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A reablement approach to living well at home
Episode 9 • 18th June 2024 • Your Aged Care Compass • Coral Wilkinson & Michelle Brown
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Having a home care package allows the older person to get services and support to keep them well and independent at home for as long as possible. These services and support can be so much more than “care”.

Enlisting a team of clinicians who can help improve the older person’s strength, mobility and overall health can allow them to regain some independence. This also contributes to a person’s ability to continue to live at home.

 In this episode: 

  • Care and support for activities of daily living
  • Use your home care package funding to remain well and independent at home
  • Reablement is an option that can run alongside care
  • Hospital admissions and deconditioning
  • Discussion about how we’ve used this approach with our mum

  

Resources Mentioned 

Related Episodes 


Connect with Coral Wilkinson: 

  

More about Your Aged Care Compass podcast: 

Are you supporting an older loved one at home and ready to give up because it’s just too hard? Your Aged Care Compass is aimed at anyone who is caring for an older loved one who still lives at home and is wondering what support is available to them.


We're Coral and Michelle, the sisters behind our business, See Me Aged Care Navigators.


Coral is a registered nurse with over 30 years’ experience in both health and aged care. A former assessor with the aged care assessment team, an advocate and author, there’s not much Coral doesn’t know about Australia’s aged care system.


Michelle is a former pharmacist with over 30 years in the public health and private sectors of pharmacy. Michelle is now client care manager for our business. 


Our story started as one of supporting our parents to remain in their own home, to be as independent as possible and remain connected to their community. We reached a point however, of needing extra support and we achieved this because we know Australia’s aged care system so well, we knew what programs could assist us and our parents.


This podcast, Your Aged Care Compass, brings together not only our personal experience in supporting our own ageing parents but also our vast professional experience in supporting other families to keep their loved ones at home. 


We will help you makes sense of Australia’s aged care system, from your first contact with My Aged Care through to the different funding streams and assessment workforces, management options for home care packages and extra funding that people might be eligible for.


There's so much more. Topics relating to dementia and legal and financial considerations will be covered, as well as real life stories of where it went wrong for people and how we guided them to get it right.

 

Your Aged Care Compass will guide you clearly and compassionately to the right support at the right time for your ageing parents and loved ones. 

Transcripts

Michelle:

Welcome to episode nine of your Aged Care Compass podcast.

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Our topic today is a reablement approach

to living well in your own home.

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Coral: Shell, this is a topic that I

love to talk about as it always opens

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people's eyes as to what is possible,

specifically how home care package funding

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can be used in ways other than care.

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So a reablement approach is the approach

that is used in the government's Flexible

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care programs, the transition care

program, and the short term restorative

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care program, which are both excellent

programs, but you can carry this approach

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across to home care packages, too.

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So a lot of people.

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Who receive home care packages, they

get locked into this mindset, into

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this way of thinking that a home care

package is about giving people care.

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And when I say care, I'm using this as

a very general and broad term to reflect

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carers or support workers coming in to

help people with their activities of

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daily living , and mainly their personal

activities of daily living like that.

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That's like showering.

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or grooming and then things

like, cooking meals or, even

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tidying up around the house.

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, so fairly simple things that people

are doing in their day to day life.

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that they're struggling to do when

people get a home care package They see

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particularly that an older loved one

might need this kind of support and they

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think they need to get carers in and

that's fine, that's totally appropriate.

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If that is the way you want to

approach the support for an older

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loved one, but there are, options.

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Having a home care package means that,

because that funding is allocated

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to you as the person, you can use

that funding however you need to.

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to remain well and independent at home.

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So, a reablement approach

is another kind of an option.

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It's not exclusive from

care that's provided.

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You can certainly have the two

things running together, but it's an

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approach that we have adopted with

our mum over the past three years.

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, and an approach that we take.

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With a lot of our clients , who

ask us should we do with this

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home care package and this funding

and how best should we use it?

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So, we're going to talk through during

this episode, how reablement has allowed

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mum over the past three years to remain

as well as she possibly can and able

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and continue to live in her own home.

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So

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Michelle: So Coral, we've adopted a

reablement approach with the support mum

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receives within her home care package, and

we've done so for the past three years.

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Had we not taken this approach, I

believe mum would have entered an

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aged care facility three years ago.

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So can you tell our listeners what's

been going on with mum over the past

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three years and how we've managed

to keep her well and able at home?

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Can

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Coral: Three years ago, mum had a,

an emergency admission to hospital.

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Then 12 months later, she had another

emergency admission to hospital and had

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some emergency surgery at that time.

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And more recently, as some of our

followers we'll be aware that,

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Mum has just come out of hospital

again after a six week admission.

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So I just want to take people back to,

two to three years ago when mum was in

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hospital at that time, after she was

discharged from hospital, Mum had to

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come and stay with me for quite a few

weeks because she was so deconditioned

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after those two hospital admissions.

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And at that point, I actually wondered if

she'd be able to get back to her own home.

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Michelle: you just explain to people

what you mean by deconditioned?

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Coral: So deconditioned means

where people have declined.

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Particularly functionally declined.

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So we know that hospitals are not

great places for older people and

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the longer people stay in hospital,

actually, the more deconditioned

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they become, because , most of the

time people are staying in bed.

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For most of the day in hospital, they

might get a little bit of physiotherapy.

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They might get a little bit of support

from the occupational therapist, but

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it's not as much as if they were in

their own home, moving around and doing

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things for themselves, but you know,

they're in hospital they're unwell.

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, they're probably, they can't get

out of bed or they're reliant on

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the nurse to get them out of bed.

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So because they are mostly immobile , they

become weaker and they become frailer

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and this is what we call deconditioned.

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Michelle: Right.

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Coral: So after those hospital admissions,

two years and then three years ago

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that mum had, she came and stayed with

me for quite a few weeks afterwards.

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And she was very weak and she

was completely dependent on me.

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, she really couldn't do anything.

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She couldn't even get out

of a chair without my help.

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And I honestly wondered at that time

if she would be strong Go back to her

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own home, but being a nurse and being a

clinician in my background, having worked

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a lot in those restorative or reablement

programs, transition care program and

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short term restorative care, I knew

that we could get mom stronger, in fact,

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strong enough to be able to return home.

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So mom had a home care

package at this time.

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, and, I was faced , with choices and

one choice I could have made was that

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I could have enlisted a whole bunch

of carers to come in and help mum with

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her showering and help her get out

of a chair and help her walk wherever

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she needed to go , and be there and

help her with all those things that

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she couldn't manage for herself.

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Or the approach I take with reablement

is getting a whole team of clinicians

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involved to literally get mum back on

her own feet and being able to do the

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things that she was previously able to

do before these hospital admissions.

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So within mum's home care package,

I enlisted an exercise physiologist

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and, or an EP as we call them.

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And the EP initially came to my

home, but then continued on when

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mum went back to her own home.

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The EP came in three times a week and

did a one on one personalized exercise

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program with mum to Optimize her mobility

and, and help her regain her strength.

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mum also had a dietician review

at this time because during one

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of these hospital admissions

she was diagnosed with diabetes.

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So, We wanted to get some good,

independent, and encouraged advice about

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how to manage that, , and what mum was

eating, was that appropriate for her?

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Were there any changes

that needed to be made?

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So mum went off and had a

consult with a dietician.

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, She was already attending group

exercise classes, which would

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also double the social access

or social interaction for mom.

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So we kept that going as well.

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So she had five days of exercise.

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She went and saw the dietician for

consult and that was all great.

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Mom was eating well, her diet was great.

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So having that reassurance.

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Mom having that reassurance in

me as her daughter and the nurse

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knowing that what mom was eating

was appropriate , was great.

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Mom also I got her off to a podiatrist and

I say specialist podiatrist because when

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people think of podiatry, they will often

think of, The podiatrist cuts my toenails,

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but podiatrists do so much more than that.

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And we, I always say to people, when

you're looking at an older loved one and

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considering their mobility, it's not just

about, how strong their legs are or how

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strong the muscles in their legs are.

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It goes right down to their feet.

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So if someone has an issue

with their feet, that's going

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to throw them off balance.

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So within mum's home care package I

got her assessed I got a assessment

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of her feet from the gait, which is

the gait is the way that she walks.

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So the podiatrist did a very thorough

assessment of how mum was walking.

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And that revealed some

interesting stuff to us.

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Mum has terrible feet and her feet were

actually contributing to her imbalance.

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So, the podiatrist recommended some custom

orthotic inserts to go into mum's shoes

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that would lift the arches of her feet.

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And the podiatrist also recommended

some appropriate footwear given now

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that mum was diagnosed with diabetes,

we wanted to make sure that mum's

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feet would always be protected.

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So she couldn't wear closed shoes

because she has these clawed feet, but

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we did look around and we found these

wonderful shoes that were appropriate

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that had, rubber soles, leather uppers.

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They had a Velcro tie across the top.

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So it was easy for mom

to put them on and off.

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So that lovely soft leather at the

top of the shoe, she was able to wear

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these shoes because they weren't rubbing

against her toes , and causing pain in

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her toes because , it was a rigid upper.

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upper.

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These, these were very lovely soft shoes.

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And so mum bought these shoes and the

home care package paid for them because it

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was the podiatrist that recommended them.

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There was a clinical indication that was

directly related to her health care needs.

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And we could demonstrate that poor

mobility, is directly linked to falls,

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which we always wanted to avoid.

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She got the custom orthotic inserts paid

for by the home care package again because

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that came off a clinician recommendation.

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And then , the other thing that I did with

mum is that I got her a continence review

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at that time because she was beginning

to struggle a bit with continence issues.

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And again, the home care

package paid for that.

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The continence advisor came in, did her

assessment, made the recommendations.

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And then from there, we've been able to

purchase ongoing continence aids for mum.

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So this great.

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team approach of clinicians who were all

excellent at doing what they're doing.

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They did get mum back on her feet and we

did get mum home after those two hospital

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admissions two to three years ago.

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Now, just skipping forward,

some people know that mum has

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just been in hospital again.

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She's just had a six

week admission this time.

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So we're.

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big admission into hospital.

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We had noticed for some time, some

months that mum had been declining,

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but we just couldn't pinpoint what was

going on, why she just wasn't herself.

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We'd been taking to her GP,

she'd been having blood tests,

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but nothing was leaping out.

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She didn't have a urinary tract infection,

but we just couldn't pinpoint why.

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Why she was so tired all the time and

why she was just losing interest , in

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doing things that she wanted to do.

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And, then she started to have falls.

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So my mum who, hadn't had falls before,

, my 83 year old mum, who's never broken

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a bone before fell and broke a finger.

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On her right hand and then a few

weeks later, she had three consecutive

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falls and she ended up in hospital

with a fractured pelvis which is a

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terrible thing for an older person.

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But it actually, looking back, even

though this was a really difficult

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time, these six weeks in hospital,

it actually took this fall and this

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admission to hospital to get to the

bottom of what was going on at this time.

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I just, I'm just going to sort of

deviate slightly here because there's

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a conversation , that came up, it

happened when mum was in hospital

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this time and it's a conversation that

I've heard many times before when I

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used to work in the hospital system.

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And , it's even a conversation

that we continue to hear now.

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So while mum was in hospital, a

nurse said to mum that she might

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have to rethink her accommodation on

discharge because she was having falls.

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The nurse was implying that,

that mum actually would need

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to move into residential care.

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So, mum was in hospital to find

out why she was having these falls.

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Despite having regular

exercise, she was falling.

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So, not only was this suggestion by

the nurse inappropriate, it was also

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premature, and it really was a blow

to mum's confidence at the time.

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And I've got to tell you, it, it made

me pretty upset when I found out.

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That this had happened.

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So we know that falls can

happen anyway in nursing homes.

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Moving into a nursing home is not

going to stop people falling or

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protect them or in any way, make

any difference despite the location

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that the older person is living in.

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So , it's this kind of myth

that I like to debunk.

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If a person is falling at home,

that's not an indicator that

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they're not safe to get at home.

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In the first instance, you need

to get out to the bottom of

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why they're having the falls.

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And then you can look at what support

can be put in place to, again, help

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that person reable, get back to a

level of functioning that will allow

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them to live safely in their own.

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So we did get to the bottom

of why mum was falling.

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She was very anemic and she

had an irregular heart rate

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that hadn't been picked up.

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She was treated for this in the

early days of her hospital admission

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and she improved dramatically.

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Like it really, it was remarkable.

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It was like mum woke up.

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She had an iron infusion and

we just couldn't believe.

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It was like it's like

we got mum back again.

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And then because she improved after

that iron infusion and she got onto

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medication to control her heart rate,

this allowed her to participate in

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her rehab program at the hospital.

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So mum has just come home and because,

a fractured pelvis is a significant

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injury for an older person, any person,

but it does take some months to heal.

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We have had to change slightly the

way we approach support for mum.

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We still adopt a reablement approach

and she does continue with her

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exercise, but at this point in time

she also needs some carer support now.

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I've also arranged, again, under

that reablement approach, I arrange

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for an occupational therapist to

come to mum's home and to have a

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really good look throughout her home.

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I've also arranged for an occupational

therapist to come to mum's home

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With regards to the home set up,

because we knew she was going to

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be coming home with a four wheelie

walker, which she hadn't had before.

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We knew that there might need

to be some adjustments at home

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to, to meet her different needs.

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And and the occupational

therapist also talked with me.

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, and they were great.

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They talked with the occupational

therapist in the hospital as well.

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And they worked out what mobility

aids were going to be most

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appropriate for mom and discharge.

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So we have introduced, that

traditional sort of care.

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We do have some carers coming in now.

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For mom.

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In fact, we we have those carers coming

in five and a half days a week two

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shifts a day in the morning and in the

afternoon, just really to be there in the

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home to ensure that mom is getting up.

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Out of bed herself.

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And if she needs some help, that's fine.

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They're there to help her to be around

while she takes her medications.

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While she prepares her own

breakfast and it's all very slow

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because she's still recovering.

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But just to have that reassurance

for us, that we've got another set of

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eyes there with mum that mum is being

supported gives us the reassurance

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then to know that she's okay.

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So over time, we do expect that

these care hours or, the hours that

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we've got the carers coming in, we

expect that they'll reduce as mum

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regains her strength and balance.

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So.

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In summary, using a home care package

to enlist carers to provide care is

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fine and it may be the most appropriate

option for some people but using a home

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care package to literally get an older

person back on their feet and continue

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to live well and independently for

us and for many people , is the goal.

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Michelle: Yep.

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Yep.

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And Coral, with our clients, this is

the type of conversation we often have.

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We like people to realize that the home

care package can be used for more than

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just care and it can enable your older

loved one to live well and independently

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at home for as long as possible.

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So thanks for joining us today.

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And we look forward to chatting next week.

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