How to put Wellness & Reablement
at the Centre of Support
National Respite & Community Care Conference Presentation October 2014
Copyright ©2014 CommunityWest
Reforms to community care:
wellness & reablement themes
• Productivity Commission Inquiry
2011 (Home Care).
• National Aged Care Alliance 2013.
• Commonwealth Home Care
Package Guidelines 2014.
• Commonwealth – Key directions
for the CHSP Discussion Paper
2014.
• Adoption of Wellness
paradigm.
• Promotion of
independence/wellness for all.
• Time limited restorative care &
overarching wellness approach
- integrated and across all existing
home support services.
• CDC packages – reablement
framework, choice and
control.
- wellness goals built into care
plan.
2
Sounds great – but some
challenges & opportunities
Inherent systemic and cultural challenges threaten the potential of wellness:
– ageism is ingrained in society – works against enabling approaches
– society devalues older people - low expectations. Insufficient attention by
sector to an individual’s healthy ageing, individualised needs and desires
– consumers ‘present’ because they have functional incapacity.
• current system provides services to address symptoms of functional
decline rather than services that could reverse or halt the decline
• reablement is essential when individuals experience a ‘hit’ to their
independence
• clients won’t necessarily choose reablement over more passive options
• a providers understanding of the value of reablement is critical.
3
Ethical dilemmas
•
If people have the capacity to be more independent and less dependent on
services, should they be required to do so?
•
Wellness and reablement require motivation that individuals may not apply
themselves:
– If I choose to...have people do everything for me, is that OK, even if I have
the capacity to do more for myself?
– How reablement is presented is critical to take up:
•
not a ‘choice’ if providers don’t invest in it
•
how do we present it so people want it?
•
it’s just “how we support people”
Are we all playing the same game?
Wellness, reablement & older people:
what do we know?
Sense of future
and hope
(I set goals for
myself)
I am ‘me’ and
want to be
involved in
planning my
support
We know older people:
I want to be
part of my
community
and
contribute
Support to be
as able as I can
be
Work with
me don’t do
for me
Know what I
can do and
support me to
do it
•
•
•
•
•
•
•
want health and wellbeing enhanced
want to be known and understood
want to set goals and be supported in a
way that builds capacity to live a good life
want choices and individualised support
generally enjoy participating but won’t
necessarily choose over familiar options
can make significant gains, but realise full
potential as an outcome not as a motivator
when unmotivated - still make gains.
5
Long term outcomes of reablement
Individuals who receive a targeted restorative service rather than usual
HACC Program home care:
• have a reduced likelihood of subsequently using - any home care service
for three years - a personal care service for five years
• are somewhat less likely to be ACAT assessed within the next 5 years and
much less likely to be approved for nursing home high level care
• are less likely to die over the next 5 years
• represent a much better return on investment.
(Long Term Outcomes of Restorative Home Care, Lewin et al 2013)
6
X (policy position) + Y (consumer desires) = a
positive outcome
If we are here primarily to improve people's health, independence and wellbeing, isn’t it our responsibility to seek every opportunity to support people
to live the life they desire to the best of their ability?
7
BUT...
•
•
•
•
Is the sector ready?
Are consumers ready?
Are families, carers and communities ready?
Is the Australian Government ready?
The WA HACC Journey:
• 2006 Wellness adopted as policy position across all service delivery
• Significant cultural/organisational change – long term change process,
still more to do.
8
WA HACC wellness & reablement journey
HIP/ PEP
(Silver
Chain)
Wellness
adopted
Evidence
• 1999 Home Independence Program – developed/implemented/evaluated
• 2003 Personal Enablement Program developed + implemented
• 2006 Wellness Approach. Significant system and organisational change across WA HACC
•2005 HIP RCT commenced
•2009 HIP/PEP long term outcomes examined
•2011 RCT analysis complete
•2012 HIP Coordinator model developed (Silver Chain)
•2012 Five year HIP/PEP/HACC outcomes analysis complete
Expanding
models •2013 HIP Dementia model developed and piloted (Silver Chain)
WAAF
•2010 - 2014 WA Assessment Framework (WAAF) developed and implemented across state
•Regional Assessment Services introduced
•2014 Pilot Reablement teams in RAS (ACNA at present)
•2014 – Interface Reablement with Home Modifications and Assistive Technology
9
Putting wellness at the centre of
policy & system development
•
•
•
•
•
Driven by WA HACC Program - underpins policy development
Built into policies and program manuals/HACC triennial plans
Part of GFR and reporting, workforce training & development
Built into Quality review process – mapped to standards
Considerable sector consultation, development & support
– lead providers and champions
– developing and piloting
– evaluation
– resource development (e.g. self assessment, training, documentation).
• Targeted reablement specific funding and development
• Key driver of Assessment Framework.
10
Wellness & reablement: centre of
organisational strategy/change
Potential positive client impacts:
•
•
•
•
organisational vision/strategic focus
review policies/systems and
supports/embed wellness practices
throughout person’s journey
documentation that supports service
changes
service delivery based on strengths, goals
and aspirations
•
•
•
•
language/marketing and communication
(reflect philosophical shift)
recruitment strategy/workforce education
(right values & attitudes)
frontline staff - key to success/enablers
routines – built around consumer not
service/staff.
Advice and problem solving not ‘management’
Shared partnership of responsibilities and
expectations
Support opportunities beyond formal service delivery
Support everyday preferences/choices important to
individual not solely organisation
Risk reduction through improved skills rather than
risk aversion
Regular checks to make change improvements
11
Wellness at centre of individual needs:
assessment
•
•
•
•
•
•
•
•
State-wide Regional Assessment
Services (separate from service
provision).
Wellness assessors – ongoing
professional development.
Standardised and integrated
assessment processes.
Strengths/outcome focused.
Solutions outside of standard support.
Place lived experiences of client, their
priorities and concepts of
independence at centre.
WAAFI – database to follow referral
pathways/journeys/outcomes.
Interface with ACAT.
Cultural and
Spiritual Beliefs
Likes &
Dislikes
Individual’s
History
Choice and
Control
Physical
Needs
Health
Needs
Emotional
Needs
Social
Needs
Risk
Appetite
Individual’s
Goals
12
Putting individual outcomes at the
centre of support
Wellness outcomes
Client outcomes
13
Putting wellness/reablement
at the centre of service support
Targeted short
term reablement
Paced plan of
support/goals
Activity analysis
Equipment
Exercise/strength
prescription
Ageing Well
Practices
Community
Connector
• Whole of person
• Health literacy
• Build strengths
& capacities
• Dementia
Partnerships
Build social
connections &
networks.
Meaningful
activities
Ongoing support
Organisations
working with
consumer.
Support goals and
desires.
Carers Support
Wellness focussed
assessments.
Integral to
reablement
outcomes
Home
modifications/&
assistive technology
• Key intervention
• Interface with
reablement
Supporting consumer desires to be enabled to live a good life.
14
Putting wellness at the centre
of conversations
What has
changed for you?
What do you
want to achieve?
Person centred/outcome focused tools
Clear goals/desires
What’s important to/for
What would
support your
wellbeing?
How can we
build your
capacity?
Relationship circles
What’s working/not working
Failure to gather information from the person can be the biggest barrier to delivering effective support.
15
What would you choose?
Elderly male, deteriorating:
•
Not cooking meals – has lunch at pub.
•
Some mobility problems.
Client desired outcomes:
•
Continue to go to pub as also a social outlet.
•
Improve mobility so can get to pub.
•
Reduce risk of falling.
Action:
•
Staff walked to pub with him (strategies identified).
•
Walking stick & new shoes purchased.
•
Strength training exercises & personal alarm
•
Support aimed at reducing current risks &
preventing future problems developing.
Standard support
Wellness support
16
Simple solutions – Mrs ‘D’
Three calls a day, reablement - personal care and meal preparation.
• Visually impaired, has OA, uses a walking frame. Wants to remain independent.
• Following assessment, Mrs D was encouraged to participate as fully as possible
with washing and dressing, however realised early on that this would ongoing.
• Has frozen foods but she struggled to heat, as could not read instructions or see
the microwave properly. Was also burning her lunch.
• Reablement workers:
– moved the microwave closer to the window for additional light
– attached large labels with the cooking times written on them (e.g. ‘7 minutes’) to all her meals
in the freezer
– attached raised, florescent stickers to represent 5, 10 and 15 minutes to the microwave dial.
•
Mrs D now able to prepare lunch independently.
17
Key enablers for service delivery
•
•
•
•
•
•
•
•
Driven by senior management/embedded in strategic plan.
Staged implementation to allow for development and testing.
Process map the service delivery journey and determine key actions where wellness is
not reflected.
Ensure front line staff along with coordinators are engaged throughout as they are key
to success.
Implementation is easier with new clients as enables more positive expectations to be
set from the start of service engagement.
Longer term clients can be a slow change process.
Engaging and gaining the support of carers and families will impact positively on
adoption/outcomes.
Time spent messaging the benefits of wellness to individuals, families and the
community (i.e. GP’s) is critical.
18
Progressing Wellness & Reablement
WA HACC Program - 2014 onwards
• Continued development of Regional Assessment Services to deliver
reablement.
• Production of a reablement specific training package (Silver Chain).
• Dementia Partnership Team (AAWA) working with and developing
assessors.
• Home Modifications and Assistive Technology/equipment – Best Practice
Model.
– ILCWA – HM & AT assessor development
– Interface with Reablement and RAS
• Self Directed Supports Project.
19
Conclusion: Embrace – don’t panic
•
•
•
•
•
•
•
Older people wish to be supported to
self care.
Governments support this desire
through community care.
Reablement and Wellness can produce
big wins.
Passive options are more familiar.
How do we support choices that
directly improve a person’s
independence?
Practice changes can make a profound
difference.
Who stands to lose the most if we don't
do this?
20
Useful references
1.
WA HACC Wellness Approach – Challenging Community Care with Wellness
https://www.communitywest.com.au/resources/cwnews/1204-now-available-challengingcommunity-care-with-wellness-report
2. The WA HACC Program Communications Kit: Talking about Wellness
https://www.communitywest.com.au/sector-development/wellness/communications-kittalking-about-wellness
3. SCIE UK Reablement at a glance/reablement: an introduction
– http://www.scie.org.uk/topic/careservices/preventionreablement/reablement
– http://www.scie.org.uk/publications/guides/guide49/index.asp
– http://www.scie.org.uk/socialcaretv/video-player.asp?guid=6886fa01-81da-4963-926ce1b41c5170f0
21
Useful references
4. New South Wales – Towards an enabling approach in Community Care
http://www.adhc.nsw.gov.au/__data/assets/file/0010/233965/Better_Practice_Project__Discussion.pdf
5. Silver Chain West Australia
http://www.silverchain.org.au/assets/GROUP/research/Lewin-2013-evidence-for-thelong-term-cost-effectivenss-of-home-care-reablement-programs.pdf
6. Active Service Model DOH Victoria
http://www.health.vic.gov.au/hacc/projects/asm_resource.htm
7.
The Young Ones Series
http://www.bbc.co.uk/programmes/b00txwgq.
22
Useful tools
•
•
•
•
•
Are you ready for Wellness – CommunityWest 2007
https://www.communitywest.com.au/index.php?option=com_docman&task=doc_details
&gid=67&Itemid=27
COTA – Organisational Self Assessment for CDC
http://homecaretoday.org.au/provider/consumer-directed-care/are-you-ready-for-cdc
Progress for providers personalisation
http://progressforproviders.org/checklists/delivering-personalised-support-for-peopleliving-at-home/
Implementing the new re-ablement journey – readiness checklist
http://www.helensandersonassociates.co.uk/media/56141/reablementchecklist.pdf
Maximising the potential for reablement
http://www.scie.org.uk/publications/guides/guide49/index.asp
23
Workshop
National Respite and Community
Care Conference October 2014
Workshop objectives
• To reinforce positive client outcomes of wellness/reablement.
• To determine your organisation’s readiness for
wellness/reablement.
• To identify and share your organisation’s change strategies
towards reablement and wellness.
• To learn what others in the sector are doing to prepare.
• To determine what your organisation/sector requires from the
Commonwealth to support this move towards
wellness/reablement.
25
Enablement UK - DVD
http://www.youtube.com/watch?v=HSNfcmlnkG8&feature=player_embedded
(START, North Yorkshire County Council)
26
Workshop format - Handout
•
•
•
•
•
Nominate someone on the table who will feedback to rest of room.
Read handout on table which contains four questions.
Each table to write each of these questions on a separate piece of butchers paper.
Everyone to write down own response to Q.1 on sticky note and put on butchers paper.
Table discussion questions 2 – 4.
– As a group discuss questions 2, then 3, then 4. Write down your tables responses to
each question on sticky notes and put sticky notes under appropriate question on the
butchers paper.
– Each table then selects:
• three change strategies from Q. 2
• two strategies to measure progress from Q. 3 and
• from Q 4 - three ideas of support required from the Commonwealth.
•
Nominated table speaker to feed responses to Q. 2 - 4 back to the room.
27
Handout - Questions
Q1. How ready is your organisation for wellness/reablement? (5 mins)
On a scale of 1 – 5 with:
• 1 not at all ready
• 3 have started planning and
• 5 ready to start
write down on a sticky note how ready your organisation is for wellness/reablement.
Q2. What change strategies are planned/have commenced in your
organisation to move towards wellness/reablement? (10 mins)
Q3. How will you measure progress of change? (5 mins)
Q4. What resources/support are required from the Commonwealth to
enable you to implement these approaches? (10 mins)
28
Contact us
Hilary O’Connell
Manager Innovation & Development, CommunityWest
Email: hilary.o’connell@communitywest.com.au | (08) 9309 8180
www.communitywest.com.au
twitter.com/CommunityWestWA
www.facebook.com/CommunityWestWA
29