Academic literature on the topic 'Re-ablement'

Introduction Despite clear compatibilities between the tenets of occupational therapy and re-ablement, there is limited research on occupational therapy in homecare reablement services. This article describes an occupational therapy intervention that was delivered as part of a feasibility randomised controlled trial (Occupational Therapy intervention in HomEcare Re-ablement Services), and evaluates whether the intervention was acceptable to participants. Method There were three phases: (1) a bespoke pro forma was completed, recording the activities undertaken after each therapy visit; (2) an acceptability questionnaire was sent to every intervention participant and (3) semi-structured interviews were completed with key informants who received the intervention. Results The principal activities undertaken were assessment, case management, goal-setting, advice and support, and practising activities in relation to bathing/showering or kitchen activities. Participants particularly valued the advice and support provided. However, there were difficulties due to fluctuations in circumstances and with activities of daily living outside the home within the 6 week timescale. Conclusion An intervention focusing on activities of daily living within the home was acceptable for participants and consistent with their goals; however, they also had goals beyond personal activities of daily living and the timescale of the re-ablement episode. Further research should focus on extended activities of daily living, beyond this time-limited period.

Introduction Re-ablement services are in a period of strong development, but the terms and definitions used remain unclear, and the scientific evidence is still weak. The aim of this systematic review was to obtain an overview of the scientific literature in this evolving research area, and investigate whether there is scientific evidence for positive effects of re-ablement services for older community-living people. Method The systematic literature search was conducted in the databases CINAHL, PubMed and Svemed+(Swemed) and covered the years 2000–2014. Owing to the heterogeneity in the included studies, a narrative synthesis was performed. Results Eight original publications were found eligible and included in the systematic review. When addressed, terms and definitions varied among the papers. Effects such as less use of home care, higher likelihood to live at home, improved activities of daily living (ADL) skills, quality of life and physical health, increased physical activity and lower costs compared to conventional home care were reported. Conclusion More high-quality research is needed to strengthen the evidence-base regarding re-ablement services. The specific roles of various professional and staff groups are often insufficiently described, as are the interventions as such, and there is a lack of attention to person-centered aspects such as the meaningfulness of the specific activities.

Purpose – Re-abling care of frail older people is highly on the agenda in several countries. The purpose of this paper is to have a closer look at the argumentation used for its establishment by local policy actors in the field and the kind of expectations towards the behaviour of frail older people it entails. Design/methodology/approach – The empirical material consists of qualitative interviews with 17 local policy actors in two Danish municipalities. The interviews have been analysed with the help of argumentative discourse analysis. Findings – The most important argument for re-abling care appears to be grounded in economic reasons. However, a second, moral argument was found revolving around the older peoples’ activity, which contributes to the establishment of moral expectations towards frail older people to be active. Research limitations/implications – As the goal of the study was to analyse understandings and values of key local actors, the implementation of re-ablement programmes and the users’ perspective were not studied. Originality/value – The paper contributes to the investigation of the shift from universal entitlement as a right to towards market rationalities in Danish elder care.

Purpose The purpose of this paper is to share the findings of a research evaluation into a Befriending and Re-ablement Service (BARS) which offers a host of positive outcomes such as reduced loneliness and keeping as well as possible for a growing segment of the world’s population. The recent increase in longevity is one of humanity’s great success stories. But ageing comes at a price, and decision takers worry about the stresses and strains of an ageing society. Design/methodology/approach Following a literature review, this paper presents the findings of an evaluation of an alternative innovative form of support for older people, namely BARS, that has been developed on Merseyside. Semi- and unstructured interviews were carried out with stakeholders including service users and carers. A cost-benefit analysis is also reported. Finally the theoretical and policy implications of this research are explored. Findings Befriending and re-ablement officers is both a socially and economically cost effective means of enhancing independent living among older people, reducing loneliness and isolation that can contribute to ill health. The research shows that funding for the BARS scheme should be sustained and expanded, despite or because of the current era of cutbacks in UK and international service provision. Originality/value The paper highlights the value, role and importance of both befriending and re-ablement in a time of acute public and voluntary sector funding pressures. The paper is of value to a range of stakeholder groups such as older people, local and central governments and health care commissioners.

Abstract Background The Integrated Care Programme for Older People has supported the development of integrated care services at pioneer sites in Ireland. Key to integrated care is embracing a move away from hospital based assessment and therapy provision, especially for re-ablement and home support care planning, to assessment in the home: “discharge to assess”. Methods The Older Persons’ Integrated Care Team (OPICT) provides a targeted, multidisciplinary domiciliary-based re-ablement programme of care to people aged 65 years and older. Using PDSA methodology for service improvement, the addition of home support provided by healthcare assistants (HCAs) was introduced and evaluated. Data was collected prospectively on baseline service user demographics, service activity and outcome measures. HCA delivered home support services were introduced in November 2017. This study contains data for the period November 2017 to March 2019. Results Since May 2017, OPICT has provided 266 episodes of domiciliary-based re-ablement to 248 clients, with a further 90 clients assessed but ineligible. The median age of clients was 84 years (8% 65-74 years; 49% 75-84 years; 37% 85-94 years; 6% 95 years and older). The majority of clients were female (58.5%), with low dependency (Barthel score 16 to 19) and classified as vulnerable to moderately frail based on the Clinical Frailty Scale (scores 4 to 6). Of 215 eligible clients, 122 received a total of 1293 hours of healthcare assistant delivered care. Flexibility in the availability of carers to meet demand and willingness of HCAs to embrace a more diverse role were important learning points. Conclusion The “discharge to assess” model of integrated care for older people can be achieved in the Irish healthcare setting, with access to flexible HCA delivered home support a key element.

There are critical concerns regarding the current state of the adult social care system in England. A number of factors such as the steady increase in life expectancy, financial cutbacks, and growing inefficiencies within the current system highlight the need for major reform. The prevalence of our aging population is increasing, and the financial burden associated with care continues to rise. Both acute and long-term care are affected equally. These changes are placing significant strain on adult social care, prompting the need for management efficiencies and more transparent information flow to ensure the efficient and effective delivery of health and social care. A major focus on early intervention and prevention services, such as home care re-ablement, is important because of the cost implications associated with providing excellent care to older people whilst offering options where possible to improve quality of life and incorporate patient preference. To understand how improvements can be made to the current care system, evidence is drawn from case-study analysis of Wirral, Liverpool and Knowsley, along with an in-depth literature review. This thesis highlights a multitude of issues affecting adult social care. The most significant findings during data collection were the obvious similarities between supply chain theory and concepts within social care and home care re-ablement. Where applicable, supply chain principles can bridge the gap and facilitate more streamlined coordination spanning multiple care providers in the supply network and reduce redundancies in the operation design, planning and control processes. As supply chain theory is fundamental to many adjacent faculties, this thesis strongly supports its use and application to social care and re-ablement. Fundamental supply chain management principles are not new, yet application of them to adult social care is unconventional and innovative. Development of an appropriate supply chain management infrastructure is essential to dramatically re-shape the future of adult social care.

Homecare re-ablement services have been widely implemented by local authorities in England, although there are widespread variations in relation to occupational therapy input within them. These services aim to improve users’ ability to manage independently at home and reduce the need for other health and social care services. It is not known whether outcomes are better for people who receive occupational therapy as part of their homecare re-ablement compared with those who do not. This thesis reports a programme of work investigating this, encompassing: a systematic review, a qualitative interview study, and a feasibility randomised controlled trial (RCT) of an occupational therapy intervention targeted at activities of daily living (ADL). For the systematic review, 11 databases were searched and 13 studies were identified comparing interventions to improve performance in ADL with routine homecare. The review found variability in the content of interventions delivered and the measures used for ADL ability. However, there was moderate evidence that the interventions led to improvements in ADL ability, although most effects were not statistically significant. Those interventions involving occupational therapists led to improvements in ADL, but the content of the occupational therapy input varied. Semi-structured qualitative interviews were completed with 12 occupational therapists working in re-ablement services and ten people who had received re-ablement services. Interviews covered experiences and opinions of the service, and were analysed using thematic analysis. Findings were categorised in three themes: (1) Re-ablement: Tasks and Activities (2) Re-ablement: Modalities and Strategies for Delivery, and (3) Facilitators and Barriers. The occupational therapists’ primary focus was delivering graded programmes to improve users’ ability to manage ADL, which they believed they were uniquely placed to provide and tailor to each individual’s needs. People using services valued this graded approach believing that it improved their confidence to manage activities. A feasibility randomised controlled trial (RCT) was conducted in which 30 re-ablement users were randomised to receive either: usual homecare re-ablement without routine OT input (control) (n=15), or usual homecare re-ablement plus a tailored OT programme targeted at ADL (intervention) (n=15). The OT programme was tailored for each participant and included: goal-setting; teaching or practising techniques; equipment and adaptations; and provision of advice or support. Outcomes were: personal and extended ADL; quality of life; falls; and health and social care service use. These were assessed at two-weeks, three and six months post re-ablement. Although there were methodological challenges due to service changes which affected usual care and trial recruitment, it was feasible to enrol and retain participants, deliver the intervention, and collect outcome data which were responsive to change. Participants in both groups showed improvements from baseline, although overall the OT group showed greater improvement; they also used homecare services less frequently and had fewer falls. However, confidence intervals were wide, reflecting the small sample. The intervention was acceptable to participants who particularly valued the tailored advice and support. The principal conclusions were that there is some evidence that interventions targeted at personal activities of daily living can reduce homecare service users’ dependency. Although the content of interventions is variable, those involving occupational therapists appear to be beneficial. Occupational therapists believed that their specialist skills and knowledge in ADL performance were essential facilitators implementing an approach which was suited to each individual’s needs and therefore to successful re-ablement. The RCT was feasible and a further powered definitive study is warranted, subject to methodological alterations. The favourable trends in the OT group indicate the potential benefits in this population group. This is the first RCT of occupational therapy in homecare re-ablement and it is therefore important in the development of the evidence base for this area of practice. A definitive RCT is needed given the widespread national and local government investment, and policy and legislation that continues to underpin the development of homecare re-ablement services.

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Background: Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer's disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design: In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion: If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration: Current Controlled Trials ISRCTN21027481