From traditional home care to reablement
For the past twelve years, Zowi has been employed by the local council as a care worker.
For the first 10 of these she was ‘doing things for’ service users, including making tea and helping them wash.
Two years ago her employer introduced the reablement service, which involves a change in the way Zowi provides care in that now, she is expected to ‘do things with’ service users with the objective of promoting independent living. She reflects on the change and explains:
“This has brought me job satisfaction as I can see how my input is enabling the service user to live an independent life. I am more involved in planning as I am now consulted by other professionals about how things should be done. Before, in domiciliary care, I was hardly consulted. I also go for regular training to increase my knowledge on how to deliver care that promotes independent living.”
A lot has been written about impact of reablement services on services users and its impact in saving costs (Rabiee P, Glendinning, 2010). Although there has been some acknowledgment on the benefit of reablement on informal carers (Manthorpe, 2011) very little is known about the impact of reablement on the people actually employed to deliver the service, like Zowi (see case study, right).
This paper, informed by qualitative research conducted with local authority reablement care workers in the North of England, discusses the impact of reablement on care workers like Zowi. These council-employed care workers are at the forefront of implementing government policies that promote an ethos of enabling adults with disabilities or various health conditions to live personalised and independent lives (Department of Health, 2010). Zowi’s employer in the North of England, like most local authorities with adult social care responsibilities across the country, has been developing home-based reablement services in the past few years.
Reablement is an approach, philosophy and a process that enables service users, after an acute clinical episode, to learn and adapt so they live independent lives. The ultimate goal is to restore the service users’ personal autonomy and independence. The service is offered after initial assessment as a short-term intervention, for a maximum of six weeks, which is free of charge and seeks to maximise independent living skills by offering, initially, services such as personal care, mobility and other practical tasks (Glendinning and Newbronner, 2008)
From ‘doing for’ to ‘doing with’
During focus group discussions, care workers in this study captured essences of these policy drives and defined reablement as:
“Getting [service users] quickly back on their feet”
“Supporting them but not doing for them”
Talking about reablement opened up discussions that enabled care workers to reflect on their past and current roles. Reablement had enabled them to build service users’ confidence while taking some risks:
“We try and promote confidence and their skills back to what they were able to do before they went into hospital say with a fall…this is completely different from the past where we did things for them.”
Enabling service users to build up their confidence and skills of daily living, such as personal care, was, at first, challenging as they had been used to doing things for the service user. However, the on-going training provided by the council, shadowing an experienced reablement worker and peer support had given the care staff the confidence to impart confidence to those they were supporting.
Improved job satisfaction
As noted in the case study, care workers like Zowi reported that, compared to their previous roles as part of the domiciliary care team, reablement had improved their job satisfaction and sense of achievement as they witnessed service users gain confidence and achieve goals set in the care plans. This contrasted sharply with traditional domiciliary care, where the client had limited rehabilitative goals.
The traditional domiciliary care service Zowi came from involved the delivery of prescribed care based upon a care plan set by senior staff, where staff like Zowi were never involved in care planning. However, under reablement, staff said they had a greater sense of being an integral part of a team and were consulted on matters relating to the service user’s support.
This change was enhanced by working with occupational therapists and physiotherapists, who brought with them the ‘science’ of rehabilitation and restorative abilities. They focused upon improving and extending Zowi’s abilities and sense that she and the service users were partners in working towards maximising their independence.
Role model for families
Increasing Zowi’s knowledge enabled her to have the confidence to make suggestions about use of equipment for service users and to become a ‘role model’, providing support to families and other informal carers, for example by advising on lifting techniques and families’ expectations of their relatives.
Although it is acknowledged that the evaluation study did not attempt to measure the economic impact, it could be argued that the training of care workers like Zowi added ‘value for money’ by creating a more knowledgeable and experienced workforce. As staff witnessed the service users they had worked alongside gain confidence and independence, they also voiced that they felt a greater level of ‘job satisfaction’, which in turn increased their motivation.
It has long been agreed that if staff feel motivated then they are less likely to have numerous episodes of sickness. The major impact of this reablement service is the positive health outcomes for service users and the increased knowledge base of the carers.Martha Chinouya is senior lecturer and Margaret Cook research associate at Northumbria University’s faculty of health, community and education studies
Department of Health (2010) A vision for adult social care: capable communities and active citizens
Manthorpe J (2011) Long-term impact of home care reablement, Community Care
Glendinning C, Newbronner E (2008), The effectiveness of home care reablement – developing the evidence base, Journal of Integrated Care