Prevention: Commissioning home care for older people

The aim of home care should be to keep people healthy at home for as long as it is in their best interests. Good reablement services – which work with the person to be as independent as possible by helping them to learn or relearn skills that they need for everyday life – can prevent older people from being admitted for acute hospital, nursing home or residential care. If admission is necessary, they can help the person to be discharged as early as possible.

Services should focus on the right outcomes for the person based on the achievement of goals that are related to rehabilitation and independence. This would mean paying by results rather than per task. At the moment, reablement provision is often limited to a six-week time period, based solely on funding rather than a person’s potential to recover their capacity to live independently. Services should also think about how reablement is being supported.

Reablement provision can also be haphazard, in that it can be up to the older person or their unpaid carer knowing what is available and how to obtain it. [4]

When reablement is done well, there can be substantial efficiency savings for local authorities or health and social care trusts – along with increased skills, confidence and independence for the person using the service. But it needs careful planning and integrated working, especially around the time of hospital discharge, to prevent inappropriate readmission. [4]

See practice example 2 how reablement can be facilitated by training existing staff.