Adrian Scaife from Tunstall Advisory Service (TAS) introduces ‘Reablement Lite’ – now with added prevention.
According to the Adult Social Care Outcome Framework just 3% of all older people discharged from hospital benefit from a reablement service out of a total of 1.34 million older people discharged in the three month sample period.
The question arises what support was needed or provided to 97% of people who didn’t receive this service?
Let’s consider what reablement is and what it provides:
- Reablement is a short and intensive service, usually delivered in the home, which is offered to people with disabilities and those who are frail or recovering from an illness or injury.
- The purpose of reablement is to help people who have experienced deterioration in their health and/or have increased support needs to relearn the skills required to keep them safe and independent at home.
- People using reablement experience greater improvements in physical functioning and improved quality of life compared with using standard home care.
- Reablement is usually free for the first six weeks
Plus there are associated economic benefits too.
A 2007 study for the Department of Health’s care services efficiency delivery network found that up to 68% of people no longer needed a home care package after a period of reablement, and up to 48% continued not to need home care two years later.
From the Better Care Fund metrics description a slightly broader view:
The rationale is that improving the effectiveness of these services is a good measure of delaying dependency, and the inclusion of this measure supports health and social care services work together to reduce avoidable admissions.
This is an important point as reablement is not ‘just’ about maximising independent living skills but also ensuring a preventative approach to reduce the probability of further hospital admissions and delaying demand.
The PSSRU Unit Costs survey 2013 estimated the average cost of a reablement service to be £2,046 per service user.
Many will argue, quite reasonably, that while reablement may be provided free to the user it is not a low cost service to provide and that expanding the usage during difficult tough times is not economically feasible.
Is there a case for a lower cost solution that could be used in larger volumes that sits somewhere between reablement and nothing that would:
- Help people re-establish themselves at home
- Support people to feel safe
- Provide the confidence that they are capable of remaining living independently
- Reassure family and friends that they are safe and if there is a problem someone will be alerted quickly?
I suggest it should be called Reablement Lite.
Perhaps surprisingly, the Royal College of Physicians has already indirectly answered the question:
We recommend that local services consider introducing a scheme for all fallers to be offered a free care alarm for a trial period on discharge from hospital. This scheme is already available in some localities.
This alone would support about 200,000 people a year in England.
A free telecare service, to support people transition from hospital to living independently, for a 6 week period would make a massive difference. For those who wanted to extend the service beyond the free period, they or their families may choose to subscribe for longer, effectively, self-funded their own prevention service. Evidence is very positive (e.g. Dudley and Surrey).