Reablement is popular with service users and although not the cheapest option, may have longer term benefits. Jill Manthorpe reviews the evidence
What is home care reablement?
Home care reablement services and staff provide personal care, help with activities of daily living and other practical tasks for a limited period. They aim to enable people to regain both the confidence and practical skills to carry out these activities themselves. Most home care reablement services are arranged as part of support after a stay in hospital and they also help provide equipment to make life easier at home. Their staff generally work for local authorities and with NHS professionals. In other parts of the world, this work is sometimes called "restorative" services.
The Research
Key words: Home care | reablement
Authors: Caroline Glendinning, Karen Jones, Kate Baxter, Parvaneh Rabiee, Lesley A Curtis, Alison Wilde, Hilary Arksey, and Julien E Forder
Aim: To provide robust evidence on the immediate and longer-term benefits of home care reablement; to identify any factors that affect the extent of benefits and how long any benefits last for service users; and to investigate the impact and savings arising from reablement services.
Methodology: Service users from home care reablement services in five English local authorities were recruited, as were users of conventional home care from five other local authorities. Both groups were recruited at the time of their referral to home care services, and initial interviews were conducted. The reablement group was next interviewed on completion of reablement and both reablement and comparison groups were followed up by interview nine to 12 months later.
Conclusion: Reablement works for people who need support to regain their independence or to improve their quality of life. It does not appear to cost more, and indeed, it may reduce the need for some social care services and even some health care costs. It fits well with government emphasis on prevention and early intervention; and on reducing dependence. Importantly, people seem to like this type of service.
Both the government and opposition are keen on home care reablement as a way to help individuals regain or maintain their independence, especially after a hospital stay. There is a small but growing evidence base that describes home care reablement as effective and well-liked by people and their family members. The evidence says that people's well-being improves. There is some evidence that people may use fewer other services as a result of using a reablement service.
This study provides further evidence about the immediate and longer-term benefits of home care reablement services, as well as detailed information on the structure, content and first-hand experiences of reablement. These may be of relevance to commissioners and managers, but also to practitioners who are working with people to set up support plans and to monitor their outcomes.
FINDINGS
The coalition government's enthusiasm for reablement seems to be shared by users and carers, who are very positive about the impact of reablement on their independence and confidence. Indeed, some would have liked more help to improve their mobility and take part in activities outside the home.
This study investigates the experiences of people who receive home care reablement and compares them with a group receiving conventional home care services; importantly both groups were followed for up to one year.
During that time, reablement was associated with a significant decrease in subsequent social care service use. However, this reduction in social care costs was almost entirely offset by the initial cost of the reablement intervention.
The success of reablement may be that it works out better for people, even if there are not huge savings. For many local authorities there might be savings, but reablement seems to need quite a sophisticated combination of support groups to work well. Equipment and specialist support from professionals such as occupational therapists are a necessary part of the picture.
In the light of personalisation and greater take up by all user groups, reablement can potentially play a part in helping with extended assessments, so that appropriate levels of long-term support or resources may eventually be commissioned or arranged. This might be helpful, for example, if there is a strong possibility a service user would rather stay at home.
ANALYSIS
The report sets out a number of points for commissioners to consider, especially at a time of reduced resources. The first is that a return to a more targeted service may be appropriate. In other words, not everyone will have the same capacity to gain from reablement.
The authors recommend close working with NHS partners when developing reablement services or changing their focus.
While the study does not focus specifically on carers, carers appear to benefit from reablement in their caring role.Certainly, having the right equipment at the right time and access to professionals to ask questions of and seek reassurance is beneficial. The authors recommend professionals involve carers more in improving people's well-being.
The authors also recommend that local managers and commissioners think about extending the scope and skill-mix of reablement services. NHS investment in this area may be a spur to improving the confidence and skills of staff, for example by helping them feel able to work on exercise regimes and undertaking activities outside the home with the client or user.
This study took place in five areas of England and these are as typical of other local authorities as possible. One of the strengths of the study is that it was able to compare the experiences and outcomes for home care reablement users with those of a group that received conventional home care services.
In addition, there was the opportunity to consider what happened over time, generally nine or 10 months. This approach is not always possible in social care research.
Practice implications
For practitioners:
● The evidence on home care reablement is positive, so hospital workers talking to people who are being discharged from hospital can tell them that this sort of service is proven to work in many cases.
● Social workers should consider involving carers more in improving people's well-being.
● For social care workers and support workers, taking up a job in reablement may make the most of your skills and is likely to provide you with the opportunities to learn more about important areas such as therapy.
● For occupational therapists working for local authorities, a focus on reablement may change practice and relationships with primary care colleagues.
For commissioners:
● The study's findings provide welcome evidence of the costings of reablement services and these may be useful in discussing budgets with clinical commissioning groups and the best way to make use of scarce resources among communities.
