SCIE Research briefing 36: Reablement: a cost-effective route to better outcomes
By Jennifer Francis, Mike Fisher and Deborah Rutter
Published: April 2011
Review date: April 2014
This is one in a series of research briefings about preventive care and support for adults. Prevention is broadly defined to include a wide range of services that:
- promote independence
- prevent or delay the deterioration of wellbeing resulting from ageing, illness or disability
- delay the need for more costly and intensive services.
Preventive services represent a continuum of support ranging from ‘primary prevention’ aimed at promoting wellbeing, through to ‘secondary’ or early intervention, and on to ‘tertiary services’ such as intermediate care provided by health and social care professionals. Tertiary services are aimed at minimising disability or deterioration from established health conditions or complex social care needs.1 The emphasis is on maximising people’s functioning and independence through approaches such as rehabilitation, intermediate care and reablement. This research briefing focuses on reablement.
- Reablement is generally designed to help people learn or relearn the skills necessary for daily living which may have been lost through deterioration in health and/or increased support needs. A focus on regaining physical ability is central, as is active reassessment.
- People using reablement welcome the emphasis on helping them gain independence and better functioning, although evidence on user and carer views needs to be strengthened.
- Reablement improves outcomes, particularly in terms of restoring people’s ability to perform usual activities and improving their perceived quality of life. From a social care perspective, there is a high probability that reablement is cost effective.
- Reablement achieves cost savings through reducing or removing the need for ongoing support via traditional home care. However, there is currently little evidence to suggest that it reduces health care costs.
- Managers and care workers are generally positive about reablement, valuing its flexibility and the more responsive way of working with people.
- Occupational therapy skills are central to reablement. These can be accessed by training reablement staff rather than having an occupational therapist as a team member.
- Complaints about reablement mainly relate to handover (to a traditional home care provider) and a lack of help with domestic tasks.
- The delivery of reablement depends on suitably trained care workers. Care workers require specific training in reablement. Ongoing refresher training or shadowing of experienced workers is vital to sustain this approach.
- Requirements for training, closer supervision of care workers and longer, more responsive and flexible visits all contribute to the greater costs of reablement compared with conventional home care. However, the higher price of reablement is likely to be offset by longer-term savings from reduced social care-related needs.
About the development of this product
Scoping and searching
Scoping began in September 2010 and was completed in November 2010.
Peer review and testing
All three authors bring research and topic expertise. Lead author brings expertise in cost–effective analysis in social care. The briefing was peer reviewed internally and externally.