UNIVERSITY OF YORK. Social Policy Research Unit
This report provides final findings of a study conducted with ten participating councils to investigate the benefits of homecare re-ablement. The study aimed to identify features of an effective and cost efficient services; maximise outcome and duration of benefits; and to understand and reduce the demands on other formal care, including other social services. The study comprised of three groups of councils: intervention sites which were enablement staff led; intervention sites with mixed staff teams; and comparison sites where service users had not undergone a phase of home care re-ablement. The previous interim study reflected on initial findings from the intervention sites. This report also adds findings from the comparison sites and long term impact from the follow up review stage. Main findings are discussed in the areas of assessment arrangements; discharge and onward referral arrangements; key features of re-ablement services; team skill mix; staff commitment, attitude, knowledge and skill; service users and carer views; and a strong vision of the service.
TRAPPES-LOMAX Tessa, HAWTON Annie
Effective reablement is dependent on service users' co-operation and motivation. It therefore needs to be highly responsive to their needs and views. This study offers specific user views about their experiences in different settings and at different stages of reablement, together with their ideas for how it might work better. The study describes the experiences of 42 older people in rehabilitation services in community hospitals and local authority short-term residential units followed by “usual care” services at home. It is based on semi-structured face-to-face interviews in 2002/3, from East and Mid Devon, England. Findings revealed four main themes: the complexity of rehabilitative need; the influence of the setting; the role of the staff; and the availability of reablement support back at home. The authors concluded that the findings demonstrate changing rehabilitative needs along the care pathway, with implications for commissioners and providers of reablement services.
SAMPSON Christopher, et al
Introduction: Occupational therapy interventions, such as home visits, have been identified as being resource-intensive, but cost-effectiveness analyses are rarely, if ever, carried out. The authors sought to estimate the cost-effectiveness of occupational therapy home visits after stroke, as part of a feasibility study, and to demonstrate the value and methods of economic evaluation.
Method: The authors completed a cost-effectiveness analysis of pre-discharge occupational therapy home visits after stroke compared with a hospital-based interview, carried out alongside a feasibility randomised controlled trial. Their primary outcome was quality-adjusted life years. Full cost and outcome data were available for 65 trial participants.
Findings: The mean total cost of a home visit was found to be £183, compared with £75 for a hospital interview. Home visits are shown to be slightly more effective, resulting in a cost per quality-adjusted life year of just over £20,000.
Conclusion: The author's analysis is the only economic evaluation of this intervention to date. Home visits are shown to be more expensive and more effective than a hospital-based interview, but the results are subject to a high level of uncertainty and should be treated as such. Further economic evaluations in this field are encouraged.