This briefing is for carers and families; it explains what reablement is and what you can do to help. It looks at how reablement supports independence, safety and wellbeing, as well as who can access reablement services and what can be expected. Others may also find this briefing useful, including those receiving reablement services, care and support workers, therapists, people managing reablement teams and commissioners of health and adult social care.
The reablement approach supports people to do things for themselves. It is a ‘doing with’ model, in contrast to traditional home care which tends to be a ‘doing for’ model.
Reablement services help people to retain or regain their skills and confidence so they can learn to manage again after a period of illness.
The service is usually provided in the person’s own home by a team of mainly social care professionals. Consistency of workers is important to enable a relationship to be built with the person and for progress to be properly monitored.
The film provides an introduction to home care reablement. Reablement is a relatively new service aimed at supporting people to regain independence that may have been reduced or lost through illness or disability. The film focuses on the reablement service in the London Borough of Sutton, known as START (Short Term Assessment and Reablement Team), where we follow the experiences of two people using the service and hear from the manager and senior carer. We also hear from health economist Prof Julien Forder about new research evidence on the cost effectiveness of reablement.
Reablement is an approach that, irrespective of diagnosis, aims to assist people to continue to live as they wish. It seeks to enable the individual to do ordinary activities like cooking meals, washing, dressing, moving about the home and going out.
Reablement may be used to support discharge from hospital, prevent readmission or enable an individual to remain living at home.
It can be provided for anyone who will benefit from it. It is typically provided for up to six weeks although it is not unusual for someone to need only a couple of weeks of reablement.
It is also possible that reablement will last longer than six weeks if full independence could be achieved with a bit more support.
There is a tendency for the terms ‘reablement’, ‘rehabilitation’ and ‘intermediate care’ to be used interchangeably. The National Audit of Intermediate Care defines reablement as services that help people live independently, provided in the person’s own home by a team of mainly social care professionals.
Local authorities have a duty to prevent, reduce or delay needs for care and support (Care Act 2014 s2) for all adults including carers; this means early intervention to prevent deterioration and reduce dependency on support from others. Reablement is one of the ways they can fulfil this duty.
As local authorities run reablement services, eligibility can vary depending on where you live. Services tend to be targeted at those most likely to benefit. It is a flexible approach that can be used with a variety of different people including those with physical disabilities, dementia and learning disabilities.
Offering and providing more support than people need can make them more dependent on others. Reablement support workers are trained to stand back, observe, encourage and prompt the individual to learn new skills or re-learn skills they may have lost.
At times this approach is difficult for those struggling to complete a task and for those observing.If the carer or support worker intervenes because of their own feelings, or to save time, it can ultimately be a setback for the individual. Positive encouragement is more helpful in the long term.
This film focuses on ‘falls prevention’ programmes. This type of preventive support can be described as ‘early intervention’. Early intervention aims to identify people at risk and halt or slow down any deterioration and actively seek to improve their situation. Interventions include screening and case finding to identify individuals at risk of specific health conditions or events (such as stroke or falls) or those who have existing low level social care needs. The film introduces us to a number of people who describe how they are benefitting from the falls prevention service and the exercise classes. People who were initially experiencing reduced mobility or had previously fallen reflect on how their physical ability has improved and their confidence has grown. As well as the exercises classes, physiotherapists work with the individuals to improve the home environment so that they can achieve mutually agreed outcomes, such as washing themselves, moving around the house safely and reduced anxiety. For some, this means a reduction in the need for ongoing care. In addition to the benefits described by the individuals in this film, we hear from the rehabilitation and falls specialist at the Cambridgeshire Falls Prevention Scheme about some of the ‘service outcomes’. By maintaining people’s independence, the service aims to reduce packages of care, most notably by preventing the need for expensive residential care. Professor Julien Forder also explains that this kind of early intervention service is likely to reduce hospital admissions, meaning a positive outcome for individuals and the public purse.
Research has shown that people who have received a reablement service view it positively and see the benefit of improvement in their confidence, functional ability, mobility, independence and wellbeing.
It has also been found that even for people who were previously receiving traditional home care services, reablement approaches brought about improvements in independence, which in turn prolonged their ability to live at home and reduce the amount of traditional care subsequently required.
This supports the view that everyone should be considered for reablement as part of the review or re-assessment process.
The reablement approach offers benefits to all concerned.