Reablement itself represents a paradigm shift in how societies care for their aging populations. Rather than doing things for older adults, a traditional model that can inadvertently erode independence, reablement emphasizes doing things with them. It is a multi-professional, goal-oriented intervention designed to strengthen older people’s participation in the activities of daily life that matter most to them. Yet despite more than 200 publications on the topic, researchers have repeatedly noted that reablement programs often lack explicit theoretical grounding, leaving practitioners without a coherent framework for understanding why certain approaches work. ASSIST 1.0 was designed to close that gap.

The program, developed and piloted in Sweden, weaves together five complementary theoretical strands. The Canadian Model of Occupational Performance and Engagement and the Do-Live-Well framework, both rooted in occupational therapy, clarify what meaningful occupation looks like and how engaging in valued everyday activities connects to health and well-being. Bandura’s social learning theory and the concept of self-efficacy illuminate how confidence and motivation can be built through mastery experiences, observational learning, and verbal encouragement. Finally, situated learning and reflective practice inform the pedagogical engine of the program: bi-weekly workshops in which an experienced occupational therapist guided the assistant nurses through discussions of their real client cases, encouraging them to question routines, examine assumptions, and co-create solutions.

The structure of ASSIST 1.0 was deliberately pragmatic. Delivered within a Swedish Supported Discharge Home Care Service, an intensive, time-limited intervention for older adults immediately following hospital discharge, the program ran for one year. Its three core components were goal-setting using the Canadian Occupational Performance Measure, a structured interview tool that helps clients identify and prioritize the occupations they find challenging; the provision of occupation-based, person-centred support by the assistant nurses themselves; and the workshop series with mentoring from the occupational therapist. Older adults were followed for ten weeks and assessed at baseline and at two subsequent points, while the assistant nurses received fifteen workshops over the year, excluding holiday periods.

To understand how the nurses experienced this novel way of working, the researchers conducted nine semi-structured interviews, three with each participant, at the start of the program, six months in, and at its conclusion. The transcripts, totaling 215 pages, were analyzed using reflexive thematic analysis under a constructivist-relativist lens, an approach that treats meaning as co-created between participants’ accounts and researchers’ interpretations. From this analysis emerged one overarching theme, supported learning and reflecting enhances understanding of reablement, along with three subthemes that trace the nurses’ intellectual and practical journey.

The first subtheme captured how regular reflection with an occupational therapist opened new professional perspectives. The nurses, who had never before participated in structured reflective workshops or worked alongside a dedicated occupational therapist, described the sessions as a resource that prevented professional stagnation. One participant, given the pseudonym Eli, reflected that even after decades in the field, one must continually learn and relearn, because the worst thing a professional can do is become stuck in their role. Another, Kim, described the therapist as a bridge to knowledge they did not possess, prompting them to question whether their usual routines were actually right for each client. Intriguingly, even when workshop topics repeated, the nurses found that new client situations generated fresh insights, an effect the authors link directly to theories of reflective practice, in which revisiting familiar material in new contexts deepens understanding.

The second subtheme revealed perhaps the most striking shift: a move away from organizationally driven goals toward genuinely person-centred goal-setting. Before ASSIST 1.0, the nurses worked with broad, generic goals written by welfare officers at hospital discharge, such as becoming more independent, and then improvised their own specific objectives based on observation, without ever asking the older adults what mattered to them. Watching the occupational therapist use the Canadian Occupational Performance Measure to ask open-ended questions, such as which occupations were essential in a person’s everyday life, proved revelatory. The nurses began adopting the same approach, sitting down with clients to agree on goals together. One nurse noted that this made the work more concrete, while another described how their questioning expanded beyond self-care to include leisure pursuits that give life richer meaning. By the program’s end, all three reported applying these strategies even with older adults outside the program.

The third subtheme showed how everyday examples made reablement tangible. Rather than receiving formal lectures on theory, the nurses encountered theoretical principles through real cases. Kim described a pivotal realization that reablement is not necessarily about exercise or hard physical training but about the small things of ordinary life, even something as humble as putting butter on a sandwich. Eli found that witnessing each step of the goal-setting process made it easier to understand which small components of an activity mattered, and that enabling older adults to manage those components on their own, at moments of their choosing, strengthened autonomy and competence. This reframing of support, from assisting with tasks to enabling participation, resonates with Bandura’s account of self-efficacy, in which encouragement and regular check-ins reinforce motivation and mastery.

The study’s authors are careful to situate these findings within their limitations. The sample comprised only three assistant nurses in a single Swedish urban setting, all aged 45 to 55 with over twenty years of experience, and the occupational therapist came from the research team rather than the local healthcare organization, a trade-off that ensured consistency but may have limited contextual adaptation. The six-month intervals between interviews may also have blurred memories of specific practice changes. Moreover, the researchers themselves are occupational therapists and developers of the ASSIST program, a position they addressed through explicit reflexivity and transparent discussion of how their perspectives shaped the analysis. These caveats mean the themes are context-specific and cannot be assumed to replicate elsewhere.

Nevertheless, the implications are significant for anyone concerned with the sustainability of elder care. The findings align with a growing body of implementation research showing that theoretical knowledge alone is insufficient; practical experience combined with reflective supervision is what fosters meaningful change. Process evaluations of other reablement training programs have identified team-based learning, practical examples, and managerial support as key facilitators, while time constraints and staff shortages remain persistent barriers. The ASSIST 1.0 experience suggests a potential model for integrating theoretical frameworks into collaborative learning sessions without formal instruction, allowing frontline staff to absorb person-centred, occupation-focused principles through situated practice. For lasting impact, the authors argue, such training must be reinforced by organizational structures that promote continuous learning and mentoring. In an era when populations are aging rapidly and home care workforces are strained, the message is both simple and radical: the most powerful technology in reablement may be the structured conversation in which a care worker is asked to think aloud about why they do what they do, and to imagine doing it differently, with the older adult, rather than for them.

Subject of Research: Theory-based reablement training and reflective practice among assistant nurses supporting older adults in home care

Article Title: Assistant nurses’ reflections on ASSIST 1.0: Theory-inspired support in reablement

Article References: Assander, S., Guidetti, S., & Bergström, A. (2025). Assistant nurses’ reflections on ASSIST 1.0: Theory-inspired support in reablement. Scandinavian Journal of Occupational Therapy, 32(1), Article 2570537. https://doi.org/10.1080/11038128.2025.2570537

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2570537

Keywords: reablement, home care, occupational therapy, assistant nurses, reflective practice, person-centred care, goal-setting, self-efficacy, situated learning, older adults, ASSIST 1.0, qualitative research

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