Reablement: a guide for carers and family

Updated: September 2020

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.

What is reablement?

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.

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.

Promoting independence

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.

Key features of the reablement approach

• Focuses on a person’s strengths to promote and maximise independence and wellbeing.
• Rebuilds confidence after a spell of illness, deterioration in health, an injury, a hospital admission or an acquired disability.
• Different to traditional home care as it involves care providers standing back and encouraging the promotion of self-care skills that may have been lost.
• Supports people to regain or retain skills to enable them to manage with minimal or no support.
• Short-term and intensive; typically provided for up to six weeks.
• Not means-tested – the service is free to people who meet the locally defined eligibility criteria.
• A focus on restoring independent functioning, rather than resolving healthcare issues.
• Aims to prevent re-admission to hospital or premature move to a care home.
• Usually provided in a person’s own home, but may be provided in an intermediate care facility.
• About setting and working toward meaningful goals.
• Aims to reconnect people with their communities to reduce social isolation.
• Can help to reduce the amount of care the person needs from carers and family.

The benefits of reablement

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.

• For the person it offers increased independence and improved quality of life.
• For carers and family members, they can enjoy seeing their relative improve and can ultimately spend less time supporting or caring for them, and therefore more time just enjoying their company.
• For staff, this is a rewarding approach where improvements lead to a feeling of real achievement.

Who is reablement for?

• If the person is being considered for home care, reablement should be offered as a first option if it has the potential to improve independence and wellbeing.
• If the person already receives home care, reablement should be considered as part of the review or re-assessment process.

There may be a reluctance in some areas to offer reablement services to people with certain conditions, such as dementia or terminal illness, but the decision on whether to offer the service should be based on an individual’s needs rather than medical diagnosis or condition.

Conventional home care still has its place when reablement is inappropriate or following a period of reablement. If traditional services are still required, they should follow the same ethos. This means enabling the person to do as much as they can for themselves and not doing it for them because it is quicker or easier. Doing things for people when they are able to do it for themselves – albeit in a different way or more slowly – can undermine independence and wellbeing. This could make the person more dependent, both physically and emotionally, on others.

Reablement services in my area

• Call or email your local authority social care services to ask for information. Find your local adult social care services department.
• People in hospital can ask the hospital social work team for information. Ward staff, such as the discharge or ward coordinator, should be able to help you contact the social work team.
• Organisations such as Age UK may be able to offer advice and support in your local area.

Who are referred for reablement services?

In some areas, only people who are about to be discharged from hospital are referred to reablement services. In other areas people can be referred by community health or adult social care teams, or their GP. There is also a variation between local authorities in that some only provide reablement services to people who meet the Care Act eligibility criteria.

Many reablement services are provided by local authorities; however, in some cases, they are provided in partnership with the local clinical commissioning group (health service). The arrangements for service provision, and therefore how they are accessed, vary from area to area.

Making reablement work for you

What does reablement involve?

The role of reablement support workers

Reablement is an intensive service provided by reablement support workers who have received additional training; they may also be assisted by occupational therapists or physiotherapists who will give expert advice and support.

Reablement uses a ‘doing with’ approach, which involves supporting people to do things for themselves. Support workers are taught to stand back and allow the person the time to complete a task on their own. This may involve the person being shown a different way to carry out the task to achieve independence, such as putting the weaker arm with the least amount of movement into the sleeve of a top first. The worker may also support the individual to reconnect to their local community by providing information, as well as by promoting confidence in outdoor mobility and the use of public transport.

Supporting people to do things for themselves initially takes more time, so reablement support workers are likely to visit more frequently and stay for longer than a conventional home care worker who may have done the task more quickly on behalf of the person. Throughout the process, reablement support workers stand back, observe, encourage and prompt the individual to learn or re-learn skills they may have lost. At times, this approach is difficult for those struggling to complete a task as well as for those observing. You may be wondering why the reablement worker is not being more helpful – but they are sticking to the agreed plan, focusing on the person’s progress. 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.

Types of support

Reablement focuses on what the person can do for themselves and sets goals that can be realistically achieved. Goals are usually focused on ordinary day-to-day things such as:

Mobility – moving around the home and going out

Making food and drinks

Personal care

Housework

Shopping

Maintaining contact with family, friends and community groups

Reablement support is not limited to day-to-day tasks, and can also involve:

• Income maximisation – ensuring the person has access to information and advice to ensure they receive all their financial entitlements and benefits.
• Health and wellbeing – supporting independence with medication and monitoring any health issues or deterioration – ensuring the person can access appropriate help.
• Managing pain – It is hard to motivate someone if they are in pain. If the person has had an injury it may be very painful at first and it is important to work with the individual so they can do tasks at a tolerable level. The reablement team should ensure that the person has access to support from healthcare professionals so that pain is well managed.

Assessment and goal setting

When a person is referred to a reablement service, a reablement assessor, an occupational therapist or social worker will visit them to assess their abilities and needs in relation to the goals the person identifies. The person’s views should be central and the process and carers and family should be included as appropriate. The process should seek to identify strengths and overcome barriers that could be:

• physical – relating to illness or disability
• environmental – relating to the layout of the home
• psychological – relating to fear or confidence.

Equipment, adaptations or mobility aids may also be recommended to support reablement, such as:

• positioning a grab rail beside the toilet to enable the person to use the toilet without assistance
• a seat across the bath if someone has difficulty stepping in and out of it
• a perching stool to prepare food in the kitchen and a trolley to move the meal to where it will be eaten
• using a stick or walker outdoors to promote physical stability and confidence
• use of a commode
• learning to use a microwave instead of an oven.

For each task, the goal is for the individual to achieve it independently or with minimal assistance. The occupational therapist may become involved in the assessment for adaptations and mobility aids; however, in some areas, reablement support workers have been trained as trusted assessors and can assess for and supply simple equipment.

Support planning

The support plan is a record of what has been agreed so that support workers can be consistent in their support. Identified goals are recorded along with how the person hopes to achieve them and what support is needed. The planning process should identify what the person wants to achieve, agree how it could be achieved and set a timescale.

Necessary changes can be made at any time as part of ongoing review. The focus is on regaining skills and, if necessary, learning different ways of doing daily tasks. The time, duration and number of planned visits will be dependent on individual need. Prompt provision of aids, adaptations and relevant equipment will enable the person to become familiar with its use during the reablement period. The plan may include:

• personal care tasks such as washing, dressing and going to the toilet
• domestic tasks such as food and drink preparation, cleaning, shopping, and doing laundry
• using transport, and accessing the community
• mobility – moving safely and confidently around the home or outdoors, climbing stairs, getting up from a chair, getting in and out of bed and getting on and off the toilet
• maximising opportunities to socialise, to start or resume hobbies.

It is important that you, as a carer or family member identified by the individual, are part of the goal setting and support planning process to enable you to fully engage. The goals will be recorded in the support plan, which is usually kept in a folder in the person’s home so that all concerned can see the achievements and help identify new goals as progress is made.

Ongoing review

There will be a focus on regular assessment and review during reablement. Support workers and assessors will want to work with you and the person you care for to record progress, identify further goals and plan ongoing support. If all goals have been achieved, reablement doesn’t need to continue for the full six weeks (or the full-time period allowed locally). The reablement support workers will be the main contact between the individual, carers and family and the reablement assessor, social worker or occupational therapist.

Consistency of support worker is important to reablement; there may be a small group of support workers providing support to an individual to cover the different times of the day and week. Each support worker will record progress and any issues and problems – usually this will be in a folder kept in the person’s home. Any issues of concern can be raised with or by the support worker, with the service manager and/ or with any other relevant professionals in their team (such as occupational therapists or social workers).

Planning for the service to end

Early in the reablement process, the assessor will determine whether an ongoing package of care may be required. If they think it will, they will make a referral to Adult Social Care Services, who will start assessing and working with the individual, their carers, family and the reablement support workers to determine what ongoing care and support may be required when reablement ends. If all goals have been achieved, reablement doesn’t need to continue for the full six weeks.

As a carer or family member, you should be invited to take part in assessment, planning and review, along with the person you care for. This is a good opportunity to raise any issues or concerns you might have about what the person needs, or your ability to continue in your caring role.

You can also make sure that any equipment or minor adaptations to the property have been put in place prior to the end of the reablement period. Sometimes larger adaptations such as a ramp may take longer to be installed. Any equipment which is no longer required should be returned so it doesn’t clutter the home.

Preventing loneliness and social isolation

When reablement works well, the person who has received the service will be able to do things for themselves again and their reablement support worker visits will be reduced and then stopped. For some people, particularly those who do not have many visitors or social activities, this may lead to feelings of loneliness and isolation.

Older people, in particular, may experience feelings of loss and isolation due to the death of a spouse or of lifelong friends. Other feelings of loss may relate to limited mobility and not being able to get out or do things they used to do.

Being an active member of society is an important part of promoting wellbeing. If you are concerned that the person you care for might become lonely, you should discuss this with reablement and/or social workers. They should be able to build social activities into the goal setting and the support plan, providing you with information regarding local community and voluntary organisations that run social groups and activities.

Making sure the person is safe at home

It is common for family and friends to be worried that the person may not be safe at home, particularly when the service starts to reduce or comes to an end completely.

If you are worried about this during the reablement period, you should speak to the reablement support workers, occupational therapist or social worker. For any particular risks, such as falls, the professional should carry out a risk assessment.

You can also talk to the person you care for, the reablement support worker or other professionals about the availability and suitability of telecare such as monitors and personal alarms, which can be used to help keep people safe and independent at home.

Further reading

• Understanding intermediate care, including reablement: A quick guide for people using intermediate care services (NICE)
• Intermediate care and reablement (Age UK)
• Care after illness or hospital discharge (reablement) (NHS)

Support from SCIE

SCIE is a leading provider of reablement resources and support. We offer training and consultancy to support the review and embedding of a reablement approach in local care and support systems.

Further information and resources include:

• a webinar produced in partnership with The British Red Cross looking at the latest evidence in reablement, along with examples of leading practice
• a suite of resources, including guidance and a range of films for professionals, carers and families on the topic of reablement.