Eight-Week Reablement Programme Shows Promise for Nursing Home Residents

Life inside a residential aged care facility can quietly erode the very capacities that give daily life its meaning. Older adults who move into such settings often surrender control over their routines, their personal care and their social activities, and research has repeatedly linked this loss of autonomy to poorer health and reduced quality of life. In Sweden, where roughly 80,000 of the country’s 560,000 residents aged 80 and above lived in residential aged care in 2022, the stakes are rising fast: by 2030 the population in that age bracket is expected to grow by about 45 percent. Against that demographic backdrop, a team of Swedish occupational therapy and rehabilitation researchers has tested a structured programme designed to do something deceptively simple, namely to help nursing home residents set and pursue personal goals for the everyday occupations that matter most to them.

The programme, called Reablement in Residential Aged Care, or Re-RAC, was evaluated in a feasibility study published in the Scandinavian Journal of Occupational Therapy. Reablement itself is a person-centred approach that aims to enhance physical and other functioning so that people can maintain independence in meaningful daily activities. Its key ingredients include a trained interdisciplinary team, initial and follow-up assessments, multiple visits and goal-oriented support plans. Most reablement research to date has been conducted in ordinary housing, where the goal is often to delay the need for institutional care altogether. Evidence from within residential aged care facilities remains scarce, although a recent systematic review and meta-analysis suggested the approach holds genuine potential for these settings. The Swedish team set out to fill that gap by adapting international reablement principles to the realities of the Swedish care home context.

Re-RAC rests on the Canadian Model of Occupational Performance and Engagement and unfolds across seven core components. It begins with an initial assessment of a participant’s occupational performance and satisfaction, followed by collaborative goal setting and the development of an individualised, goal-oriented support plan. That plan is then introduced to trained staff, and an eight-week delivery phase begins, during which nursing assistants provide daily support according to the plan. An occupational therapist and a physiotherapist offer ongoing supervision throughout, and the programme closes with a follow-up assessment to evaluate progress. The specific activities, which might include physical exercise, occupation-based training, support in social interactions or practice with assistive devices, are typically performed in short sessions of five to thirty minutes that can be repeated several times a day, and they can take place anywhere inside or outside the facility.

Before the intervention started, all relevant staff at the participating wards received three and a half hours of structured training covering the theory and practice of reablement, gerontology, motivation and teamwork. The study took place at a residential aged care facility in a medium-sized municipality in central Sweden, a facility with 81 apartments divided across nine wards oriented towards either somatic or dementia care. Two somatic wards were selected, together housing 16 residents, because severe cognitive impairment was an exclusion criterion. Residents were screened with the Clinical Frailty Scale and the Mini Mental State Examination, with very severe frailty and severe cognitive impairment both ruling out participation. Ethical approval came from the Swedish Ethical Review Agency, and every participant’s willingness to continue was monitored throughout the study to ensure ongoing assent.

Recruitment proved challenging but instructive. Of the 16 residents on the two wards, three were immediately excluded because they were terminally ill, and eight agreed to take part. After eligibility screening, six participants were enrolled, all of them frail to some degree, with four categorised as moderately to severely frail. Their cognitive scores ranged from 19, indicating mild impairment, to 30, indicating no impairment. All six completed the eight-week intervention, and none withdrew, even though two experienced unrelated medical complications, a fracture and an infection, that delayed their start by three weeks each. The researchers judged the eligibility criteria to be appropriate, and they noted that providing information face-to-face in residents’ own apartments was a crucial facilitator, since many had visual decline and needed help reading the study information and time to ask questions.

The methodological machinery of the trial also held up well. Questionnaires were administered as structured interviews, which removed barriers posed by impaired vision and reading difficulty, and participants reported that the questions felt relevant and that answering them was not exhausting. They wore hip-mounted accelerometers for seven days before and after the intervention to capture physical activity, recording median wear times of 12.6 and 11.9 hours per day respectively, and they reported no discomfort from the devices. Staff kept logbooks documenting every support visit, and these records matched the digital registration system used at the facility with only a few discrepancies. The outcome measures, including the Canadian Occupational Performance Measure, the EQ-5D-5L quality of life instrument and the WHO-5 Well-Being Index, all detected changes in the expected positive direction, suggesting they are suitable for a larger trial.

Those changes, while modest, were meaningful. Performance and satisfaction scores on the Canadian Occupational Performance Measure improved, with a median change of one point for performance and half a point for satisfaction. The EQ-5D-5L index showed a median improvement of 0.177, which exceeds the threshold for a minimally important difference in quality of life. The WHO-5 well-being sum score, which started low at a median of 44, rose to 50 after the intervention. The accelerometer data, by contrast, showed no detectable change in activity levels, with sedentary waking hours remaining high throughout. The researchers attribute this partly to the frailty of the participants, four of whom were largely wheelchair-bound, meaning upper-body movements may simply have been invisible to a hip-mounted device. They plan to switch to wrist-worn accelerometers in the larger trial to come.

The qualitative interviews revealed a more textured picture of what the programme felt like from the inside. Participants described how having a personal goal gave them a reason to practise, and many reported renewed initiative, feelings of hope, belonging and a sense of being able to influence their own situation. Yet the interviews also exposed friction points. Some participants struggled to choose goals because of their limited functional capacity, and others deliberately avoided goals they feared would demand too much from the nursing assistants, reflecting a well-documented pattern in which residents adapt themselves to staff routines at the cost of self-determination. Communication about the goals was often lacking during the intervention, with nursing assistants rarely using them to encourage progress, and participants said their motivation faltered when planned activities were cancelled or when they received too little praise and encouragement.

Staff perspectives, gathered through a study-specific questionnaire and observations at ward meetings, were broadly positive. The twelve nursing assistants who participated, all women with basic nursing assistant education, felt they had received adequate training and considered the intervention relevant and well explained. But they also reported difficulty knowing how to motivate participants, and notably they seldom requested the supervision that was available from the occupational therapist and physiotherapist. The biweekly team meetings, which were supposed to serve as a forum for reviewing and adjusting the goal-oriented support plans, largely followed their usual agenda of medical care and daily nursing tasks instead. A shift change during the Swedish summer vacation period, when untrained substitute staff took over, coincided with a visible decline in intervention fidelity during the final three weeks, a reminder of how fragile new working practices are in settings with established routines and high staff turnover.

Overall, the researchers concluded that Re-RAC and its associated procedures were feasible and well accepted, and the study now serves as the foundation for a planned multi-centre randomised controlled trial. Several refinements are already on the table: more systematic support for completing the performance rating scales, deeper staff education on motivational strategies, an expanded supervisory role for the occupational therapist, alternative formats for team meetings, and continuous staff training to buffer the effects of turnover. The feasibility study also offers a sobering lesson about implementing complex interventions in real-world care environments, where procedural drift is a well-known hazard. As Sweden’s care home population grows, the question is no longer whether reablement can work in residential aged care, but how to embed it so firmly in daily practice that residents’ own goals become part of the ordinary rhythm of care.

Subject of Research: Feasibility of a reablement intervention for older adults in residential aged care facilities

Article Title: Reablement in residential aged care (Re-RAC): A feasibility study

Article References: Strålman, L., Lidström-Holmqvist, K., Arvidsson Lindvall, M., Philipson, A., & Pettersson, C. (2025). Reablement in residential aged care (Re-RAC): A feasibility study. Scandinavian Journal of Occupational Therapy, 32(1), 1-16. https://doi.org/10.1080/11038128.2025.2611541

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2611541

Keywords: reablement, residential aged care, nursing homes, occupational therapy, older adults, feasibility study, quality of life, physical activity, goal setting, frailty, well-being, Sweden