Maximising the potential of reablement

Introduction

Reablement should not be limited to a focus on regaining physical independence but should also address people’s broader social and psychological needs to build their overall confidence and maximise their quality of life.

Guide focus and audience

This guide is for people who plan, refer to and provide reablement. It is not aimed at people using reablement or their families although they might find it useful in understanding what to expect from those planning and delivering their support. People using reablement and their families play a fundamental role in the success of reablement, an issue that is addressed throughout this guide.

SCIE and Carers UK have produced a short guide to reablement for families and carers.

Reablement is sometimes seen as a distinct service (with dedicated staff and systems) and sometimes as a philosophy for the provision of all adult social care and support.

The focus of this guide is the former: supporting the commissioning and delivery of distinct reablement services. However, the recommendations are also useful for encouraging a more ‘reabling’ ethos in the wider domiciliary care market and across all of adult care and support.

The scope of reablement

Reablement is one service on a continuum of intermediate care. This continuum spans acute and long-term care and responds to a range of health and social care needs. Other ‘intermediate’ services can include rehabilitation, rapid response and supported discharge teams.

Although there is no single delivery model for reablement, it is generally designed to help people accommodate illness or disability by learning or re-learning the skills necessary for daily living. These skills may have been lost through deterioration in health and/or increased support needs.

Reablement services are generally provided for a period of up to six weeks although people often meet their goals in a far shorter period of time. The focus is on promoting and optimising independent functioning rather than resolving health issues. It is about helping people do as much for themselves as possible rather than doing things for people that they cannot do.

Recommendations

Active, ongoing assessment is a fundamental aspect of reablement. It ensures that support is tailored to the often fluctuating nature of people’s recovery.
Although a focus on regaining physical ability is central, addressing psychological support to build confidence as well as social needs and related activities is also vitally important and often neglected.

Reablement has been criticised for failing to meet people’s social needs, which are often central to their perception of independence.

Recommendations

An important part of people’s recovery is the resumption of hobbies and social activities, seeing friends or walking to the local shop for their daily paper. It therefore follows that reablement is not restricted to support provided in people’s homes. Reablement may take place in the wider community, for instance with a trip to the shops or an outing to a local café.
Reablement services must ensure the scope of their work recognises these wider needs and can support people by removing obstacles to community participation – for example, enabling them to walk down their front steps safely or accompanying them the first time they return to a social group or club.
Reablement services have an important role to play in signposting people to other suitable services or activities in the local community. They can help enormously by accumulating and sharing good local knowledge about activities, clubs, groups and transport services.

In some areas, there are formal ‘community connector’ services, which link people up to local services, addressing social and psychological needs.

Case study: community connectors

Richard was assessed as having mental health support needs and had been attending a day centre for a number of years. He was at risk of becoming socially isolated within his community. Following reassessment the community connector looked into more meaningful community options for him. At first Richard was very anxious about leaving what he had known for a number of years and his family expressed concerns. The community connector supported Richard in accessing public transport and travelled with him until he became confident with using the service independently. Richard was introduced to other community options such as an art class in town, and is now regularly attending this and other groups.