What is Reablement?

Reablement has been an active approach in healthcare for over a decade, with its continuation being accredited to its positive outcomes. It has become an efficient and cheaper way of providing care, as it has reduced the need for many people to enter into long-term care plans. Studies suggest that the benefits of reablement have thus lessened the need for long-term care by 60%.

What is reablement?

The term ‘reablement’, sometimes also called ‘immediate care’, refers to the process of re-learning daily skills for an independent lifestyle. This includes short-term interventions and methods implemented at home for those who are mentally or physically ill, in order to help them function with their injury.

This may be offered to people who have a temporary illness, and is typically always offered to people who have been involved in serious accidents. Reablement is not a cure or solution, but is instead centred around giving the affected individual an increased level of independence and autonomy over their own lives. Many people who receive reablement have suffered from a sudden impact on their physical functionality, rather than a long-term condition.

Reablement typically involves a group of care workers, including occupational therapists, physiotherapists, and speech and language therapists, who come together in the individual’s home setting to provide different approaches and support. The reablement services available for different individuals vary, depending on their condition. They are offered at the appropriate level needed to increase independence, so that individuals do not become dependent upon the support given to them.

The term ‘rehabilitation’ is used in place of reablement, both referring to ways to increase an individual’s independence within their home/usual environment. Local care providers have an obligation to provide services to all individuals to lessen their need to depend upon others to provide care for them. Reablement doesn’t necessarily denote that other methods of care will be removed, as many individuals still require care workers to provide consistent support.

Essentially, it aims to keep the individual from readmission to consistent medical care settings, since there have been financial cuts to this sector. Keeping an individual in hospital for a prolonged period of time can lead to a reliance upon medical staff, and reinforce ideas within themselves that they cannot function independently. In this sense, reablement is different to post-operative care, which is a broad offering in the discharge plan for people who have had an operation.

When is reablement arranged?

Reablement services are usually offered after an accident, injury or whilst an individual is recovering from an illness, when the individual is due to return to their home. It is also arranged for people who usually require home care but are changing their home location.

It is a short-term service that recognises that whilst the individual has left a medical setting, they may still be in need of support to adjust to the effects of their illness or injury.

The conversation around reablement will begin whilst the individual is still in a medical setting, if they were in one, and is handled by the ward’s discharge coordinator, or by social services or GPs. Reablement is also arranged for elderly individuals who naturally may begin to find difficulty in carrying out their day-to-day tasks, or have difficulties due to illnesses.

How long does reablement take?

Most programmes of reablement last anywhere between two to six weeks, depending on the level of illness or injury. The assessor works with the patient, their family and carers to identify the goals and outcomes of the reablement programme, and if these outcomes are met, the process can be terminated sooner than six weeks.

The NHS only provides a maximum of six funded weeks of reablement, after which, adult social services and private services are responsible for providing other care options. Most individuals find that six weeks is enough to have increased independence in their living and ability to look after themselves. Whether or not an individual needs a longer programme of care is assessed at the beginning of the reablement.

It is important to note that the six funded weeks of reablement are allocated for a singular incident/reablement period. There is no indicated limit to the number of times one can be issued with a reablement plan. However, the healthcare providers may take into account any previous reablement programme that the patient has undertaken, which could affect the offer of care that can be provided.

What is involved in reablement?

Reablement care involves different elements of rehabilitation and re-training, depending on the severity of their limitations. Some teams of staff need to only attend to the individual once a day, or a few times per week, whereas some individuals will need to be visited multiple times each day.

Initially, carers may undertake tasks that cannot be done in the initial stages of being back in a home environment, such as doing the laundry, helping them bathe and use the toilet, cooking meals, administering medication or helping them get dressed.

An assessment which is done during the discharge process determines what level of care is needed, and at what frequency. Reablement may also include physiotherapy to help improve the patient’s functionality.

All staff involved in the reablement programme have the same duty of care to the patient as they would have in any other setting. You can read about the importance of duty of care by visiting our knowledge base.

The process will usually be undertaken in five stages:

1. The patient will be assessed by a medical professional to decide how they will benefit from reablement, factoring in the patient’s level of mobility and their stamina to undertake daily living tasks.

2. The staff will then begin their visits. Initially these visits will be more frequent and hands-on, but over the course of the reablement period, the level of support offered in the programmes is gradually reduced, as the patient’s independence returns. They will only get involved if they think it is necessary.

3. The reablement staff will continue to assess the patient’s level of independence to understand their needs and when the programme of care may terminate. Staff will keep records of these assessments and ensure that their communication of the patient’s progress, and their next steps, are communicated effectively. You can read more about effective communication in health and social care by visiting our knowledge base.

4. Before the end of the programme, reablement staff will make suggestions for any physical adjustments that may need to be made within the home, so that they can continue to function independently. Many people find such adjustments essential to being able to live in their homes. This may include things such as handlebars, ramps, higher-level seating, adjusted toilet seating, bed levers, accessible shower cubicles, stairlifts etc.

5. Before the reablement programme is complete, there will be a plan detailing what will happen after the process, which will be adapted on a regular basis. The plan will include interactions with healthcare providers, family members and anyone else involved in caregiving.

The reablement team will keep a record of visits, reviews and issues. This is important as the team is often made up of different care workers, who will access the records to understand the full picture of the patient’s progress after each visit. A reablement plan highlights what the individual is capable of, rather than what they cannot do, and aims to bolster their feelings of confidence.

Many carers who tend to the individual within their home setting aim to get to a point where they are able to remain relatively passive in the tasks that the individual completes, essentially pushing them to rely upon their own capabilities.

This too relieves family members and carers from tasks which consume much of the time that they could use to benefit the patient in another way. In extreme cases, some care staff will live in the individual’s home initially, until they have managed to regain some of the skills needed to be left alone for longer periods of time.

What are the benefits of reablement?

Reablement is largely beneficial for the patient, their family and carers. It aids in the more rapid improvement of their abilities independently. It helps to reduce early admission to care homes, allowing patients to work towards functionality in their own homes.

For families, this increased independence allows for them to expend less time caring for them, and instead nurturing their relationship with the patient. For the patient, the sense of confidence and accomplishment it instils can be life-changing.

Patients report feeling more like themselves in their new-found autonomy, by consistently reviewing what they can do, rather than what they can’t, taking the attention away from the injury or illness. Whilst elements of physiotherapy are involved, reablement focuses on the skills needed to function independently, rather than improving their medical condition.

A live-in carer can be beneficial in the initial stages of the programme, as it can make the transition from round-the-clock care to independence less daunting.

Reablement is also a rewarding occupation. Staff feel as though their actions have really changed the lives of those they have helped, and feel value and pride in what they do.

Who is reablement care for?

Reablement is available for anyone who meets the criteria, which are determined by the local authority. It should always be offered to any patient who might need caring for at home. It would not, however, be offered to patients with long-term medical illnesses and conditions that would not improve from a reablement programme.

For example, people who have a terminal illness would not likely be put forward for reablement as it would not be likely to be beneficial for them. Reablement is most beneficial for those who will improve after leaving a hospital setting.

Reablement services vary from region to region in England. In some areas, reablement is only offered to those who are leaving hospital, and in other areas, you can only be offered reablement through your General Practitioner.

People who are eligible for reablement care are usually:

• Patients who need care throughout the night.
• Patients who need support to re-learn basic actions and skills.
• Patients who are on medication which leaves them drowsy and disorientated.
• Patients who are disorientated generally following their injury or illness and cannot be left by themselves.
• Patients who are extremely physically weak and are at risk of readmission to hospital.

This means that reablement is unlikely to be offered to those with illnesses such as dementia and other degenerative diseases. Whilst the symptoms of such illnesses are life-changing, there is question around how effective reablement would be, and how much the patient and their family would benefit from the programme.

What happens after reablement care?

Almost 70% of patients do not need further reablement services after six weeks of home care, showing how effective it is if it is implemented immediately. However, this statistic highlights that for many patients, six weeks of reablement doesn’t achieve the goals outlined at the outset.

Whilst injuries themselves may heal within that time, the physical fallout can last much longer. Many people do not fully recover from an injury or illness for months, and even years. This can lead to a need for further support, which would often not be paid for by the local authorities.

The Department of Health states that if you have savings and assets above a certain value, which is region dependent, then you must fully fund your own care package. If you have savings and assets lower than the regional threshold, you must still make contributions to your care package, but could be entitled to some support. More information about Local Authority Adult Social Care services can be found by using the search tool on the NHS website.

There are agencies that assist with providing information about care services after the reablement period:

• Hometouch is an organisation dedicated to providing a range of different types of care, and information about how to select the right type of care plan for you or a loved one. They also detail funding options in their care guide.
• Age UK provides information surrounding funding for care after the free reablement period, including what you can expect to pay based on your income.
• NICE offers a guide to understanding the stages of reablement and the team who will likely be involved in the care plan.