Senior staff experiences of implementing a reablement model in community care

Introduction

Reablement is defined as an innovative approach to improving in-home care services for older adults at risk of functional decline by re-orienting care away from treating disease and creating dependency to maximising independence (Social Care Institute for Excellence 2020). A recent review of integrated care identified that active ageing was enhanced for older people when they felt motivated to engage in health goals, their preferences were taken into consideration, and they were supported in their wellbeing through a relationship with a key community worker (Karacsony et al. 2022). Furthermore, the World Health Organization (WHO)defines healthy ageing as the ‘process of developing and maintaining functional ability that enables well-being in older adults’ (World Health Organization 2017). Functional ability consists of the intrinsic capacity of a person, the relevant environmental characteristics, and the interaction between them (World Health Organization 2017). Reablement is intended to deliver both person-centered and goal-oriented care that encourages clients to remain as independent as possible for as long as possible, and to actively participate in home-life, community, and society (Campbell et al. 2022; Ratcliffe et al. 2022; Rostgaard et al. 2023). Internationally, reablement has been developed to support integrated frameworks that achieve long-term care and assistance across community settings that both align with the needs and goals of the client and consider staff experiences. This may include the involvement of staff in training, goal-setting, and working with clients in different ways (Doh et al. 2020; Bramble et al. 2022). Applying a holistic, person-centred approach is central to implementing the reablement model of care. It requires all community care staff across an organisation to understand the importance of personhood; gain input from the individual client, family, and carers; appreciate the client’s social networks; and take a collaborative approach to enhancing individual care (Hjelle et al. 2016; Gyllensten et al. 2020; Jobe et al. 2020; Karacsony et al. 2022). The reablement model of care aligns closely with the person-centred approach through collaboration between health and social care professionals (staff) and clients and their families. This collaboration has been shown to improve physical and psychological health status, increase capability to self-manage, and reduce length of stay in acute care (Lewin et al. 2013; Coulter et al. 2015).

Underpinning the philosophy and practice of reablement, therefore, is the principle of empowering and enabling clients to make choices about their own wellbeing goals as part of shared decision making (Karacsony et al. 2022). Client choice is also central to staff engagement in the coordination and delivery of care services to meet the needs of clients and families, as part of the integration of health and social care alongside an associated interdisciplinary plan (Jobe et al. 2020). All staff across the organisation can then work together to deliver care that is responsive, person centred, and respectful. These support services may include home maintenance, domestic assistance and the provision of personal care, respite care, and social support (Maxwell et al. 2021). The benefit to clients, their carers, and their families can be seen through a change in staff behaviour as a result of education and leadership development, with a more reablement-focused approach to service delivery and care (Campbell et al. 2022). Other benefits are increases in staff job satisfaction and staff retention, reflecting an overall positive development in organisational culture (Rostgaard 2018).

Countries that have implemented reablement into their health and social care services have taken distinctive approaches suited to their individual needs. However, some features shared across countries include holistic care assessment and comprehensive care planning and care coordination (Wodchis et al. 2015). Reablement has also been commonly utilised in community care services to assist clients to both maintain and regain independence when they have experienced functional decline as part of the ageing process or as the result of an acute medical incident or chronic medical condition. Previous studies have reported that the effects of reablement on personal activities of daily living (PADL) are positive, with improved self-perceived performance and satisfaction with performance in prioritised daily activities that are sustained on a long-term basis (Tuntland et al. 2015; Rooijackers et al. 2021a). Rooijackers et al. (2021a) found that community care staff’s compliance with reablement program meetings was as high as 73.4% and that staff supported reablement and valued its practical elements and team involvement. They also found that informal carers increased their knowledge, attitude, and skills in the practice of reablement and received both peer and organisational support for its implementation (Rooijackers et al. 2021a).

Despite the wide range of online learning tools and short courses around the delivery of reablement as an approach to care, globally, there is little evidence evaluating the outcomes of these educational initiatives and their implementation and sustainability in organisations. One study in Taiwan examining the health literacy of home health professionals delivering reablement services found that to be competent in reablement requires unique skills focused on increasing older adults’ participation in everyday activities and interdisciplinary collaboration (Yu et al. 2022). This study supports the view that further developmental work is required to integrate the components of interdisciplinary training programs in individual organisations, depending on individual client, family, and organisational expectations (Liaaen and Vik 2019; Karacsony et al. 2022).

This study, therefore, aimed to investigate the value of a reablement model of care, implemented following a bespoke training and education program, to better understand the needs of staff and clients of community care organisations, from the senior staff perspective. The question that guided this research is how do senior staff experience a co-designed, bespoke reablement model of care?

Materials and methods

Results

Staff from Family Based Care provided in-depth discussion of how reablement has become a routine part of their daily activities in the care of clients by the direct care workers from the perspective of senior staff and indirectly through organisational activities such as training, formal and informal feedback, and policy development. Discussion centred around several categories within major themes, and three key themes were extracted. Fig. 1 shows how each theme was derived from the original coding categories.

Fig. 1.

Categories and theme development. This image provides an overview of the categories and themes that were developed as part of the data analysis.

Discussion

The topics that were explored as part of this study focused on the benefits and limitations of implementing a reablement model of care into a community care-based organisation. The findings suggest three key themes to demonstrate the long-term benefits of integrating a reablement training and education program into practice in a community care organisation. From a macro-economic perspective, governments worldwide need to prioritise the best use of resources for our ageing populations across community and residential care and focus on their preferences and needs to achieve quality of life (Ratcliffe et al. 2022). Recent research has provided further evidence that a major priority for older people is to remain mobile and independent at home for as long as possible, considering current and future health needs (Ratcliffe et al. 2022; Rostgaard et al. 2023).

Senior staff highlighted that for long term success in reablement practice to continue, organisational leadership must ensure that an appropriate governance and organisational strategy is in place, supported by a strong organisational culture to support its key principles, highlighted in the first key theme. Senior staff also identified that, from a macro-economic perspective, different models of care such as reablement do not currently align with current government funding that is skewed towards residential care. This was seen as a barrier to the development of organisational values driven by reablement in community care organisations, as all staff felt that they are working hard to keep their clients out of residential facilities and in their own homes. It is clear that reablement models support older people to maintain intrinsic capacity in their home environment and that there are many benefits of reablement despite some initial reluctance of clients and their families to engage with this type of care model.

The Australian Commission on Safety and Quality in Health Care (2017) recommended that all healthcare organisations develop and embed an appropriate governance and organisational structure that places the client at the centre, ensuring the person and their family are supported by a safe environment, good leadership, and a high standard of patient care quality. Focusing on the philosophy of reablement in this way would allow for its integration into core values and processes across the organisation, thus enhancing reablement as best practice care (Masood and Afsar 2017). As suggested in key theme 1 and key theme 3, our findings highlight that culture change is a major influencing factor in the success of embedding reablement into an organisation and support from local and wider leadership groups is instrumental in sustaining meaningful change. Consistent with previous studies, our study found that an organisation may be able to demonstrate success based on outcomes for clients and staff if it has (1) a bottom-up approach to change and (2) structured policy on the implementation and sustainability of new models of care (Bramble et al. 2022).

In both focus groups, senior staff made it very clear that they considered reablement a beneficial practice for staff, clients, and their families. They described feelings of satisfaction and pride when helping clients to regain their confidence and maintain their independence, also noted in previous studies (Maxwell et al. 2021; Rooijackers et al. 2021b). The resulting organisational benefits were an increase in the number of new clients and their families as they heard about the benefits of reablement practice. Previous research has supported the perceived beneficial nature of reablement to staff and clients across organisations (Glendinning et al. 2010; Aspinal et al. 2016; Smeets et al. 2020; Rooijackers et al. 2021a).

Perceived barriers to reablement practices include resistance to change from clients and/or their social network, complex care situations, time pressure, and staff shortages (Rooijackers et al. 2021a). Smeets et al. (2020) found that community care workers need further support from their organisations with mastering skills and dealing with challenging situations to avoid a tendency to ‘take over’ tasks from clients. This focus on staff mastering the skills associated with reablement also ensures that the organisation meets the required aged care standards and quality of life for consumers is maintained (Aged Care Quality and Safety Commission 2019; Ratcliffe et al. 2022). Senior staff in our study felt well supported in their skill and knowledge attainment journey within their organisation but also commented on the limited uptake and use of reablement practice more broadly within the health and aged care sector.

The strong and supportive culture depicted within the organisation involving ongoing and regular team meetings together with regular staff supervision sessions helped to reinforce and sustain reablement within the organisation, demonstrated in key theme 3. This ongoing commitment to the notion of reablement is supported by previous research which found that staff who adopt a broader perspective of supporting clients in achieving their goals are instrumental in facilitating reablement practices to become embedded in the culture of their organisations (Rabiee and Glendinning 2011; Maxwell et al. 2021). In particular, Smeets et al. (2020) recommended that offering organisational support to community care workers was important in embedding reablement practice and that establishing a long-term implementation plan was essential. Jobe et al. (2020) focused on the importance of professionals being supported by management in delivering reablement and being involved in the planning process. European experience suggests that ongoing training, especially for new staff, is required to embed reablement practice into an organisation (Rostgaard and Graff 2017; Jobe et al. 2020).

Conclusions

This study contributes to the growing body of evidence that moving the focus of community care services long term from ‘doing for’ to ‘doing with’ older adults involves a major shift in understanding and practice, both for individuals and organisations. Achieving long-term outcomes involves ongoing training for all staff, including management and integration with other person-centred models of care. In this way, changes in organisational culture based on sound governance principles can be achieved, with long-term benefits for all staff and clients.