A case study from Tŷ Aberdafen illustrating short-term rehabilitation prior to repatriation to residential care setting

Amir* was admitted to Tŷ Aberdafen for a short period of rehabilitation in May 2015. The longer term goal was for him to live in a non-specialist residential facility close to his family in Wales. Amir had acquired his brain injury in 2004, and was living in a brain injury residential home in Scotland until recently, when the family decided to return to Wales.

Amir’s aggressive behaviour around personal care meant many residential care homes felt unable to provide appropriate care and support. He has severe cognitive impairments affecting memory, orientation, insight, attention and fatigue. Amir was doubly incontinent and required support with all personal care and activities of daily living.

The team at Tŷ Aberdafen assessed the factors that were affecting Amir’s participation, and set rehabilitation goals which would:

  • reduce risks to Amir and others, including improved functional mobility
  • enable behaviour changes, especially around personal care
  • increase motivation and widen Amir’s participation in social opportunities/access, including enabling him to practice his faith

Amir’s stay at Tŷ Aberdafen was a successful one in terms of rehabilitation gains around behaviour, physical and psychological well-being and maximising his potential in preparation for him to move into a residential care setting. After seven months, Amir was discharged to a care home local to his family, something vital to them as his wife is in poor health. Amir continues to need active support to work towards his identified goals so Tŷ Aberdafen provided a discharge report with recommendations some guidelines for techniques which would support Amir in this new placement.

Below is a summary of the outcomes and the rehabilitation delivered by the team at Tŷ Aberdafen.

*name changed to protect identity

Outcome

  • Challenging behaviours around personal care decreased dramatically over the admission period

Rehabilitation delivered

  • A detailed personal care routine plan – to reassure Amir and reduce anxieties around personal care as well as improving his personal hygiene and reducing infection risk.
  • Continence training, through consistent positive affirmations when Amir indicated the need to use the toilet.
  • Increased confidence in standing and improving his overall fitness, which helped with his transfers. Since admission he has progressed from a lengthy and inconsistent transfer regime often requiring a maxi-hoist, to consistently using the standing hoist.

  • Physical stability work – Amir had anxiety around falling and, as a result, was not physically confident, lacked physical strength and stability, and displayed challenging behaviours. A combination of structured encouragement, patience and consistency were needed to help him overcome this, particularly around helping him with transfers.
  • Wider opportunities for social access (including enabling Amir to practice his faith)

  • Tŷ Aberdafen supported and encouraged Amir to :
    • attend the local mosque. Visits were also arranged by a local Imam
    • participate in groups (e.g. craft, baking and music groups)
    • attend community activities e.g. Headway social meetings.
  • Greater confidence and improved mood.
  • The structured and therapeutic environment at Tŷ Aberdafen, involving consistent implementation of rehabilitation guidelines has also facilitated an improvement in Amir’s motivation, followed by increased engagement in rehabilitation