Maximising the potential of reablement
The role of families in supporting the reablement process
A person’s family and friends can play a big part in the success or failure of reablement. It is key for the person using the service to be motivated to achieve agreed outcomes and improve their independence. If they live with, or have frequent contact with, family and friends, those people can help to stimulate and maintain motivation.
- Reablement services must recognise the important role played by families, carers and friends. They are part of the whole care circle supporting the individual and this must be genuinely respected.
- Reablement managers and care workers should ensure that appropriate family and friends receive a clear explanation of the service, particularly in terms of the nature of support provided. There should be a clear description of the aims of reablement.
- Those referring to and providing reablement must be sensitive to concerns that families may have about the ‘risks’ of this approach. They will need reassurance that their relative is being looked after despite being encouraged to do things independently. At the outset, there should be a frank and sensitive discussion about balancing risk and building independence and this should be reiterated throughout the duration of the service.
- The reablement team should encourage family members and friends to contribute to the reablement process. As well as motivating the person, family and friends might also benefit from practical tips and techniques for providing support in ways that help achieve goals. If they are completely ‘signed up’ to the concept of reablement, they can help to motivate the person throughout the process. At the end of the service, family and friends can encourage the person to continue using new-found skills so as to maintain their confidence and independence.
Case study: involving family members in the reablement process – Mr Radcliffe
Mr Radcliffe is an 80-year-old man who lives with his wife. He fell and sustained a left hip fracture, which needed surgical intervention. As a result of the surgery Mr Radcliffe was limited to the movements he was able to do without disrupting the healing process and was provided with information on hip precautions. A reablement care worker initially assisted him with all of his personal care. Mrs Radcliffe is her husband’s primary carer at home and wanted to assist her husband’s recovery where she could. A care plan was therefore developed to include Mrs Radcliffe in the personal care routine so that she learned the correct way of moving so as not to cause any injury to her husband’s hip. The caseworker provided a further pamphlet on hip precautions so that Mrs Radcliffe could understand what is required to prevent further injury.
The care plan provided a progressive programme that encouraged Mr Radcliffe to regain more independence in his personal care activities and allowed Mrs Radcliffe to assist.
Case study: involving family members in the reablement process – Mr Patel
Mr Patel was referred for reablement from the admissions avoidance team (AAT) in February 2013. Reablement assistants were supporting him with his medication by calling once a day in the morning, but Mr Patel declined support with any personal care.
He had previously been taken to hospital with a chest infection. He suffered a heart attack while in hospital but refused the recommended treatment of having a stent fitted. He was suffering with weakness following ill health and had a chesty cough, although he reported on the occupational therapy assessment visit that he was feeling better than he had been. He lives with his wife.
Extracts from occupational therapy functional assessment form
- Medication: Happy to accept assistance with medication. Referral reports previously found that he has taken three days’ dosage of medication in one go, and family found 28 packets of old medication that he had not taken. Has eight tablets to take each morning – one has to be taken half an hour before eating, which he was aware of. Also has an inhaler and currently on antibiotics. Blister packs have been requested, which will be delivered in a few weeks. Substantial need for support, to administer medication to ensure he takes it correctly and to prevent neglect/overdose in this area. Plan to monitor his ability to manage when blister packs are provided and to see whether Mrs Patel may be able to assist in future.
- Customer outcome: to remain living at home and be safe and supported.
- Options considered: reablement support to continue with morning calls to ensure medication is taken correctly. Reablement assistants to work with and educate Mr and Mrs Patel when blister packs are delivered, to see if Mrs Patel may be able to support with this task. Mr Patel maintains he does not want support with personal care, although there are concerns that he was previously self-neglecting in this area. Occupational therapist to discuss with social worker.
Mr Patel continued to refuse help with personal care and managed in his own way. When the blister packs were provided, the reablement assistants visited for a few more days to check that Mrs Patel was able to support her husband with his medication. She was happy to do this once it was easier to manage (regular pills in blister packs and antibiotics stopped). Reablement support was therefore ceased after a total of two weeks. With support from his wife, Mr Patel did not require any ongoing support from formal services and was taking his medication appropriately.
- If family and friends provide regular support to the individual, they should be invited to participate in the assessment process and development of the care plan. This is usually undertaken by a social worker prior to referral to the reablement service. Where conflicts arise, social workers will use their professional judgement and skill to mediate the individual’s and the families’ views and needs.
- Those referring to reablement and reablement workers should be alert to any concerns family members might raise or attempt to voice. These may relate to the support they feel the individual requires or, crucially, to their ability to continue in a caring role. Those referring to reablement should establish exactly what support family members are willing and able to offer. Those providing reablement should also be alert to the fact that this could change over time.
- If family members and friends provide, or intend to provide, a substantial amount of care, social workers are obliged to offer them a carer’s assessment. This will determine whether any help can be given to support them in their caring role and should have been carried out during the assessment phase, before the individual was referred to the reablement service. If it comes to light that this has not happened, the reablement service should inform the social work team.
- Following a period of reablement, a person may require less or no support, both from formal services and from family and friends. The reablement service should encourage the family to consider continuing to provide social support, catching up on local or family news or going on outings.
On the other hand, after reablement, a person may still require ongoing support from formal services and/or family, friends and carers. Even if family and friends express a willingness to provide this support, the reablement service will need to educate them about the sustainability of that support. In other words, families and unpaid carers may need help to accept that the care they can offer now may become too demanding for them to continue in the future.