A relative told us that when her mother moved to a nursing home, she was not allowed to use the aids she was used to. Instead of being allowed to walk slowly to the dining room, she was driven in a wheelchair. She saw that the beautiful words mean nothing when you see the reality.

Rehabilitative approach

In elderly care, it is of the utmost importance to see each individual as a unique and resourceful individual, regardless of age or state of health. A rehabilitative approach is a philosophy that emphasizes the possibility of improving the quality of life and independence of older people, regardless of any physical or cognitive limitations. In this article, we will explore the importance of a rehabilitative approach in elderly care and how it can contribute to creating a meaningful and dignified old age.

What is rehabilitative approach?

Rehabilitative approach in elderly care is a philosophy that ensures that elderly people have the opportunity to regain or maintain as much of their physical, mental and social function as possible. It is based on the principle that aging does not necessarily mean decline or helplessness, and that older people have the right to live their lives as independently as possible.

Basic principles of rehabilitative approaches

Individual-centered: Each older person is unique with their own needs, goals and preferences. A rehabilitative approach adapts care and support to the individual.
Function and quality of life: The goal is to improve or maintain older people's function and quality of life, rather than simply managing disease or age-related problems.
Independence: Promoting independence and self-determination is a central aspect. Older people should be given the opportunity to participate in decisions about their own care and lifestyle.
Holistic perspective: A rehabilitative approach includes both physical, psychological and social rehabilitation. It ensures that all aspects of a person's well-being are taken care of.

How do we work with a rehabilitative approach in elderly care

Individual Rehabilitation Plans: Every older person should have an individual rehabilitation plan that takes into account their specific goals and needs. This plan should be regularly reviewed and adjusted.
Educate the employees: The staff in elderly care needs education and training in using a rehabilitative approach. This includes developing skills to motivate and support the elderly in their rehabilitation efforts.
An active environment: Nursing homes should strive to create an active and stimulating environment. This can include physical activities, social events and opportunities for the elderly to participate in decision-making about their own care and daily routines.
Respectful communication: Open, honest and respectful conversations between co-workers, older people and their families are fundamental. Listening to the elderly and taking their wishes and preferences into account is an important part of a rehabilitation approach.

With a rehabilitative approach, quality improves

Improved quality of life: Older people who are supported with a rehabilitative approach can experience an increased sense of well-being and independence.
Reduced need for medical care: By focusing on improving health and function, rehabilitation can reduce the need for emergency medical care and care interventions in the nursing home.
Preserved dignity: Empowering older people to actively participate in their own care and lifestyle preserves their dignity and self-esteem.

A rehabilitative approach to elderly care is an investment in the health and well-being of older people. It gives them the opportunity to age with dignity, independence and a higher quality of life. It is a philosophy that focuses on possibilities rather than limitations and that gives older people the chance to live their lives to the fullest.

To support without taking over

Already in the eighties, people talked about the LEON principle in nursing education. We would work with the lowest effective care level. By supporting the resident to do what he can do himself, we help the resident to maintain functions. For example, it could be pressing buttons, which is fine motor training for the hands. Since we work this way from the beginning, when a person moves in, it becomes natural for both us and the resident.

Sometimes there is a gray area between function preservation and function-enhancing working methods. If a person has undergone hip surgery, walking training can be about regaining the ability to walk. For others, it may rather be about maintaining the ability by practicing going to the toilet or to the common dining room.

Everyone who works must work on functional preservation with everyone who lives there, regardless of which diseases and other medical treatments are ongoing. Functional maintenance work is part of the culture where it works best, where supporting instead of helping is an approach.

Functional maintenance measures

• practice the ability to go to the toilet, kitchen, dining room.
• take care of your hygiene to the extent that works
• the clothes are laid out so that the individual can dress himself.
• help to remember toilet visits
• everyday conversation to maintain the language
• Take care of your oral hygiene as far as possible
• The resident should be able to maintain normal mobility (basal contracture prophylaxis)
• The resident should be allowed to sit on the edge of the bed daily.
• In a function-preserving working method, it is to support the resident to find and carry out activities that engage and stimulate.

Function-enhancing working method

A function-enhancing working method is used when someone has temporarily lost an ability or function. It could be, for example, after a hospital stay. A stroke or a fracture can mean that the ability to cope with everyday tasks has deteriorated. Many times it is possible to regain the ability to cope with what you coped with before with the right training and support to exercise in everyday life.

All care should be based on a function-preserving working method. This means that the individual is stimulated to manage as much as possible by himself in order to maintain the ability to cope with everyday life. Function-enhancing or rehabilitative work methods take time in the beginning, but save both time and quality of life in the long term.

Many residents have suffered strokes or other illnesses that limit what they can do. In the aftermath of many diseases, a disability follows. Those who have a disability can receive support in regaining functions or getting help to learn ways to manage everyday life with or without aids. Rehabilitation takes place partly through everyday rehabilitation, i.e. that the individual himself does as much as possible of the activities in daily life or through function-enhancing interventions prescribed by an occupational therapist or physiotherapist.

In this way, the nursing home can work in a good way with, for example, everyday rehabilitation after a hip joint operation.

Contracture prophylaxis

In the Vårdhandboken, we can read that contractures occur when a joint is not used normally. Contracture means that there has been misalignment in a joint. The connective tissue then becomes firmer and less elastic, the joint capsule becomes stiffer and the muscles shorter with a risk of misalignment. If there has been a misalignment, the possibilities of using the joint to walk, for example, deteriorate.

Movement and load are a prerequisite for maintaining the function of muscles and bones. If a resident has an amputated lower leg, the impaired ability to move means that it will be more difficult to practice walking with a prosthesis. Residents who have had a stroke may have a reduced ability to extend and bend their joints as a result of, for example, hemiplegia.

The resident must receive clear information about the importance of maintaining mobility in the joints and that contractures must be avoided. The employees are instructed in how to help the resident to maintain mobility and routines so that the task is carried out. Often it is good to have a signature list for the task that can be completed several times per day.

It is possible to adapt the use of aids so that they help the resident to naturally extend, for example, a remaining leg stump below the knee joint after amputation. Lying on the stomach for a while every day can help the resident stretch out the hip flexors so that the ability to move in the hips is maintained.

It is an important task to prevent unnecessary deterioration of the residents. Being able to maintain body functions and independence contributes to both mental and physical increased well-being. Being sedentary and immobile increases the risk of many diseases.

When the resident performs daily activities such as washing, dressing or moving around, it becomes a natural exercise that contributes to reducing the risk of incorrect posture as well as other health problems. Well-adapted aids that are used correctly can help maintain mobility. For those who are not active, there is a risk that their self-esteem decreases and that their confidence to cope with everyday activities decreases.

Reduced mobility in the joints to other problems such as pain, fungus and wounds. Many older people are too sedentary, which in itself risks causing reduced mobility in the joints. Movement training in everyday life can be prescribed even without previous amputation or stroke. For employees, it is therefore necessary to both motivate and help with movement training and contracture prophylaxis.

ADL

Physiotherapist and occupational therapist perform an ADL (Activities of Daily Living) assessment upon moving in and design individual exercise programs. The ADL assessment forms the basis for the extent to which the immigrant receives help with and what the immigrant can cope with independently. For example, the physiotherapist can design an exercise program or the occupational therapist can prescribe aids. Occupational therapists and physiotherapists supervise other employees so that through their work they contribute to a rehabilitative approach. In home care, this can mean that the municipality helps adapt the home so that the individual can remain in their own home.

For the interventions to have the best effect, they should be early, coordinated and versatile. Rehabilitation can take place in the apartment, as group activities or in a special room. Where the rehabilitation takes place depends on what the needs and conditions look like.

Through work instructions or delegation, some training can be left to assistant nurses. For example, it can be about regaining the ability to move, personal care, training of mental functions, hand training, standing training, strength training, balance training and walking training.

Function-enhancing work methods or specific rehabilitation are related to disease and medical treatment. It requires knowledge of normal functions, current illness and treatment and requires specific skills and can only be performed by a licensed occupational therapist or licensed physiotherapist. The task can sometimes be delegated or prescribed. Authorized personnel have a responsibility to follow up, evaluate and document prescribed treatment.

ADL function and purpose

ADLs, or Activities of Daily Living, are basic everyday activities that all people need to be able to perform in order to live independently and maintain a good quality of life. In aged care, ADL assessments are an important part of evaluating and supporting the health and well-being of the elderly. Here's why it's so important to complete ADL assessments:
1. Person-centered care: By performing ADL assessments, health care professionals can understand each senior's unique needs and abilities. This enables person-centred care that is adapted to the individual and not a generic standard.
2. Early detection of problems: ADL assessments can identify early signs of physical or cognitive problems. It makes it possible to intervene early and prevent small problems from developing into serious health challenges.
3. Goal-directed care planning: The results of ADL assessments help create a goal-directed care plan aimed at improving or maintaining the older person's ability to perform daily activities.
4. Quality improvement: ADL assessments can be used to evaluate the effects of care and treatment. If an exercise program does not produce the desired results, the care can be adjusted.
5. Support for caregivers: For family members and caregivers, ADL assessments can provide insight into what their elderly loved ones need help with. This can facilitate planning and care decisions.
6. Research: Data from ADL assessments are valuable for research and development. It contributes to a better understanding of the health and needs of the elderly.

ADL assessments typically include activities such as personal hygiene, dressing and undressing, eating and drinking, toileting, mobility, and the ability to take medications. The assessments can vary in scope and detail depending on the care environment and individual situation. ADL assessments are a fundamental part of elderly care aimed at promoting the elderly's independence, well-being and quality of life. By understanding and supporting the residents' daily needs, we can provide the care and respect they deserve.

Reflection - health-promoting, function-preserving way of working
Caringstaff:
• What do you do in the working group so that everyone remembers to work on functional preservation?
• Has the resident you are the contact person for received an assessment by a physiotherapist or occupational therapist if there is a need for function-enhancing working methods?
• Do you and your colleagues work on function preservation?
• Is the working method documented in an instruction or in the implementation plan?
• Do you have signature lists so that you are reminded to carry out prescribed treatment?
• Do you have good routines for movement training?
• Do you receive the necessary supervision and training to be able to perform contracture prophylaxis?

Manager, nurse, occupational therapist and physiotherapist:
• What are you doing to create a culture where functional maintenance is the norm?
• Are occupational therapists and physiotherapists well equipped to provide support to the individual and to develop employees' skills?
• Do you work actively with rehabilitation so that the resident can regain functions that he lost during a previous period of illness?
• Do you have good routines for contracture prophylaxis and other movement training?
• How is compliance with prescriptions from occupational therapists and physiotherapists in relation to other prescriptions, for example drug prescriptions?
• If it differs, what is the difference due to?

Resident and next of kin:
• Does the function preservation method work?
• Does the staff work so that your loved one maintains functions such as eating or dressing?
• Do they exercise to regain functions that have been lost?
• Do you make sure to keep your body in shape?

Erland Olsson
Specialist nurse
Sofrosyne - better care every day