Home' Community Care Review : CCR Jan-Feb 2015 Contents STRATEGIES FOR SUCCESS with Lorraine Poulos
No doubt you will have heard a
lot lately about reablement and
And yet, with so much information out
there, it's often hard to know what these
philosophies actually mean in practice.
The following (from Alt Beatty
Consulting) is a summary of the objectives
of an enabling approach:
• maximise client capacity and confidence
to do things for themselves;
• restore or improve function by using
short-term interventions or assistive
• reconnect clients with their community;
• prevent unnecessary deterioration in
• reduce, delay or prevent the need for
ongoing services (where appropriate); and
• avoid unnecessary admission to hospital,
residential aged care or progression to
higher levels of community care.
Haven't we been doing this all along, you
might ask. Yes, I think we have, as we are in
an individual's home and they are usually in
control. However, our model has traditionally
been one of 'serving' the clients. Indeed I
have heard staff complain of clients who
referred to them as "the cleaner" when we are
not cleaners; we provide a holistic service to
assist people to live independently.
The research demonstrates that if we do
with clients rather than for, the health and
quality of life outcomes are much better -
and staff enjoy their work more.
For example, a trial from 2002 to 2004
compared the outcomes of 100 individuals
receiving a Home Improvement Program (HIP)
from Silver Chain Group in one metropolitan
region of Western Australia with 100 other
clients receiving usual home care services.
It found the HIP group demonstrated better
ability in performing activities of daily living,
better mobility, reduced falls and higher
morale. Further, receiving HIP made it 15
making it happen
times more likely that an older person at
three months would no longer be receiving
assistance, and seven times more likely not to
be in need of ongoing services at 12 months.
Studies like this have demonstrated
that the enablement and promotion of
independence approach to service delivery
has improved outcomes for older people.
Now let's look at what the Home
Care Common Standards states about
the evidence that is required by service
providers in this area.
Providers are required to have the
following evidence in care plans/service
agreements, and whether they contain
effective strategies to promote and foster
independence such as:
• retraining in activities of daily living;
• facilitating access to allied health services
such as physiotherapy, occupational
therapy and dietitians;
• encouragement to participate in local
health promoting activities;
• strengthening social support including
family and community links.
There are simple changes we can make
in our daily work that would promote this
Change your language: no more "my
clients" as this indicates ownership. Try
referring to older people as "the people I work
with." This is very powerful as it indicates a
more respectful and balanced relationship.
Give regular praise: For example, "You
managed to make your bed; thanks so much."
Change your care plans: they should
always reflect the abilities of the older
person. Many providers have a personal
profile for workers that reflect the abilities
of the older person and how the worker will
assist them in a task.
Start conversations with "What's been
going really well for you?" This is a powerful
and positive way of communicating with an
Consider having an independence 'tip of
the month' prize - this can involve staff and
clients and family friends. One example I saw
was an older lady using long handled kitchen
tongs to put her ticket in the pay station ticket
machine in the car park! (Simple but very
effective for short armed people).
Consider using the above points in
a short education session with staff,
followed up with a practical handout. Ask
for feedback about any changes they have
made, and don't forget to document these
on your continuous improvement register.
It's important to remember that not
all older people we provide assistance
to have capacity to be completely well or
independent, but many do and want to
remain that way. It is often said that human
beings need someone to love, to feel useful
and have something to look forward to. If
we can change our practice in some small
way then I believe we are providing a person
centred enabling approach.
Until next time, take care and please
provide me with any ideas you have so we
can share. n
Lorraine Poulos is a trainer and consultant
with extensive experience working with
government and aged care providers.
Feedback is welcome and can be sent to
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