I often get asked what is reablement and why is it important?
A 2015 survey conducted in the United Kingdom found that older people feared losing their independence more than death.
“I don’t fear death, getting old comes slowly, what I fear is becoming dependent on others and losing control. I fear losing control, my dignity and my independence.”
Reablement aims to support a person who has started to have difficulties managing everyday activities to rebuild their confidence, regain previous skills or learn new skills, improve their independence to their best capacity, reengage with community and social activities and provides valuable time to help adjust to a new situation.
How do we ensure we add life to years rather than merely add years to life?
Where and how does reablement help with supporting people to continue to live as well and as independently as possible?
And what might this look like to an older person who is experiencing difficulties with some of their day to day activities such as walking, personal care, shopping or getting to social activities?
I think this is best explained through the story of a person who has been in this situation and is now as far as possible back in control of their own life.
Peter’s story – Being me again
Imagine a situation where you are in your early 90s and have recently lost your wife of 65 years. You have been her carer for over 15 years. You yourself have several chronic conditions that you have ignored whilst caring for your wife.
You have been managing all the necessary everyday activities including getting out and about to the local shops and participating in all of your much-loved social activities. However, during the last few months you have noticed your walking getting worse, you have trouble with steps, slopes and you often feel tired. You have also had a couple of falls, which have knocked your confidence. But you just find that too hard so you start going out less as you are scared you might fall in the street.
You have needed a knee replacement for some years and the time has come to have the surgery. You’re hopeful that this will get you back to your old self. A day after surgery you have a heart attack. You are in hospital for 12 weeks getting over the surgery, heart attack and other complications. All these things combined have left you anxious, lacking in confidence, breathless, tired and experiencing difficulties in walking, showering, shopping and all other general household activities. Let alone going out or driving. All you want to be able to do is get back to what you were doing before the fall and the surgery.
You are now at home and someone from the local assessment agency visits to see how you are doing. They discuss what support you might need and how you can be supported through what they are calling “reablement”. They ask and you show them some of the things you are finding difficult and discuss what you are hoping to be able to get back to doing.
They call them goals, but to you it is just being able to do what you want to do when you want to do it. You say you want to feel more stable on your feet, be able to turn without feeling like you were going to fall over, shower in private without anyone helping or watching you, get in and out of the car, go up and down steps, walk short distances without feeling nervous and to also do your own shopping and return to some of your social activities. The most important thing for you is being able to walk and drive with confidence and to do these things you also need to get stronger and do it in small steps.
You both agree on a plan. You are advised that reablement means that support staff will work with you in your own home and encourage you to do as much as possible for yourself. They wouldn’t do for you what you could do yourself and you would work together so that, gradually, you could do more and more for yourself.
While it may seem easier just to give in to being helped you don’t want to come to rely on anyone to take you shopping, to visit friends, the bowls club and your favorite coffee shops. So, you agree to the plan to get you back on your feet.
The support staff initially help you with showering by working with you to slowly increase your independence by encouraging you, waiting and not stepping in too quickly to do it for you when all you need is the time and confidence to do it yourself. Yes, you are slow, but you got there. You have some pieces of equipment delivered too that help – a shower chair and some long-handled things that help you to wash your own feet and back. This approach enables you to build your capacity and self-belief and after a short period you feel able to shower independently.
The support staff and the simple but effective equipment give you confidence to achieve your goal, plus of course those exercises the physiotherapist gave you and which your daughter makes you do daily (according to them) “strengthen your legs and improve your balance so you can prevent having any further falls and feel more confident walking”.
OK, you hate doing them but, yes, you have to admit they made a difference. You can see by doing them you slowly feel more stable, able to bend your knees and can tackle walking up and down the drive on the walker. Of course, once you can do that, they make you walk further and gradually take the walker away and you start using crutches.
The staff continue to help prepare and cook a main meal and do the shopping but slowly you feel able to prepare your own meals and go shopping with the support worker, pushing the trolley around for stability. Getting out of the house means you also have to get in and out of the car, walk from the car to that supermarket and walk around. This all adds to your daily activity and helps to get those legs moving and remembering that they can move.
The support staff watch and encourage you to do the exercises the physiotherapist has given you (along with your daughter and grandchildren, in fact the whole family ganged up on you). It’s not all smooth sailing as you often don’t feel up to the exercises or trying to walk up and down the drive every day or go out with the support staff to do the shopping. But you persevere. There are set backs, you have a few days when you don’t want to do anything and it all feels like the good work is being undone. So, your daughter suggests that the two of you go to the local beach and try a short walk along a flat path and have a coffee. You realise after she has made you walk further than you thought you could, but it got you back trying again. You also have to tackle a few slopes and steps and realise that you can do them, as long as there is a rail. You just need the time, encouragement and confidence to do so.
Gradually, the support staff reduce the number of times they visit you and you slowly do more and more for yourself until you don’t need them anymore. Then within a few months you feel able to walk with just a stick and now three months later you are driving and shopping on your own.
Six months later you are back and able to drive, accessing your normal haunts, popping in for coffee to your favourite coffee shops, nipping to the hairdresser and back to what you were hoping for.
Without the support you had and the way it was provided you doubt whether you would be in such a good place right now.
So, what does reablement mean to you?
I would call it helping me get back on my feet again. Yes, it required me to be do more than I felt like doing when I didn’t always feel like it, but we kept trying a little more each day and had a laugh. Having people tell me “you can” was very important as a lot of the time when you are old you just get people saying, “don’t do that” and “I can help you”. But what’s the point of that, if they help me too much how am I going to be able to live at home on my own and do what I need to do when I want to do it? Whilst the support staff were lovely, I hated having to rely on them.
Keen to hear more? Watch this space
I hope that you have found this blog helpful in your understanding of reablement and the difference it can make to a person’s wellbeing and quality of life.
If traditional home support had been provided to Peter, with staff doing everything for him, and not enabling him to do as much as possible for himself, or encouraging him to do more and more each day, he would not be anywhere near as independent as he is today. Peter’s desire to be able to get back, as far as possible, to how he was, would not have happened without a reablement approach.
If you want to learn, see and hear more, follow this YouTube link to Colin’s reablement story. Colin describes reablement as a renewal of life.
Principal Advisor Wellness and Reablement