Re-ablement the new theme in home care: Special report

Government advisers claim to have found a care system that saves money and reduces dependence. Mithran Samuel reports

Local authorities face two conflicting imperatives in adult social care.

Rising demand and financial limits are forcing up eligibility criteria. However, last year’s health and social care white paper said services should prevent people from needing intensive services.

The Department of Health’s Care Services Efficiency Delivery (CSED) team, which is charged with promoting efficiency savings in adult care, claims to have found a solution in home care re-ablement, and has won council backing.

Re-ablement involves helping people in poor physical or mental health relearn the skills of daily living – such as washing or eating – through intensive, time-limited support at home, designed to prevent, delay or reduce their need for ongoing care.

CSED held a workshop on the issue in late January, where it launched a discussion document detailing 18 existing case studies. Representatives from 100 of the 150 councils attended, and a questionnaire found 50 councils were planning to implement or enhance such a scheme in the next year, with a further 25 saying they would do so in the following year.

Salford Council has transformed its in-house provision into a re-ablement service under director, Anne Williams (pictured), who is incoming president of the Association of Directors of Adult Social Services.

Williams says home care usually involves merely carrying out tasks for people, rather than helping them relearn skills. Because of this, switching to re-ablement has involved retraining and cultural change.

She says: “It has very good feedback from users who feel it’s all focused on getting them back on their feet.”

But Williams adds: “There are areas where efficiencies alone won’t deal with the demographic and cost pressures”.

Gerald Pilkington, CSED lead on re-ablement, admits there is no proof of re-ablement’s long-term ability to keep people independent.

He adds: “Part of the work we are doing now is trying to support councils to solidify the evidence.” 

Q & A

Who provides it?
Mostly in-house council teams, often including occupational therapists or carers trained in new skills.

How does it work?
Targets are set for users to relearn activities. After a short period, the service assesses how many have been met, and whether there is scope to achieve more. If not, users may be given a care package.

Can councils find the money?
Some authorities have outsourced all ongoing home care, releasing money for in-house re-ablement services.

What evidence is there so far?
A Leicestershire Council study found 58 per cent of those who had gone through re-ablement did not subsequently need ongoing care, compared to 5 per cent who had not.

Case study

Westminster’s re-ablement service is run by Housing 21 Care Options, an external provider. Most referrals are for people who have just left hospital. Operations manager James Sparks says few leave the service without needing a care package, but in most cases packages are less intensive than they would have been. He says people tend to be re-abled for a maximum of two weeks, after which they are referred for ongoing care. Despite the emphasis on efficiency, he says the team, unlike many conventional home care services, are not restricted to providing short appointments and can offer longer periods of care, helping build users’ trust in services.

Further information
Care Services Efficiency Delivery

Contact the author
  Mithran Samuel

This article appeared in the 8 March issue under the headline “Re-ablement bandwagon rolls”