be substantial, as we show using a reform in the budget for municipalities for the most common type of publicly financed home care in the Netherlands, domestic help. This reform generated an exogenous change in the grant for domestic help that does not depend on changes in its demand. We show that the change in budget affected consumption of this care type, but that this effect was mitigated by offsetting changes in the consumption of three other types of home care that are financed through another public scheme and are organized through regional single payers. We find that a 10 euro increase in the grant for domestic help increased use of domestic help and nursing by 0.13 and 0.03 h per capita (4.4 and 5.2% of use in 2007), whereas it decreases use of individual assistance and personal care by 0.03 and 0.05 h per capita (4.1 and 2.9% of use in 2010 and 2007, respectively). As a result, the total spending effect is closer to zero than the effect on domestic help suggests. This finding means that the fragmentation of long-term care financing limits the ability to control expenditure growth.

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Effects, costs and feasibility of the ‘Stay Active at Home’ Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial

Cited by 13 publications

References 70 publications

Development of an internationally accepted definition of reablement: a Delphi study

Development of an internationally accepted definition of reablement: a Delphi study

Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults

Substitute services: a barrier to controlling long-term care expenditures

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