1. The Reablement Service
The Reablement Service is a multi-disciplinary team consisting of: (customer to provide detail) a service manager (covering this team, ICT and the business support function), team managers, senior practitioners, occupational therapists, social workers, assistant practitioners and administration.
Team hours are: (customer to provide detail)
The out of hours function will be supported by: (customer to provide detail)
2. Definition of Reablement
Reablement consists of services and support provided to adults with care and support needs in their own homes for a specific period of time, usually up to six weeks. Reablement services promote wellbeing and independence by supporting adults and encouraging them to regain, maintain or develop skills and capabilities in daily living, instilling the confidence to carry them out independently. The aim of reablement is to support people in taking greater control of their lives, thus eliminating or minimising the need for further intervention.
Reablement provides support that is tailored to the needs of the adult, focussing on their strengths and abilities and working alongside them to see how they can best get around areas where they are struggling, including seeing if aids and/or adaptations can help them overcome difficulties. The person is encouraged to do as much as possible for themselves; reablement has a ‘do with’ not ‘do for’ ethos to assist the person in rebuilding skills and confidence and gaining new skills. Progress against individual goals is tracked by regular visits from the team.
The objectives of the service are:
- to help adults regain, maintain or develop skills and capabilities in daily living in their own homes;
- to maximise long term independence and wellbeing;
- to remove or minimise the need for ongoing support.
The reablement service is free for up to six weeks regardless of people’s financial status or whether they meet the threshold set by the national eligibility criteria. Reablement is usually a time limited intervention, but the period of time for which the support is provided may depend on the needs of and outcomes for the individual. When it is provided beyond six weeks, it can be charged for or it can continue to be provided free of charge beyond six weeks if there are clear benefits to the adult and, in many cases, a reduced risk of hospital admission.
Where an adult is considered likely to benefit from reablement, they are supported to access the service. If they have already begun the assessment process (see Assessment), it may be paused to allow time for the benefit of a period of reablement to be realised so that the final assessment of need (and decision about eligibility (see Eligibility) is based on the remaining needs that have not been met through reablement.
3. Criteria for the Reablement Service
Anyone who is over 65 and could benefit from a short period of intensive and focused support to maximise independent living. Reablement services are often helpful to people recovering from an illness or a fall or who are experiencing a major life change. Those who may not benefit from reablement services and who may be excluded from them include people with advanced dementia, complex neurological / cognitive deficits, high levels of risk, terminal illness and those involved in drug and alcohol misuse.
Referrals may come from the information and advice service (see Information and Advice), the Hospital Discharge Team (see Hospital Discharge Service), GPs, or community teams following initial assessment.
4. Reablement Service Outputs and Outcomes
Outputs for this service should be:
- personalised assessment and goal setting (customer to add as required);
- regular reassessment / review (see Assessment and Review of Care and Support Planning)
- referral on to Case Management Team (see Case Management Team);
- referral on to community support / voluntary sector support;
- referral under local adult safeguarding procedures (customer to provide link to local procedures);
- referral to Care and Support Planning / Direct Payments (see Care and Support Planning and Direct Payments).
Outcomes for this service should be:
- no ongoing service required / reduced number of care packages in place;
- decreased level of care and support required / lower cost care packages in place;
- increased level of care required;
- fewer adult with care and support needs admitted / unnecessary hospital admissions / re-admissions;
- early discharge from hospital;
- decreased numbers of adults with care and support needs admitted to long term care;
- increased numbers of adults with care and support needs remaining as independent in their own homes;
- increased independence and confidence for adults with care and support needs.