No longer engaging in activities due to physical or mental health problems?
Having difficulty with routine daily activities?
Not currently receiving homecare but feeling the need for help at home?
Already have a package of care but keen to regain skills?
Worried about safety in or outside the home?
Increasingly reliant on family members for support?
Studies of what is now referred to as “successful ageing” demonstrate the importance of remaining independent with everyday activities. However, following an illness or disability older people often find it difficult to resume previous activities of daily living and can become dependent on home care. One study, the “Well Elderly Study” was a ground-breaking clinical trial with nearly 500 participants on the effectiveness of therapy for the elderly. It demonstrated that those who received occupational therapy showed significant gains in physical functioning, social functioning, vitality, mental health and life satisfaction, compared with those who didn’t. Indeed the therapeutic benefit of “occupation”, or purposeful and meaningful daily activities, has long been recognised.
What is the ReABLE Programme?
The ReABLE Programme begins with an assessment of physical, psychological and/or cognitive abilities and how these affect ability to perform activities of daily living independently. Activities of daily living could include washing and dressing, cooking a meal, doing the shopping, gardening, doing the housework or climbing the stairs. Any activities that are purposeful and meaningful to the individual are relevant. The programme is designed to retrain the client in everyday activities in such a way as to enable clients to develop the confidence, strength and practical skills to carry out these activities themselves. Overall, the aim is to maximise long term independence and quality of life.
1. History taking
Gathering information from clients and families about medical/psychiatric conditions, problems with mobility, memory etc. and how these are impacting on independence and quality of life from both perspectives.
2. Home Environment
We complete a functional assessment within the home environment and provide a report detailing recommendations for equipment and adaptations for your local council if required.
According to the National Dementia Strategy, it is best practice to screen all older people for cognitive impairment. Issues with cognition (such as memory, concentration and higher level brain functions) can have a significant impact on independence and safety in the home and are not always obvious in daily life. We use a standardised screening tool which tests all brain functions involved in completing even the most basic activities we all take for granted.
4. Mobility, muscle strength and balance
People with mobility, strength and balance problems commonly encounter difficulty in the home such as using stairs, washing and dressing and doing shopping. We will complete an assessment of strength and mobility in the home environment including a formal assessment of balance using a validated tool.
5. Activities of Daily Living
We use an internationally recognised method of obtaining a score of a person’s current level of independence in activities of daily living. The measure is well researched and validated for use with the elderly. This score also helps to formally measure rehabilitation gains.
6. Mental Health
Depression or anxiety is not a normal part of the ageing process and can indicate medical, psychological or social problems. We complete a formal screen of mental
health. Problems are common in the elderly and can often go unnoticed, but can significantly affect the quality of life of the individual concerned.
7. Goal setting
The ReAble Programme is centred on an individual needs, wants and wishes. The potential for rehabilitation is discussed and, if required, we set achievable goals. The aim is to achieve greater independence in one or more activities of daily living that are purposeful and meaningful to the individual. Most elderly people will have at least some level of rehabilitation potential. The recommended amount and frequency of rehabilitation sessions will be discussed. Alternatively, we will devise a care plan for your chosen care agency to optimise long-term functional ability tailored to personal strengths and limitations.
This involves working on goals identified at assessment stage and can include a combination of:
- Strength and balance training
- Cognitive restructuring (confidence building)Exercises
- Therapeutic activity retraining
- Environmental modifications
- Manual handling training
- Mobility practice
- Training in therapeutic techniques to compensate for loss of function.
As mentioned, the amount of rehabilitation sessions required depends on individual circumstances such as problems identified, progress with rehabilitation, and the wishes of the individual and his/her family. On average, people generally can expect to achieve rehabilitation goals within around 3 sessions.
ReABLE Programme vs Home Care
Our experience is that older people want to remain independent for as long as possible. There is a common misconception that the older you get the more help you need, when it is often not wanted or needed. Of course, there are cases where people do need and rely on home care services to live safely at home. However, clinical evidence suggests that is more beneficial and health-promoting to empower and enable an individual to achieve an activity for themselves where appropriate, considering safety concerns and within the context of one’s environment. As well as the human benefits, rehabilitation can also generate significant savings versus traditional home care. A recent research study into the cost benefits of similar programmes reported significant cost reductions. See below example of how the ReABLE Programme can help reduce cost:
Average home care package for personal care (twice daily over 7 days @ €13 per visit) = €728 per month
ReABLE programme (Assessment + 3 rehabilitation sessions) = €330 + Independence with personal care
~ That’s almost a 50% saving in just one month~
Case example – Patrick
Patrick was a 79 year old gentleman who had problems with his heart and was being admitted to hospital on a regular basis. He also had rheumatoid arthritis. His hospital admissions contributed to him feeling weaker and weaker following discharge home and as a result Patrick was struggling to do things that he used to be able to do with ease. His family felt that he needed a carer to help him in the home but Patrick was adamant that he wanted to maintain his independence. His family were concerned about his safety and wellbeing as they lived miles away. Patrick was keen to engage with the ReABLE Programme which shed light on various issues:
1. Background: Patrick was being admitted to hospital as his legs were accumulating fluid due to his heart having problems pumping blood to his lower extremities. Patrick disliked being admitted to hospital as he found it very boring. He was usually quite active and the hospital environment did not allow him his usual routine, he spent most of the time in bed as there was nothing else to do. When he was discharged home he found it difficult to maintain his routine having spent so much time inactive in hospital.
2. Cognition: Upon further questioning it came to light that Patrick’s family felt his memory was getting worse, so much so that he would often leave his keys in the door or forget to turn the taps off. A cognitive assessment was completed which showed mild-moderate memory impairment.
3. Mental Health: A screen of his mental health revealed moderate depression. He lost his wife the year before after a long battle with cancer and felt he never really got over it. He described problems sleeping, loss of motivation to complete activities and low mood due to not being able to physically complete activities he previously did.
4. Activities of daily living: Patrick was losing weight as he was not cooking for himself because he found it very difficult. He was also not attending to his personal care properly as he could not get in and out of the bath anymore.
5. Mobility assessment: Patrick was visibly short of breath and had generalised weakness and reduced exercise tolerance following an assessment of him mobilising around his home. He also had reduced range of movement in his fingers, especially his index fingers. Patrick’s balance was not impaired.
6. Home Environment: Patrick’s bedroom and bathroom were on the first floor of his house, he did not have any equipment to help him get about and the stairs were posing a major problem.
7. Goal setting: Patrick’s favourite thing to eat was boxty and all he wanted to be able to do was to go to his garden, pick some potatoes and prepare his favourite dish again. He also wished that he did not have to go into hospital so much.
Following assessment an action plan was agreed and the following took place:
1. To help Patrick achieve his goal he engaged in a period of rehabilitation. The therapist completed an activity analysis of preparing boxty which involved some gardening activities and domestic tasks. The activity was then broken down into achievable segments and Patrick got to work on strengthening his upper and lower limbs using rehabilitation equipment, completing exercises and practicing mobility techniques. The garden was unsafe therefore the therapist worked on adapting it to better enable Patrick to access it and to improve his safety.
Within 4 sessions, Patrick was able to prepare boxty again and he even gradually started to put on weight. His family agreed that he did not now need a carer. Patrick told us he felt his mood had improved but we still recommended he be assessed for bereavement counselling. As mood can have an impact on memory, we re-administered the cognitive screen which actually demonstrated a slight deterioration in his previous score (completed 6 months before).
2. We wrote to Patrick’s GP about our concerns regarding his repeated hospital admissions and agreed that Patrick needed a medical review to ensure that his medications were working properly to help with his fluid management. We also expressed concern regarding the deterioration in his memory and agreed that further specialist assessment was necessary to rule out dementia.
3. Home Environment: Despite making gains in his rehabilitation, he still found stairs very difficult and we agreed that assessment for a stairlift would be beneficial to help him conserve energy for more valued activities. We gave Patrick a report for his local council and a stair lift was installed a few months later.
Patrick’s ability to get in and out of his bath improved however following assessment it was deemed still too unsafe for him to complete himself. The main difficulty was due to his reduced strength and range of movement in his arthritic fingers. Due to the nature of this condition it would not be expected for Patrick to regain significant function therefore his local council also provided assistive equipment which increased his safety in the bath significantly. As Patrick was forgetting to take his keys out of the door and turn the taps off, we worked with him to install some visual cues in the home to help remind him.