Facilitating family engagement in older people's home-based reablement: A realist inquiry

An ageing population brings pressures and opportunities. Since 2010, the UK Government has invested substantially in reablement, to release pressure in health and social care services and to promote wellbeing. When a deterioration in an individual’s health results in increased difficulty with everyday activities, reablement offers them short-term help to start doing things for themselves again. Current policy and guidelines for reablement emphasise a person-centred approach to delivery, making no differentiation between a service user with family and one with none. This exposes gaps in knowledge about family engagement in reablement.AimThe aim of this thesis is to build theory-led explanations about what works and does not, when engaging families in their relative’s home-based reablement.MethodsRealist methods were used to develop and refine theories. Preliminary consultation with stakeholders led into a review and synthesis of existing literature. This resulted in initial theories that were then refined through fieldwork (within a Local Authority reablement service in England). Data were collected through interviews and a focus group with study participants. A group of members of the public contributed their expertise as family carers. Data were analysed using a realist approach to identify what contexts are relevant to engaging families in reablement, how different people might respond to resources aimed at engaging them, and how, as a result, outcomes might be affected.FindingsThe findings explore four areas: instilling an understanding of reablement, the additional skills and support required by the workforce to engage families, customising service delivery to family circumstances, and empowering families to use a reabling approach themselves. They identify and link mechanisms associated with applying a reabling approach to different family contexts. They show how, for example, families can be encouraged to adopt the core mechanism of standing back with empathy in different circumstances. Considering reablement as a mindset that needs to be instilled actively in service users and their families during service delivery, the findings show that if this mindset is only introduced in a superficial way, there is a risk that families will revert to doing things for their relative, rather than helping them to maximise their capabilities in the longer term.ImplicationsThis research provides new insights into how reablement can either be enhanced or threatened by family members. It identifies considerations to take into account in future development of guidelines, policy and practice to optimise and sustain the benefits of reablement beyond its immediate delivery. It contributes to the field by reframing reablement as a relationship-centred service and mindset so as to empower families to enhance its success