At a glance 54: Reablement: a guide for families and carers
Published: March 2012
This briefing has been co-produced with Carers UK.
- Reablement is a short and intensive service, usually delivered in the home, which is offered to people with disabilities and those who are frail or recovering from an illness or injury.
- The purpose of reablement is to help people who have experienced deterioration in their health and/or have increased support needs to relearn the skills required to keep them safe and independent at home.
- People using reablement experience greater improvements in physical functioning and improved quality of life compared with using standard home care.
- Reablement is usually free for the first six weeks.
- To find out more about reablement services in your area, contact your local social services department.
Reablement appears to be welcomed by people receiving the service.
It is common for people to be unsure about what reablement is, and for family and friends to be uncertain about what it means for them. This At a glance briefing is designed to help people understand what reablement is, and what family and friends can do to help.
The focus of reablement is on restoring independent functioning rather than resolving health care issues. The objective is to help people relearn how to do things for themselves rather than the conventional home care approach of doing things for people. Reablement appears to be welcomed by people receiving the service, and represents an investment that may produce savings.
Research on reablement has examined whether it is a better approach to supporting people than conventional home care. Key questions are whether better outcomes can be achieved, and for whom, and whether savings can be made through investment in reablement. Findings are broadly positive. People using reablement experience greater improvements in physical functioning, health-related quality of life and social care outcomes compared with people using standard home care.
What is reablement?
My husband is in hospital following a minor stroke. We have been told that he is eligible for the local reablement service after he is discharged, but I don’t know what reablement is.
Reablement services are for people with disabilities and those who are frail or recovering from an illness or injury. The aim is to help people regain the ability to perform their usual activities, like cooking meals, washing and getting about, so they can do things for themselves again, stay independent and live in their own home.
Reablement services are provided by local authorities, sometimes in partnership with the health service.
Reablement is usually non-chargeable for the first six weeks, which means it is free of charge even for people who usually pay for all or part of their care.
If a person is referred to a reablement service, reablement workers will visit them in their home, assess their abilities and needs and agree goals. Over the next few days or weeks the individual will be supported to regain physical function, relearn skills and if necessary learn different ways of doing daily tasks such as meal preparation, washing and dressing.
Who is eligible for reablement services?
My sister has early onset dementia and has been getting treatment for a broken wrist and nerve damage in her hand. I think she would benefit from reablement services to help her manage at home again, but I have heard she won’t be eligible because of her dementia.
Reablement services are run by local authorities, so eligibility can vary depending on where you live. They tend to be targeted at those for whom reablement will be most likely to lead to improvement. This means prioritising those people who are most likely to benefit by regaining physical function and improving their independence.
For this reason, in some areas, people with certain conditions such as dementia, or those who are near the end of their life, tend not to be offered reablement. In other areas, these groups may be offered reablement services, depending on their individual circumstances. Ideally people should be referred for reablement because of their needs and not their medical diagnoses.
In some areas, only people who are about to be discharged from hospital are referred for reablement. In other areas people are referred by their general practitioner (GP) or by a community social services team. There is also variation between local authorities in that some apply the Fair access to care services (FACS) eligibility criteria (used by councils to judge whether a person qualifies for a service) before referral to reablement, while others do so only where an individual has ongoing needs at the end of the reablement period.
What to do now
Ideally people should be referred for reablement because of their needs and not their medical diagnoses.
The first step you should take is to find out what reablement services are available in your local area, any eligibility criteria and how to access reablement. To do this, talk to your local social services department or GP.
Reablement can help families balance caring, paid work and other responsibilities by assisting people who are disabled, frail or recovering from an illness or injury to regain their skills and confidence.
For more information on how to get in touch with your local services have a look at the ‘Where do I go now?’ section on the back page of this briefing.
How will reablement make our lives better?
My mum doesn’t like asking for help, even though she had a fall recently and is finding it harder to manage around the house. I try to help, but it is hard to juggle work, the kids and mum, especially when she wants to do things herself, but can’t. How will reablement help us?
Reablement can help families balance caring, paid work and other responsibilities by assisting people who are disabled, frail or recovering from an illness or injury to regain their skills and confidence. This can reduce the need for support and care from friends and family and lessen the strain on family relationships.
Hints and tips: making reablement work for your whole family
- Talk and plan as a family. You can use reablement assessments and goals as anopportunity to start discussing the pressures caring and being cared for can put on people, and begin planning arrangements that everyone can agree on.
- It is common for family and friends to disagree with the person they care for about how and when they need support. Remind family members that they share the same goals. You all want the same thing – to help the person become more, not less, independent.
- Encourage learning and independence. You can help make reablement successful by encouraging the person you care for to practise new skills and recover physically. This sometimes means stepping back and giving the person the time, encouragement and space to practise doing things for themselves, even when you want to help them.
- Access support for carers. Ask about and use information, advice and services available to carers, to reduce the strain of caring on your family. If you are in paid work, you are likely also to have statutory rights to protect you and help you balance your paid work and caring responsibilities. These include protection from discrimination by association with a disabled person and the right to request flexible working.
Have a look at the Where do I go now? section of this briefing for more advice on seeking information and support.
If you are in paid work, you are likely also to have statutory rights to protect you and help you balance your paid work and caring responsibilities.
What should we expect from reablement services?
My dad gets out of hospital in a few days after having surgery on his back. Instead of the care package he usually has, he will be getting the local reablement service for the first few weeks. What should we expect?
You should notice important differences between reablement and usual home care services.
At the start
Common goals include dressing, using the stairs, washing and preparing meals.
When reablement begins, there should be an assessment of what the person is able to do. Everyone, including the person being supported, should then agree on some achievable goals. Common goals include dressing, using the stairs, washing and preparing meals. Other goals might include increasing opportunities to socialise or to start or resume hobbies.
Reablement is an intensive service, so it is likely that reablement workers will visit more frequently and stay for longer than a conventional home care worker. The workers who visit may be care workers who have been trained in reablement, but they may also be assisted by occupational therapists or physiotherapists who will give expert advice and support.
Instead of doing things for the person, such as helping them get up and dressed, reablement workers will actively assist them in doing things for themselves. This means they are more likely to stand back and give encouragement, or show the person a new way of doing something, such as using a perching stool for support while they wash themselves rather than being washed by the care worker. This takes longer than conventional home care, which is why visiting times tend to be longer.
People are most likely to improve if they are willing and enthusiastic about reablement. Motivation is the key to success.
There will also be more focus on assessments. During reablement, workers will want to measure how the person is improving as time goes on, so they are likely to assess them regularly in order to record progress and plan their ongoing support.
Finally, the worker may introduce equipment or modifications to the person’s home. This is where an occupational therapist is likely to contribute. The equipment and modifications might be temporary, to help reablement, or permanent, to help keep the person safe and independent at home.
What you can do
People are most likely to improve if they are willing and enthusiastic about reablement. You can help maintain enthusiasm by ensuring any goals are achievable and reminding the person how much they will enjoy regaining certain skills, such as being able to get upstairs to their bedroom on their own, or cooking their favourite meal. Motivation is the key to success. You could even plan a celebration for when they achieve a certain goal.
After reablement: how can we keep the person we care for independent, safe and well?
My friend lives alone. After starting reablement, she is now much more confident and better at doing things around the house so I do not feel I need to visit as often. We are worried about what will happen to her when reablement ends. She says she will miss the company and I am scared that she might not get enough help to keep her safe. What can we do?
As a friend or family member who helps care for the person, you should be invited to take part in this assessment and planning, along with the person you care for.
Input into social services planning and assessments
Social services should start assessing and working with the reabled person and their family early on in reablement, to decide whether the person needs an ongoing care package and to plan for what happens when reablement ends.
As a friend or family member who helps care for the person, you should be invited to take part in this assessment and planning, 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 you care for needs, or your ability to continue in your caring role.
You should be asked what care you provide and whether you are happy to continue to care for the person, and to what extent. If you are providing or intend to provide a substantial amount of care on a regular basis, social services should offer you a carer’s assessment to determine what help they can give to support you in your caring role.
Remind social services and reablement workers about any equipment that needs to be removed, so they can make arrangements to have it collected.
Preventing loneliness and social isolation
When reablement works well, the reabled person will be able to do things for themselves again and their care worker visits will be reduced or no longer needed. For some people, particularly those who do not have many visitors or social activities, this may lead to feelings of loneliness and isolation.
If you are concerned that the person you care for might become lonely, you should discuss this with reablement and social services workers. They should be able to build social activities into any support plan or put you in touch with 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 reabled person may not be safe at home, particularly if care worker visits are reduced or come to an end completely.
If you are worried, you should speak to the reablement workers and social services staff about your concerns. They should be able to explain how they reached their decisions and why they think the person will be safe.
You can also talk to care workers and the person you care for about the availability and suitability of different support options such as telecare – i.e. monitors and personal alarms – which can be used to help keep people safe and independent at home.
You can continue to enable the person you are caring for by encouraging them to use their new skills so as to maintain their confidence and independence.
Look after yourself
If looking after someone else is a large part of your life, it can be difficult to adjust when your caring role ends or changes. Having more time to yourself may give you the opportunity for a much needed rest but it can also leave you with a lot of time to fill. Your local carers organisation or group can offer support and advice in these circumstances.
For information on local reablement services and local services for carers:
- Call, email or write to your local social services department to ask for information. Their contact details should be in the phone book and on your local council’s website.
- 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 make contact with the social work team.
- Your local carers organisation may also have useful information. The Carers UK website includes information on how to find your local centre
For information on eligibility for benefits and financial support for your caring role
- Contact your local carers organisation or use the Carers UK website, or the welfare rights service in your local council.
- For a carers assessment to determine if you are eligible for extra help and support from social services, write to or email the social services department responsible for the person you care for to request one.
- For advice about juggling paid work and caring, and carers’ rights at work, see the Carers UK website, ‘Help and advice’ section.