This resource accompanies "The journey to intermediate care in a care home". This is the story of how Jim's move to a care home turned his life around. We hope to share some learning about the role of residential care in reablement, and explore how staff culture in care homes can be key to supporting the outcomes of residents.
Jim is 72 years old. He has enjoyed a long and successful career managing freight deliveries across Europe which saw him become a seasoned traveller.
Jim first fell unwell when he had a stroke at 59. His illness meant he had to go from a life which centred around work to a life where he wasn't sure what to do with himself. After his stroke, his wife was diagnosed with cancer and died shortly afterwards. Jim was devastated by the loss.
He was unable to keep living at his home as there were steep steps to get upstairs, and he had difficulty using the bath. A nurse and OT visited him and agreed it was ‘an accident waiting to happen’ and so Jim moved to a small accessible flat. Jim began his road to recovery by walking two hours a day every day and travelling by bus across Scotland; Aberdeen, Inverness, Glasgow, wherever he could go. He carried on this 'tour of Scotland' for years.
However, after some time Jim was admitted to hospital with chronic obstructive pulmonary disease (COPD) and had a bad fall when he was there, breaking his hip and impacting on his mobility.
Life after hospital
Once discharged, Jim stayed in his small flat, unable to get out on the buses and requiring support three times a day from home care. Jim really liked the staff and knew they were doing their best but they were always in a hurry. Jim didn’t enjoy the ready meals that the staff microwaved for him, so he usually put them in the bin once he was alone. Jim’s mobility was made worse by staying in the house and he ended up losing two stone because he wasn’t eating properly. He became really depressed staring at the four walls, and relied on the shop downstairs to bring up trucking magazines and alcohol to numb the boredom. Jim became increasingly dependant on alcohol over time.
A social worker became aware of how isolated, underweight and unwell Jim was, and recommended that he enter residential care.
Arriving at Wheatlands care home
When Jim arrived at Balhousie Care Home he relied on a wheelchair to get around and needed support from staff for almost everything. He lacked confidence in his mobility and was very unsteady. He was underweight and uninterested in food and staff in the home found that he was also very anxious without regular access to alcohol, and began to experience withdrawal symptoms.
A year on, he is walking completely independently, able to get down to the shops on his own and organising his move to a housing with care facility.
So what made a difference for Jim?
Jim credits his change to the staff at Wheatlands care home. Staff used an enablement approach from day one to support Jim to do more on his own, without ever letting him feel that he was unsafe.
From the beginning of his stay, staff set little goals with Jim like walking to the loo, or getting to the dining room without relying on his wheelchair. The staff always expected him to do what he could for himself, and they celebrated with him every additional step he could take. When the staff learned more about Jim and how much he valued his independence, they pushed him further and set mini community challenges like getting down to the shop and back. Jim took it one step further and made the trip without any kind of walking aide.
This reablement approach meant he felt confident and began to test the waters around what he could do himself.
Jim also began to enjoy food again and now savours his meals, getting back up to a healthy weight. He’s looking forward to getting back to his usual pub lunches. Jim realised that he couldn’t be enabled without addressing his relationship with alcohol, and he no longer relies on drinking for comfort; he is close to the staff and can find company and activity whenever he needs it.
A man with a new lease on life; Jim is ready to go back into the community. He feels that he simply doesn’t need the level of support the care home offers and that he would like to get back to living on his own and doing things for himself. At the time of this case study, Jim was arranging his move into housing with care.
Jim knows due to his COPD and issues with walking, he may have to move back into a care home again in the future, but he’s no longer worried about what that will be like.
Jim’s last test for himself was whether or not he could handle the step onto a coach bus; and it was a success! This means Jim will continue his tour of Scotland taking in the views.
Key Learning Points:
- Staff and Jim quickly set expectations for his enablement rather than accepting his poor health as permanent.
- Jim worked with staff to shape his own goals so that they related to his own personal outcomes (ie his tours of Scotland).
- There was a mutual trust between Jim and the staff which made him feel okay about doing things that were ‘risky’ and ultimately helped build his confidence.
We hope that this case study serves to demonstrate that care homes are able to deliver a wide range of outcomes for older people. Although many of the residents in care homes may not be able to live in the community, staff are able to do great things when they have freedom and flexibility to think outside of the boundaries of a residential setting. We also hope that this story shows that a reablement attitude can be just as effective as a reablement ‘service model’.
Postscript: Jim’s initial move was from a care home to a housing with care facility. However, since the time of this interview, Jim has moved again from housing with care into an independent flat in the community.
For more information about reablement please see all of the reablement resources on the Learning Exchange.