Maximising the potential of reablement
The required culture change: Providers of reablement - service managers and frontline workers
This section addresses those involved in providing reablement, whether as service managers, co-ordinators or frontline reablement workers. The recommendations apply to in-house and independent sector providers.
- Reablement requires a particular culture change for care workers. They need to start by discussing and agreeing goals with the person using the service and break them down into achievable targets.
- Care workers must learn to stand back and encourage people to regain or re-learn the ability to do things for themselves. In practice, this means learning to observe and not automatically intervening even when a person is struggling to perform an activity such as dressing themselves or preparing a snack.
The crucial skill in delivering reablement is in knowing when to do something for a person (for instance, right at the start of the support package or if they experience a setback) and knowing when to do things alongside and with a person. Compared with conventional home care, this is a new way of working and making the shift can be challenging. If people have a long work history in home care they may find reablement does not appeal to them. On the other hand, with good training and support, care workers often welcome the opportunity to work in this new way and report greater job satisfaction. Please see the recommendations in the section on workforce development and training.
- Reablement care workers must be responsive to a person’s changing needs. They must communicate these changes effectively with their manager so that the amount of support provided is reduced as the person gains independence – or increased if the person’s progress is slow.
- Service managers should ensure greater flexibility than conventional home care would normally offer. They should provide more intense supervision to support reablement workers’ training and promote the ‘reabling’ ethos. They should allow for the constant assessment of people’s needs and re-adjustment of the level and nature of support provided.
- The more flexible, responsive visits by reablement workers are likely to last longer than a traditional home care visit: managers should account for this in service business planning and implementation.
- Managers also need to plan staffing in a way that allows continuity of reablement care workers. This is also important in the context of a conventional home care service but the need is heightened in reablement which only lasts for a limited period and requires rapport and trust to be established quickly.
- Managers and reablement workers should ensure that people using the service are fully supported and informed so they have a clear understanding of what is involved in receiving reablement. It is particularly important to explain the following:
- The aim of reablement: for instance, to improve their confidence and ability to carry out day-to-day tasks without help. This means that reablement care workers will be working alongside them rather than doing everything for them.
- The finite nature of reablement: the service will last for a limited period of time. It is useful to state the usual upper limit (in some places this is six weeks) but be careful not to imply any entitlement to this length of service since some people will reach their goals within a far shorter space of time. Please also see the section on successfully ending a period of reablement.
- The pattern of visits: reablement workers (and associated professionals such as occupational therapists) may visit with much greater frequency at the start of the service when the person may need more support. Visits may last longer at different times and will certainly be longer than a conventional home care visit, with which they may have past experience. For example, it is likely to take longer to support someone to dress themselves than it would to do this for them.
- As well as clear, verbal explanations, information about reablement should be available in a range of different formats at the beginning and throughout the service.
- There are a number of circumstances in which it is particularly important to take extra care explaining what is involved in reablement and what should be expected, for instance:
- If the person has experienced traditional home care, since they may be used to care workers doing things for them.
- If the person is adjusting to major changes in their life, has been discharged from hospital or is in great pain. In such circumstances they should not be expected to understand or remember a ‘one-off’ explanation.
- If the person lives alone or has little support from family or friends. Such people have no one to listen to the explanation with them and subsequently explain or reinforce it.