Institutionalized seniors, even those who are physically frail, incontinent and/or have mild dementia, can respond positively to a challenging exercise program. The FFLTC program demonstrated clear benefits over typical, seated ROM exercises. Moreover, with minimal training, the program can be safely delivered at low cost by institutional staff and volunteers.

RÉSUMÉLes soins de rétablissement visent à rompre le cycle de la dépendance et du déclin fonctionnel dans les maisons de soins infirmiers en répondant aux besoins particuliers des divers résidents. Le programme RCET (Restorative Care Education and Training) comprend un atelier de cinq semaines ainsi qu'un manuel d'information destiné autant aux superviseurs qu'aux prestataires de soins directs. Ce document décrit l'approche du programme RCET et présente la mise en oeuvre, les procédés et les résultats d'une évaluation quasi-expérimentale portant sur 42 résidents qui ont reçu des soins réguliers dans six lieux d'intervention différents et six établissements de « liste d'attente ». Les données de base ont permis de confirmer que le personnel mettait surtout l'accent sur les résidents qui souffraient de handicaps fonctionnels substantiels. En quatre mois, les résidents qui ont reçu des soins de rétablissement ont vu plusieurs de leurs indicateurs relatifs aux résultats fonctionnels s'améliorer de façon considérable, tandis que dans le groupe de contrô le, les sujets voyaient plusieurs de leurs fonctions décliner. Les entrevues menées auprès de la direction de l'établissement et du personnel ayant participé à l'étude ont permis de dégager certaines orientations visant à modifier le programme RCET, ainsi que certaines perspectives relatives aux possibilités et aux défis à relever afin de mettre en oeuvre des activités de soins de rétablissement dans des maisons de soins infirmiers. ABSTRACTRestorative care attempts to break the cycle of dependency and functional decline in nursing homes by addressing individual resident needs. The Restorative Care Education and Training (RCET) Program consists of a five-week workshop and resource manual for both supervisory and direct care staff. This paper describes the RCET approach and presents the implementation, process, and quasi-experimental outcome evaluation findings with 42 residents from six intervention sites and six ''wait-list'' facilities who received usual care. Baseline data supported the fact that staff primarily targeted residents with substantial functional impairments. Over four months, residents who received restorative care improved significantly on several functional outcome indicators, while the comparison sample declined in several areas of functioning. Interviews with facility directors and participating staff provided direction for modifying the RCET and insight regarding opportunities and challenges when implementing restorative care activities in nursing homes.

The Home Support Exercise Program (HSEP) was developed to reach frail community seniors through home support workers (HSWs) rather than more costly health care professionals such as visiting nurses or physical therapists. This article describes the development and formative evaluation of the HSEP prototype, including the training of case managers and HSWs. In the HSEP’s final form, each client is instructed on 10 simple, functional, and progressive exercises and given an illustrated booklet and a short video. Ongoing encouragement is provided by specifically trained HSWs during regular visits (at least once a week). Formative evaluation of the HSEP model was used to examine and resolve implementation and delivery issues. Qualitative data were collected through focus groups or interviews with each stakeholder group—administrators/coordinators, case managers, HSWs, agency supervisors, and clients themselves. Evaluation findings were used to modify training, instructional, and support materials and the exercises.