So-called ‘evryday-rehabilitation’ is intended to help elderly patients manage everyday life at home after discharge from hospital. The scheme has been well received by its users, but research has revealed some teething problems.
Evryday-rehabilitation at home for the elderly following hospital discharge has been standard practice in Sweden and Denmark for some time. And in Norway we are hot on their heels. The scheme is already up and running in 52 Norwegian municipalities, and as many again are planning to start it up.
“In everyday-rehabilitation, users define targets in terms of the things they want to do in order to experience a feeling of managing for themselves – whether it’s going for a walk in the countryside, preparing their own meals, or meeting friends for coffee”, says researcher Hanne Linander at SINTEF. “Then they get professional help and support to do these things”, she says. “The aim is to maintain quality of life following an illness, and to focus on what users can do, instead of what they can’t”, explains Linander.
The 'evryday-rehabilitation' scheme provides elderly people with help towards helping themselves so that they can enjoy a comfortable life at home with support from an occupational therapist, physiotherapist, or other form of home care service, for a given period after discharge from hospital. The aim is that the elderly will be able to manage for themselves to a much greater degree, and thus experience the self-esteem of coping and a better quality of life. The scheme will also generate savings for society as a whole, which is facing ever-increasing health care costs. A so-called 'evryday rehabilitation' scheme is already underway in 52 Norwegian municipalities, and fifty more are planning to start it up. The research project has been carried out in Arendal and Kristiansand municipalities.
And it works! Last year, the newspaper Avisa Nordland wrote a piece about Magny Busch who hadn’t been out of her house in six years following a hip operation. Her greatest wish was to be able to shower by herself and go for walks. Today, following motivational support and training, she can do both. At first she used a stair lift due to her problems with walking. “Can you guess what I use it for now? I put the laundry basket on the lift and walk up the stairs all by myself “, Magny told the paper.
Satisfied users and some teething problems
SINTEF has now studied the scheme and can see what works and what needs improving – because even though the scheme works well, not all users have reported results as sensational as those from Magny from Nordland.
“We see that this type of work requires new know-how, training, and supplementary education of support personnel. This is because we are in a transitional phase in which very little has been tested and where we have little experience on which to base our conclusions”, says Linander. “Since evryday-rehabilitation is so new, we believe there is a massive potential for making work run more smoothly both for the users and support personnel – for instance, with the help of technology”, says Linander, who has been heading the project.
She has carried out a survey based on observations made during home visits and combined with interviews with those taking part in the rehab scheme, either as users or support personnel.
In spite of the fact that participants receive only advice and support, and not practical assistance, from their “helpers”, and that some users encountered major and difficult problems, they were for the most part satisfied with the rehabilitation scheme.
“It’s healthy to get out and exercise, even if it’s very difficult” said one of the respondents in the interviews conducted by researchers. Another said: “I am very pleased I was picked”.
Missing human contact
Even though the majority of respondents were positive to this type of training, many felt that because subsequent follow-up was inadequate, the end of the rehab period seemed very sudden.
“This wasn’t always linked to a direct need for help, but more to a need to experience human contact”, says Linander. “For example, they missed someone calling to ask how things were going, or dropping in after a month to see how they were managing”, she says.
And these weren’t the only issues. Some patients felt that the biggest problem was inadequate communication between the day-to-day rehab team and the home care nurse. Some wanted clearer information about what time of day the various ‘helpers” would be calling.
Day-to-day rehabilitation is all about:
- Starting with the question "what activities are most important to you at the moment?"
- Intensive and targeted focus on day-to-day activities which users themselves regard as being meaningful to them.
- Early, time-limited interventions in the user's home or local community
- Strengthening the involvement of, and coordination between, occupational therapists, physiotherapists and home care service personnel
- Targeting the scheme towards either the user, the activity and/or the physical surroundings
- Promoting an increased ability among users to help themselves carry out everyday tasks so that they can remain at home, lead an active and social life, and participate in society as a whole.
- Adopting a mindset in which the users themselves decide how they participate and manage their everyday lives.
- Promoting the opportunity to include relevant local resources, next of kin and voluntary workers.
(Tuntland and Ness, 2014)
“The fact that communication was less than optimal may have been because the scheme was so new and many of the municipalities are still in the testing phase”, says Linander. “In those municipalities where the team and home care nurse work together, home care service shift arrangements might have made it difficult to deliver information to where it was needed. But this wasn’t a problem in municipalities where a larger team replaced home care services during the test period”, she says.
A quiet revolution
Nils Erik Ness is Project Leader for the evryday-rehabilitation program in Norway and Vice-President of the Norwegian Association of Occupational Therapists. He describes the project as a quiet revolution for the elderly.
“We know that in 20 years we simply won’t have enough health service personnel to cope with the ever increasing proportion of elderly people in the population” he says. “We have to stop focusing on passive care and adopt a new mindset. Instead of asking users about what they want help with, we will have to start asking them about things they want to participate in and manage for themselves. This will release resources”, says Ness.
“Right now, it’s important that we record the impact of this new way of working, and gather new information about what can make the rehab scheme even better”, he says.
Support by technology?
SINTEF researchers now want to carry this idea forward. They are convinced that welfare technology can help make rehabilitation even more effective.
“We wanted to see how tech-based rehabilitation works, and to assess the need for using digital tools for day-to-day support tasks”, says Linander. “Examples might be patients recovering from femural fractures and elderly people with functional disabilities.
In this project we see a particular need to identify effective tools for communication between the support team and the users, robust evaluation tools which allow the users to observe their own progress, and several follow-up tools”, she says.