First things first – let’s start with a definition of these two terms.
Wellness is an approach that involves assessment, planning and delivery of supports that build on the strengths, capacity and goals of individuals, and encourage actions that promote a level of independence in daily living tasks, as well as reducing risks to living safely at home. (from Living Well at Home: CHSP Good Practice Guide)
Reablement is the process of helping people regain or re-learn skills required for daily living which have been lost due to deteriorating health or advancing frailty. Reablement programs are time-limited interventions (6-12 weeks) that are targeted towards a person’s specific goal or desired outcome to adapt to some functional loss, or regain confidence and capacity to resume activities.
The purpose of these approaches is to maximise an individual’s capacity to self-manage and foster independence. They improve an individual’s quality of their life by addressing their physical limitations and using adaptations to reduce the overall impact of these limitations on their life, while reducing the need for continuing support.
This is a shift away from the traditional community care services model which has had a focus on illness, impairments and dependence by providing passive support for individuals, to one that works with an individual’s abilities.
Key Driving Principles
Reablement and wellness practices:
- Accept that the person is the expert in their life
- Supports a service focus on independence
- Build on the person’s strengths, abilities and resources
- Explore the difference between where the person is and where they want to be
- Are based on goals identified and developed in liaison with the individual
- Provide time-limited personalised support
- Aim at empowerment and maximum independence
- Aim to either improve or maintain current levels of function, wellbeing and/or service usage or reduce the rate of decline
- Focus on building capacity and social connectedness to promote a client’s capacity to live as independently as possible
- Include a planned review process and changes to support plans to accommodate and measure progress
Evidence to Support a Wellness and Reablement Approach
The Home Independence Model (HIM), an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time.
Lewin et all (2008) found consumers on a Reablement program had:
- 71% had less difficulties with IADLS
- 60% of people left the reablement program not requiring any immediate homecare
- 42% of that group still required no homecare at 2 years
- 44% had maintained or reduced their levels of care 2 years after reablement
Benefits reported by older people:
- Increased feelings of independence, empowerment and autonomy
- Improved physical and emotional well-being
- Improved ability to self-care and to perform activities of daily living
- Reduction in the need for ongoing home care services
- Reduction in falls-related injuries
Key Strategies to Assist in Implementing a Wellness & Reablement Approach
Traditionally home-care has been task driven. For example, where traditional home care might be to wash and dress a person, prepare a meal for them and then assist them to eat it, a wellness and reablement approach involves providing moral support, encouragement, reassurance and some physical assistance to enable the individual to undertake these tasks independently.
Changing approach requires patience and diligence as it is a philosophical and significant culture change that needs to be part of an organisation’s overall vision and approach to service delivery.
For many staff, the changes challenge their traditional habits and assumptions about how they work and make decisions. Care workers will now need to encourage and support individuals to regain or relearn the ability to do things for themselves.
Organisational Changes Required
- Changing the mindset of stakeholders i.e. management, staff, volunteers, clients and their families through early and ongoing communication, education, training and awareness raising strategies
- Building staff skills and confidence to both understand and promote the approach
- Review systems and policies and procedures to support new way of working i.e. referral processes, reviews and staff feedback mechanisms
- Need for senior management to be key drivers, including encouraging a ‘can do’ organisational culture
- Engage and inform clients what the approach entails and what this means to how they will work with them.
- Increased support for front-line staff to ensure that they have a shared understanding of how to implement key changes.
To learn more about how to implement Wellness and Reablement in your organisation, register for our November Regional Forum.
Home Support & Partnership Coordinator