Reablement: a guide for carers and families
Published: June 2020
People using reablement services experience greater improvements in physical functioning and improved quality of life compared with using standard home care. This briefing looks at how reablement can help with independence, safety and wellbeing, as well as who can access reablement services and what can be expected.
This briefing is for carers and families; it explains what reablement is and what you can do to help. Others may also find this briefing useful, including those receiving reablement services, care and support workers, therapists, people managing reablement teams and commissioners of health and adult social care.
What is reablement?
There is a tendency for the terms ‘reablement’, ‘rehabilitation’ and ‘intermediate care’ to be used interchangeably. The National Audit of Intermediate Care defines reablement as ‘services that help people live independently, provided in the person’s own home by a team of mainly social care professionals.’
Section 2 of the Care Act (2014) places a duty on local authorities to prevent, reduce or delay needs for care and support for all adults including carers. Reablement is one of the ways they can fulfil this duty. This means early intervention to help people retain or regain their skills and confidence.
Key features of the reablement approach
- A person-centred, strengths-based approach that promotes and maximises independence and wellbeing.
- Rebuilds confidence after a spell of illness, deterioration in health, an injury, a hospital admission or an acquired disability.
- Different to traditional home care as it involves care providers standing back and encouraging the promotion of self-care skills that may have been lost.
- Supports people to regain or retain skills to enable them to manage with minimal or no support.
- Short-term and intensive; typically provided for up to six weeks.
- Not means-tested ¬– the service is free to people who meet the locally defined eligibility criteria.
- A focus on restoring independent functioning, rather than resolving healthcare issues.
- Aims to prevent re-admission to hospital or premature move to a care home.
- Usually provided in a person’s own home, but may be provided in an intermediate care facility.
- About setting and working toward meaningful goals.
- Aims to reconnect people with their communities to reduce social isolation.
- Can help to reduce the amount of care the person needs from carers and family.
Reablement is an approach that, irrespective of diagnosis, aims to assist people to continue to live as they wish. It seeks to enable the individual to perform ordinary activities like cooking meals, washing, dressing and getting about the home and community.
Reablement may be used to support timely discharge from hospital or enable an individual to remain living at home. It is typically provided for up to six weeks, but may be extended slightly if cutting the service off at that point is likely to reverse or limit the progress made.
Research has shown that people who have received a reablement service view it positively and see the benefit of improvement in their confidence, functional ability, mobility, independence and wellbeing. It has also been found that even for people who were previously receiving traditional home care services, reablement approaches brought about improvements in independence, which in turn prolonged their ability to live at home and reduce the amount of traditional care subsequently required. This supports the view that everyone should be considered for reablement as part of the review or re-assessment process.
Who is reablement for?
- If the person is being considered for home care, reablement should be offered as a first option if it has the potential to improve independence and wellbeing.
- If the person already receives home care, reablement should be considered as part of the review or re-assessment process.
Local authorities run reablement services, so eligibility can vary depending on where you live. They tend to be targeted at those most likely to benefit. It is a flexible approach that can be used with a variety of different people including those with physical disabilities, dementia and learning disabilities. There may be a reluctance in some areas to offer reablement services to people with certain conditions, such as dementia or terminal illness, but the decision on whether to offer the service should be based on an individual’s needs rather than medical diagnosis or condition.
Conventional homecare still has its place when reablement is inappropriate or following a period of reablement. If traditional services are still required, they must follow the same ethos. This means enabling the person to do as much as they can for themselves and not doing it for them because it is quicker or easier. Doing things for people when they are able to do it for themselves – albeit in a different way or more slowly – can undermine independence and wellbeing. This could make the person more dependent, both physically and emotionally, on others.
How to find out more about reablement services in your area
- Call or email your local authority social care services to ask for information. Find your local adult social care services department.
- 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 contact the social work team.
- Organisations such as Age UK may be able to offer advice and support in your local area.
How can I refer someone for reablement services?
In some areas, only people who are about to be discharged from hospital are referred to reablement services. In other areas people can be referred by community health or adult social care teams, or their GP. There is also a variation between local authorities in that some only provide reablement services to people who meet the Care Act eligibility criteria.
Many reablement services are provided by local authorities; however, in some cases, they are provided in partnership with the local clinical commissioning group (health service). The arrangements for service provision, and therefore how they are accessed, vary from area to area.
Making reablement work for you
Family members Open
Some top tips include:
- Talk and plan as a family with the person at the centre.
- Use the process as an opportunity to discuss the pressures of caring and being cared for.
- Ensure everyone can agree on the plans.
- Try to resolve any disagreements about what is needed with a focus on maximising the person’s independence.
- Resist the temptation to help – step back and give the person the time, encouragement and space to practice doing things for themselves.
Assessors and support staff may show you new approaches to provide support to the person you care for. You can continue to use these when support workers are not there or when the reablement period finishes; it will help the person you care for to maintain their skills and independence. Just as reablement support workers are taught to stand back, you will be encouraged to do the same, resisting your natural response to intervene. This does not mean that we stand back and watch people struggle; as we have said, goals must be agreed and achievable, and your role will be to support and encourage. You can remind the person how much they will enjoy regaining certain skills, such as being able to get upstairs to their bedroom, cooking their favourite meal or going out to their favourite place.
Professionals should be clear with you about the nature and length of support on offer. This helps you to support the individual with understanding what reablement will entail and how long it will continue for. It also helps to ensure that neither the individual nor yourselves feel abandoned when the service is withdrawn.
Rights for carers Open
It is important that carers take care of themselves. As part of the reablement assessment and planning, you should be asked what care you provide, whether you are happy to continue, and to what extent.
- You are entitled to a carer’s assessment under the Care Act 2014, carried out by local authority of the person you care for, to determine what support you need to sustain your caring role. Carers UK have an assessment factsheet.
- Reablement can reduce the need for support and care from carers and family, help you balance caring, paid work and other responsibilities and reduce any strain on relationships.
- Carers in paid work have statutory rights to help balance paid work and caring responsibilities. These rights are explained in a Carers UK Fact Sheet.
- Carers UK and Carers Trust offer useful information, advice and services for carers.
What does reablement involve?
The role of reablement support workers
Reablement is an intensive service provided by reablement support workers who have received additional training; they may also be assisted by occupational therapists or physiotherapists who will give expert advice and support.
It uses a ‘doing with’ approach, which involves supporting people to do things for themselves. This may involve the person being shown a different way to carry out the task to achieve independence, such as putting the weaker arm with the least amount of movement into the sleeve of a top first. The worker may also support the individual to reconnect to their local community by providing information, as well as by promoting confidence in outdoor mobility and the use of public transport.
Allowing people to do things for themselves initially takes more time, so reablement support workers are likely to visit more frequently and stay for longer than a conventional home care worker. Consistency of workers is important to enable a relationship to be built with the person and for progress to be properly monitored. Throughout the process, reablement support workers stand back, observe, encourage and prompt the individual to learn or re-learn skills they may have lost. At times, this approach is difficult for those struggling to complete a task as well as for those observing. If the carer or support worker intervenes because of their own feelings, or to save time, it can ultimately be a setback for the individual. Positive encouragement is more helpful in the long term.
Assessment and goal setting
When a person is referred to a reablement service, a reablement assessor, an occupational therapist or social worker will visit them to assess their abilities and needs in relation to the goals the person identifies. The person’s views should be central and the process and carers and family should be included as appropriate. The process should seek to identify strengths and overcome barriers that could be:
- physical – relating to illness or disability
- environmental – relating to the layout of the home
- psychological – relating to fear or confidence.
Equipment, adaptations or mobility aids may also be recommended to support reablement, such as:
- positioning a grab rail beside the toilet to enable the person to use the toilet without assistance
- a seat across the bath if someone has difficulty stepping in and out of it
- a perching stool to prepare food in the kitchen and a trolley to move the meal to where it will be eaten
- using a stick or walker outdoors to promote physical stability and confidence
- use of a commode
- learning to use a microwave instead of an oven.
For each task, the goal is for the individual to achieve it independently or with minimal assistance. The occupational therapist may become involved in the assessment for adaptations and mobility aids; however, in some areas, reablement support workers have been trained as trusted assessors and can assess for and supply simple equipment.
A plan will be agreed that outlines the person’s support needs over the next few days or weeks. The focus is on regaining skills and, if necessary, learning different ways of doing daily tasks. Goals are likely to relate to:
- personal care tasks such as washing, dressing and going to the toilet
- domestic skills such as food and drink preparation, cleaning, shopping, and doing laundry
- using transport, and accessing the community
- mobility – moving safely and confidently around the home or outdoors, climbing stairs, getting up from a chair, getting in and out of bed and getting on and off the toilet
- maximising opportunities to socialise, to start or resume hobbies.
It is important that you, as a carer or family member identified by the individual, are part of the goal setting process to enable you to fully engage and support the achievement of goals. The goals will be recorded in the support plan, which is usually kept in the person’s home so that all concerned can see the achievements and help identify new goals as progress is made.
There will be a focus on regular assessment and review during reablement. Support workers and assessors will want to work with you and the person you care for to record progress, identify further goals and plan ongoing support. If all goals have been achieved, reablement doesn’t need to continue for the full six weeks (or the full-time period allowed locally). The reablement support worker will be the main contact between the individual, carers and family and the reablement assessor, social worker or occupational therapist.
Planning for the service to end
Early in the reablement process, the assessor will determine whether an ongoing package of care may be required. If they think it will, they will make a referral to Adult Social Care Services, who will start assessing and working with the individual, their carers, family and the reablement support workers to determine what ongoing care and support may be required when reablement ends.
As a carer or family member, you should be invited to take part in 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 needs, or your ability to continue in your caring role.
You can also make sure that any equipment or minor adaptations to the property have been put in place prior to the end of the reablement period. Sometimes larger adaptations such as a ramp may take longer to be installed.
If there is any equipment which is no longer required, this should be returned to the local equipment service following the instruction given when it was issued. Unused equipment can get in the way and cause a hazard.
Preventing loneliness and social isolation
When reablement works well, the person who has received the service will be able to do things for themselves again and their reablement support worker visits will be reduced and then stopped. For some people, particularly those who do not have many visitors or social activities, this may lead to feelings of loneliness and isolation.
Older people, in particular, may experience feelings of loss and isolation due to the death of a spouse or of lifelong friends. Other feelings of loss may relate to limited mobility and not being able to get out or do things they used to do.
Being an active member of society is an important part of promoting wellbeing. 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 the goal setting and the support plan, providing you with information regarding 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 person may not be safe at home, particularly when the service starts to reduce or comes to an end completely.
If you are worried about this during the reablement period, you should speak to the reablement support workers, occupational therapist or social worker. For any particular risks, such as falls, the professional should carry out a risk assessment.
You can also talk to the person you care for, the reablement support worker or other professionals about the availability and suitability of telecare such as monitors and personal alarms, which can be used to help keep people safe and independent at home.
Support from SCIE
SCIE is a leading provider of reablement resources and support. We offer training and consultancy to support the review and embedding of a reablement approach in local care and support systems.
Work with us to explore the potential of reablement as a genuinely preventative form of care.
Our consultancy support can be tailored to local needs, budgets and timescales. Get in touch to find out more.
Further information and resources include: