Getting people involved, or promoting participation, applies at three different levels:
- Making sure that “hard to reach” groups of older people with frailty have access to supported self-care opportunities;
- Activating individuals that are involved with health and care services;
- Promoting participation in supported self-care amongst other care professionals.
Groups of individuals may be hard to reach either because of access difficulties or personal / professional attitudes, or because of service criteria. For example, services (such as, intermediate care and other forms of rehabilitation) are often not available to individuals with high levels of dependency due to advancing / more severe frailty and / or dementia as they may be deemed to have low ‘rehabilitation potential’. This same mindset may also limit supported self-care opportunities for this group of individuals. Traditionally individuals who are in 24-hour care settings, whether temporarily in hospital beds or more permanently as residents of care homes, have been ‘hard to reach’ and offered limited opportunities in terms of supported self-care. Hard-to-reach groups could also include those considered to be making more ‘risky’ choices that result in care professionals feeling their advice is not being heeded and so they disengage.
Some key principles for professionals to consider when reaching out to all people with frailty, who might benefit from supported self-care, are:
- To make the assumption of capacity in decision making;
- To strive to ‘do with’ rather than ‘do for’;
- To consider the most effective forms of communication;
- To feedback to service managers if concerned that individuals are being discriminated against through any aspect of service provision.
The Frailty Fulcrum puts quality of life as the key outcome. Focusing self-care discussions upon the individual’s quality of life, thinking about their situation across all domains and taking a genuine interest in what is most important to them will maximize the chances of them becoming more engaged in self-care. Promoting participation by considering ‘what is important to me’ is likely to be the most
successful way of encouraging individuals to embark upon a process of change.
Promoting Participation of Other Care Professionals
Alongside the challenge of engaging older people with frailty in supported self-care sits the challenge of shifting the mindset of care professionals from ‘doing for’ to ‘doing with’ (or ‘supporting to do’), particularly given the pressures of time and the expectations of others upon this group of professionals. You have the opportunity to be at the forefront of that change by explaining the importance of self-care, role-modeling the skills and behaviours required to support-self care, and coaching others to develop them.
There are times when participation will be hard to achieve and your own motivation may wane. Having the support of others will be important to help you overcome the obstacles and setbacks and continue to lead the way in promoting independence and encouraging activity amongst older people with frailty.