Maximising the potential of reablement

Skills mix and supporting services

Overview

Achieving the full potential of reablement relies not only on the internal organisation of the service but also on how access to other professionals and supporting services is organised.

The overall skills mix of a reablement team is important. Although care workers are the foundation of a reablement service, social workers, nurses, physiotherapists and occupational therapists make important contributions and decisions need to be made about how to involve them.

Recommendation

Nurses, physiotherapists and occupational therapists do not necessarily have to be involved as full-time team members within a reablement service. However, it is crucial to ensure that professionals with appropriate skills can be accessed by the reablement service in a timely manner. For example, research found [7] that although it is not critical for occupational therapists to be embedded in the service, they have an important role in the delivery of reablement.

Having said this, it is important to note that while occupational therapists are commonly associated with reablement, it is unclear from available research evidence whether their skills are essential to successful reablement. However, we do know from research and practice evidence that managers and staff value input from occupational therapists, especially in terms of ensuring prompt access to equipment.

Recommendation

There is no single model for how occupational therapists should be included in a reablement service – examples from a range of authorities include [9]:
- Incorporating them as core team members. Reablement care workers appear to value the close working relationships when occupational therapists are team members and particularly welcome advice and input at progress reviews.
- Occupational therapists as trainers. The input of occupational therapists is highly valued for training reablement care workers – for example, to assess for smaller pieces of equipment, thereby reducing unnecessary delays. Occupational therapists can also give essential training on assessment, goal-setting and maintaining a ‘reabling ethos’.
- Occupational therapists working collaboratively, an arrangement that may be helped by co-location of teams. In one London borough, although occupational therapists are not full team members, their close working with the reablement team is seen as critical to success. There are robust working relationships with community-based occupational therapists as well as the hospital rehabilitation teams. Joint working takes place where there are concerns about assessment or complex cases.

Those planning reablement services could adapt these models for involving other relevant professionals such as physiotherapists.

‘Telecare’ refers to systems for the remote monitoring of safety (e.g. fall detectors), lifestyle (e.g. ‘just checking’ movement sensors) and environment (flood detectors). Sensors in the home connect to monitoring centres which can elicit a response from designated friends or family members, a response team and/or the emergency services. This technology can play an important part in the reablement process. It can help inform the assessment process, manage risk and offer support during and following a period of reablement.

Recommendations

It is therefore important that telecare assessors and systems are readily accessible to reablement teams.
To help achieve a seamless connection between reablement and telecare services, the potential use of telecare should be assessed at the same time as the initial reablement assessment takes place. This can be achieved either by reablement workers being appropriately trained or by having timely access to telecare assessors.
In the same way that reablement workers need rapid access to other professionals and services (such as equipment), they should have rapid access to telecare systems. Supply arrangements should be reviewed to ensure that what is needed can be sourced at the beginning of the reablement period.
Particularly where people are assessed as needing no ongoing domiciliary support, telecare can contribute to monitoring safety, which can provide reassurance to people and their families. Post-reablement procedures should therefore be in place to ensure that telecare systems are not automatically withdrawn at the end of the reablement service.

In one local authority, telecare introduced during the period of reablement is provided at no charge to the individual. At the end of the reablement service, if there is an ongoing need for telecare, the system remains with the person and still no charge is made.

Although telecare can contribute to monitoring safety and improving people’s confidence and independence, its limits should be understood and its use should be carefully considered.

Recommendations

Telecare is no substitute for human contact and should not be relied upon to judge changes in a person’s wellbeing. If this kind of monitoring is deemed to be required after the reablement service then options such as voluntary sector befriending schemes or hobbies and interest groups should be explored. Please refer to the section on successfully ending a period of reablement.
Additional equipment and services for supporting reablement should only be introduced with the understanding, co-operation and consent of the individual. It would be unethical to introduce systems for monitoring movement and lifestyle if the individual did not understand the nature and purpose of the information being recorded.
Equipment and systems must be introduced sensitively and with careful explanation about their operation. Where an individual lives alone it may be helpful for installation to take place when a family member or friend can be available so they also develop an understanding of how to operate the system.