Reablement: a guide for frontline staff. Supported by

Transcription

1 Reablement: a guide fr frntline staff Supprted by

2 What is this learning guide? Wh is this guide fr? What is cvered in this guide? What is this learning guide? This guide gives an intrductin t reablement. Over the past decade, there have been increasing numbers f reablement services develped by lcal authrities, ften in partnership with the NHS. Mre and mre evidence is shwing that reablement can lead t majr imprvements in the well-being and independence f vulnerable peple. Hwever, nt all areas yet have reablement services, and reablement services are ffered t different grups f peple, and wrk in different ways, in different parts f the cuntry. Many peple including staff, ptential service users, and the general public are still cnfused abut what the term reablement actually means. This guide explains what reablement is all abut, what is different abut reablement, wh prvides and funds these services, and the kinds f peple wh use reablement services, and wh wrk in them. This guide was cmmissined by the Nrth East reginal Imprvement and Efficiency Partnership (NE IEP), as part f its Excellence in Reablement prject. The NE IEP has been wrking with the 12 lcal authrity areas f the Nrth East f England t supprt them as they develp and extend their reablement services. It was funded by the Department f Health s Care Services Efficiency Delivery prgramme (CSED) and develped by the Office fr Public Management (OPM). The Reablement fr All lg was develped fr a reginal cnference in December 2009, as part f the Excellence in Reablement prject. The lg reflects the cmmitment f lcal authrities and the NHS in the Nrth East t make reablement services available, nt nly t lder peple, but t all wh culd benefit. The guide can be read n-screen, r its pages can be printed if yu prefer a hard cpy. On-screen, underlined text indicates a hyperlink that will take yu either t anther part f this guide r t an external website. September 2010 Images used in this guide are the cpyright f: Yuri Arcurs and Lisa F Yung / Dreamstime.cm Steve Debenprt, Brad Killer, Lrelyn Medina, Gary Radler and Studi van Caspel / istckpht.cm 2

3 Wh is this learning guide fr? The guide has been prduced fr frntline staff in scial care and health in the Nrth East f England. It is designed t help staff wrking with peple wh may get supprt thrugh reablement, nw r in the future. S yu may find this guide especially helpful if yu wrk with: lder peple; peple with a physical r sensry disability; peple with a learning disability; peple with dementia; peple being discharged frm hspital; peple at risk f needing t g int a hspital r care hme; r peple living in sheltered husing, extra care r a care hme. Hwever, we hpe it will be useful t anyne wh wants t find ut mre abut reablement. What is cvered in this learning guide? The learning guide is split int this intrductin and seven ther sectins, and cvers: an explanatin f what reablement is, wh reablement is fr, and wh prvides it, and the plicy cntext the different kinds f reablement service the benefits f reablement t users and clients, t staff, and t lcal authrities and the NHS what it is like t wrk in reablement what it is like t g thrugh reablement examples f access, referral, assessment and reassessment prcesses, reablement supprt plans, the kinds f infrmatin reablement services shuld cllect, reablement services in the Nrth East, and reablement services in ther parts f England where yu can find ut mre abut reablement. 3

4 Intrductin The definitin and eths f reablement Hw is reablement different frm ther services? Wh is reablement fr? Plicy cntext and links with persnalisatin What is reablement? Intrductin We must place renewed emphasis n keeping peple as independent as pssible, fr as lng as they feel able, nt least by prviding earlier supprt. Peple need t feel help is there as sn as prblems ccur... We have t maximise the ptential f reablement, telecare and ther innvatins which can dramatically imprve peple s lives while als being highly efficient. Sme lcal authrities have picked up this challenge, thers have nt. We need t accelerate this change s that these services and this apprach is the nrm. Rt Hn Andrew Lansley MP, Secretary f State fr Health, speech n The Principles f Scial Care Refrm, July 2010 Supprt fr reablement was given strng backing by the previus gvernment and has cntinued t be a plicy pririty under the Calitin gvernment. Reablement services have been set up by lcal authrities in many parts f the cuntry. The Care Services Efficiency Delivery prgramme (CSED) estimates that by March 2010 ver 80 per cent f English lcal authrities had sme frm f reablement service, with the remainder all in the prcess f develping a service. Althugh led by adult scial services, they are ften develped in partnership with the NHS, and smetimes ther rganisatins including charities and the independent sectr. diagnsed with dementia). Reablement supprt can take place in a variety f places, and be delivered by staff frm a range f prfessinal backgrunds. Despite these differences, what all reablement services have in cmmn is a shared eths, f wrking practively with their users ver a defined perid f time, t achieve gals set by the user and reablement team tgether, and with the verall aim f maximising the user s independence, chice and quality f life, and reducing their need fr supprt in future. Sme reablement services have develped ut f traditinal hme care (dmiciliary care) services, whilst thers have evlved frm hspital discharge r intermediate care schemes. Sme wrk with a very wide range f peple (fr example, everyne wh has been referred t the lcal authrity fr supprt frm adult scial services), whereas thers fcus n a very specific client grup (fr example, lder peple being discharged frm a particular hspital, r peple 4

5 The definitin and eths f reablement There is n single, straightfrward definitin f reablement. Reablement has been described and defined in many different ways. Fr example: Reablement can be described as an apprach r a philsphy within hme care services ne which aims t help peple d things fr themselves, rather than having things dne fr them. (Care Services Efficiency Delivery prgramme (CSED), Hmecare Reablement, Prspective Lngitudinal Study, Interim Reprt 1 f 2, CSED, Department f Health, Oct 2009) Services fr peple with pr physical r mental health t help them accmmdate their illness by learning r relearning the skills necessary fr daily living. (Care Services Efficiency Delivery prgamme (CSED), Department f Health) The essence f reablement is t wrk with individuals wh have supprt needs t rebuild their cnfidence, supprt the develpment f daily living skills and prmte cmmunity access and integratin. (Reablement fr All Best Practice Framewrk, reprt by the Scial Wrk C-perative fr the Nrth East reginal Imprvement and Efficiency Partnership, 2010) The active prcess f regaining skills, cnfidence and independence. This may be required fllwing an acute medical episde r t reverse r halt a gradual decline in functining in the cmmunity. It is intended t be a shrt-term intensive input. (Newprt Lcal Health Bard, Wales) Even thugh there is n single definitin, there are several essential elements that are defining features any reablement service. Reablement is abut helping peple t d things fr themselves, rather than ding things t r ding things fr peple. Reablement is time-limited; the maximum time that the user can receive reablement supprt is decided at the start. In mst reablement services, this is fr six r eight weeks. Reablement is utcme-fcused: the verall gal is t help peple back int their wn hme r cmmunity. Reablement invlves setting and wrking twards specific gals agreed between the service user and the reablement team. Reablement is a very persnalised apprach the kinds f supprt given are tailred t the individual user s specific gals and needs. Reablement ften invlves prviding intensive supprt t peple. Reablement treats assessment as smething that is dynamic nt static. This apprach means that yu cannt decide a user s care r supprt package n the basis f a single, ne-ff assessment, instead yu need t bserve the user ver a defined perid f time, during which their needs and abilities may well change, with a reassessment at the end f the perid f reablement. Reablement appraches assume that smething shuld change by the end f the reablement interventin; yu are wrking twards psitive change. Reablement builds n what peple currently can d, and supprts them t regain skills t increase their cnfidence and independence. Reablement may als invlve ensuring peple are prvided with apprpriate equipment and/r assistive technlgy, and understand hw t use it. Reablement aims t maximise users lng-term independence, chice and quality f life. Reablement aims t reduce r minimise the need fr nging supprt after the perid f reablement. 5

6 Examples f reablement supprt The kinds f supprt given thrugh reablement services are typically mre varied than traditinal hme care supprt, and are tailred t the individual user s needs, gals and preferences. They can include: persnal care, fr example help with washing and dressing practical supprt, fr example help with preparing meals dmestic supprt, fr example help with making beds, washing dishes prmpting fr medicatin (reminding peple t take medicatin; checking that they ve taken it) assessing risk and ensuring a safe hme envirnment, fr example in relatin t layut r equipment btaining equipment fr users, such as grab rails, walkers, trlleys teaching peple exercises t help regain mbility, strength and cnfidence, and supprting and encuraging them t practise the exercises taking peple ut fr a walk r t g shpping prblem-slving t supprt independence; finding practical slutins supprting users t increase scial cntact, fr example referring r infrming users abut lunch clubs, day centres, scial activities advising n reducing the risk f falls helping peple t budget and manage their mney prviding infrmatin and signpsting fr example t services such as Dial-a- Ride. Hw is reablement different frm ther services? If yu wrk in hme care r intermediate care, r in ther services prviding care and supprt t vulnerable peple, yu may think that reablement des nt sund very different frm what yu d nw. In many ways, this is true. Reablement has bth many similarities, and sme differences, cmpared with ther services such as intermediate care, hme care, preventin services, and rehabilitatin. Hwever, ne f the biggest differences is in the culture and eths f reablement services reablement services are very fcused n imprving peple s health, well-being, cnfidence and independence their whle aim is t help peple regain the ability t live as independently as pssible. Everyne invlved in reablement services needs t be supprting and mtivating users t achieve these changes, every time they wrk with them. Differences and similarities with intermediate care Intermediate care is a term cvering a variety f services that supprt patients in the transitin frm hspital t hme, r frm depending n medical care t n lnger needing such care. The aim f intermediate care is t reduce the length f hspital stays, and/r t prevent the need fr admissin t hspital r t lngterm residential care, by prviding alternative supprt fr a limited perid f time. Reablement is nt the same as intermediate care. Intermediate care patients have a defined clinical need, and intermediate care services are clinician-led. In cntrast, reablement service users have a scial care need (which may result frm a clinical need) and reablement services are nt clinician-led, and tend t adpt a scial mdel f supprt. Reablement users can include peple wh have been thrugh a perid f intermediate care. Hwever, reablement users als include thse wh have nt been in hspital, and are nt at high risk f admissin t hspital r a care hme, but wh need supprt t cntinue living independently. Many peple wh wuld nt be eligible fr intermediate care may be able t access reablement. 6

7 Intermediate care is free fr the first six weeks, whereas sme reablement services are free and thers charged fr. In sme areas, reablement services are prvided as part f the brader intermediate care service, s reablement is viewed as ne element f intermediate care. Hwever, in ther areas, the tw services are seen as separate and distinct. Differences and similarities with hme care (dmiciliary care) Many reablement services have been develped ut f traditinal hme care, and are delivered primarily by hme care staff. Hwever, reablement is much less task-based than traditinal hme care. With reablement, the aim is t help the user regain skills and abilities t maintain their independence, rather than simply t ensure that the defined task has been cmpleted t a high standard and t the user s satisfactin. Where a traditinal hme care apprach might be t wash and dress a user, prepare a meal fr them, and then assist them t eat it, in cntrast a reablement apprach might invlve prviding mral supprt, encuragement, reassurance and sme physical assistance t a frail user t wash and dress themself, t prepare their wn meal and eat it. Reablement recgnises that many users needs and abilities will change day-t-day, and f curse sme assistance will ften be necessary. Hwever, the verall aim f reablement is t help the user practise and regain skills. This different apprach means that reablement ften requires mre intensive supprt at the beginning such as mre care hurs, and input frm a greater range f prfessinals cmpared t traditinal hme care. It als means that staff will need t prvide skilled bservatins f any changes in the user s cnditin and abilities, and be able t recrd these effectively in the supprt plan. Staff need t draw n a wider range f skills than are needed in traditinal hme care, including being able t mtivate and encurage users t try things and in sme cases, t take risks. Differences and similarities with preventin services Preventin services is an umbrella term, cvering a very wide range f services aimed at supprting peple s health, well-being and independence. Preventin services include screening services (fr example screening fr breast, cervical and bwel cancer), vaccinatins and immunisatins (fr example flu vaccinatins fr lder peple, and childhd immunisatins), and the prmtin f healthy lifestyles (fr example health educatin abut exercise, nutritin, and hw t achieve and maintain a healthy weight). Preventin services d nt always require users t have a frmal referral r assessment. Reablement can be seen as ne element f preventin services, but preventin is a much brader term, and cvers a much wider range f services than just reablement. Differences and similarities with rehabilitatin CSED explains that rehabilitatin services are fr peple with pr physical r mental health, t help them get better. The Welsh Scial Services Imprvement Agency says that rehabilitatin is... the prcess f restratin f skills by a persn wh has had an illness r injury s as t regain maximum self-sufficiency and functin in a nrmal r as near nrmal manner as pssible. Fr example, rehabilitatin after a strke may help the patient walk again and speak clearly again. The wrd cmes frm the Latin rehabilitare meaning t make fit again. Reablement, in cntrast, is nt nly fr peple wh have had an illness r injury. Reablement can als be available t peple with lwer level needs, r wh have had a gradual deteriratin. Reablement fcuses as much n a persn s emtinal and scial needs as n their medical needs. 7

8 Wh is reablement fr? Reablement has the ptential t help many different peple, including lder peple, peple with physical disabilities r sensry impairments, peple with learning disabilities, peple with mental health difficulties and peple with dementia. In practice, each lcal authrity that is setting up r develping its reablement services will have t decide in cnjunctin with the NHS and thers, if apprpriate wh its reablement services will be fr. Many reablement services are targeted at specific grups, such as thse aged ver 65. Sme reablement services are specialist nes, delivered by staff with special training and expertise, wrking exclusively with peple with dementia fr example. Others are pen t all peple aged ver 18 wh live in a certain area, and culd benefit. The Reablement fr All Best Practice Framewrk fr the Nrth East 1 recmmends that authrities culd usefully assess the cverage f reablement and assciated services t ensure that all client grups have access. This des nt have t be dne thrugh ne single service; ne way t ensure all client grups have access is thrugh a cmbinatin f general and specialist reablement services. The sectin n reablement services gives mre explanatin f the different kinds f reablement service, and the different grups f users that they supprt. Plicy cntext and links with persnalisatin Reablement has strng links with ther develpments in scial care, and especially persnalisatin, persnal budgets, and Putting Peple First. The 2006 gvernment White Paper Our Health, Our Care, Our Say set ut prpsals fr large scale refrm f health and scial care services. It stressed that service users shuld have chice and cntrl ver the supprt they receive, and that scial care shuld enhance peple s independence. The paper s fur main gals were: better preventin services and earlier interventin giving peple mre chice and a luder vice tackling inequalities and imprving access t cmmunity services mre supprt fr peple with lng term needs The White Paper intrduced Individual Budgets (which have since evlved int Persnal Budgets), putting users at the centre f decisin-making abut their scial care needs and hw these can best be met. The paper als said mre resurces shuld be shifted int preventin and health prmtin, and mre services delivered away frm hspitals, and in cmmunity settings and peple s wn hmes. Anther pririty was t see better c-rdinatin and integratin f services at lcal level, with mre jint planning and delivery frm the NHS and lcal cuncils. Putting Peple First 2 was a jint statement published in December 2007, setting ut a shared visin fr transfrming adult scial care. It was signed by six gvernment ministers, the NHS Chief Executive, the Assciatin f Directrs f Adult Scial Services (ADASS), the Lcal Gvernment Assciatin (LGA) and ther natinal scial care and health rganisatins. The signatries agreed n the need fr a system fcused n preventin, early interventin, reablement and tailred nging supprt services. They emphasised achieving better utcmes 1 Reprt by the Scial Wrk C-perative fr the Nrth East reginal Imprvement and Efficiency Partnership, Putting Peple First, A shared visin and cmmitment t the transfrmatin f adult scial care, HM Gvernment and thers, December

9 fr service users and making better use f resurces. A natinal prgramme, als called Putting Peple First, was created t imprve peple s experiences f scial care and make the visin a reality. In September 2009, the Department f Health, ADASS and the LGA published five milestnes fr lcal cuncils t measure prgress with Putting Peple First. 3 Each milestne says what shuld be happening, and what lcal cuncils shuld be ding by three key dates: April 2010, Octber 2010, and April The themes fr the milestnes are: mre chice and cntrl ver the kind f care they receive, helping peple t remain independent fr lnger, and frequently achieving better utcmes fr users. Reablement services are als ften cst effective and invlve partnership wrking between lcal cuncils, the NHS and ther agencies. Once smene has been thrugh a perid f reablement, they are assessed t determine whether they need nging scial care, and at this pint may be ffered a persnal budget, s that they can cntinue t exercise chice and cntrl. effective partnerships with peple using services, carers and ther lcal citizens self-directed supprt and persnal budgets preventin and cst effective services infrmatin and advice lcal cmmissining. The milestnes require cuncils t wrk jintly with health services t develp and implement plans t shift investment twards reablement and preventin services, and t mnitr the impact f these changes, by tw key dates. Increasing persnalisatin f services, making persnal budgets available t mre peple, greater chice and cntrl fr users, mre tailred supprt fr individuals, cst effective services, and mre effective partnerships have all cntinued t be plicy pririties fllwing the change f gvernment in The Revised NHS Operating Framewrk fr England 2010/11, published in June 2010, emphasised the imprtance f reablement. In this dcument, the Calitin gvernment signalled that reablement and supprt fllwing hspital discharge will be pririties, and that they want t see hspitals wrking with GPs and lcal authrities t develp such services t imprve patient utcmes and reduce emergency hspital readmissins. The best reablement services are excellent examples f these new appraches t scial care prviding mre persnalised and tailred supprt, ffering peple 3 Putting Peple First, transfrming adult scial care: prgress measures fr the delivery f transfrming adult scial care services, Department f Health, ADASS and LGA, September

10 Wh cmmissins and wh prvides reablement services Access and referral arrangements Lcatin The make up f the reablement team Time limits fr the service The Fair Access t Care Services (FACS) criteria Charges fr services What happens at the end f reablement? Hw reablement services vary Many different kinds f reablement service (different service mdels) exist. There are seven main factrs: Wh cmmissins and wh prvides the service Access and referral arrangements Lcatin where the service is based and prvided The make-up and skill mix f the reablement team Time limits fr the service Applicatin f the Fair Access t Care Services (FACS) criteria Charges fr services These differences are explained in the sectins belw. The final sectin explains what happens at the end f reablement. Wh cmmissins and prvides reablement services Reablement services are part f the services prvided by adult scial services departments. Lcal authrities play a lead rle in deciding what reablement services shuld be available in their areas, and in designing, cmmissining and funding these services. In sme areas, reablement services are jintly funded by the lcal authrity and the NHS, and the NHS is als invlved in deciding what they shuld lk like, and wh is eligible fr them, within that area. Under gvernment plans, GPs are likely t becme invlved in cmmissining reablement services in future. Reablement services are smetimes prvided in-huse by cuncil staff, fr example hme care staff. In ther cases, they are prvided by inter-disciplinary teams bringing tgether staff frm bth the lcal authrity and the NHS. Fr example, staff frm hme care, scial wrk, nursing and ccupatinal therapy teams may cme tgether t frm a reablement team. In sme areas, lcal authrities have decided t cmmissin independent hme care prviders t prvide reablement services. Smetimes, the lcal authrity will cnduct the initial assessment f the user t decide whether they are suitable fr reablement, and t draw up the reablement care and supprt plan, and then independent sectr hme care staff will cme in t prvide the day-t-day reablement supprt. Smetimes ther rganisatins, such as husing assciatins, r thse running care hmes, day centres, r advice and supprt services fr lder peple may becme invlved as partners in delivering reablement. 10

11 Access and referral t reablement There are tw main appraches t access and referral arrangements fr reablement. The first is called the intake and assessment mdel (r wide-access mdel), and the secnd is the selective r targeted mdel. If yu are trying t wrk ut which apprach a particular reablement service takes, then the key questins t ask are: Wh is the target client grup wh is the service fr? Hw can peple access the service? A reablement service that uses the intake and assessment mdel will accept all referrals f adults wh are being cnsidered fr hme care, r fr scial services supprt. The reablement service then des its wn assessment, and screens ut peple unlikely t benefit frm reablement. The apprach f this kind f service is t assume that mst peple can benefit frm reablement. This is als knwn as a wide-access mdel, as it takes n, and can be accessed by, peple with a wide range f needs r circumstances. Sme intake and assessment reablement services cnsider every adult wh is referred t adult scial services (including peple referred fr pssible lng-term care in a care hme), whilst thers cnsider everyne wh is referred fr pssible hme care (dmiciliary care) supprt still a very large number f peple. The kinds f peple wh will be screened ut by an intake and assessment mdel reablement service will vary, as each service still has its wn access criteria, decided by the lcal authrity that is running the service. Peple needing end-flife care will always be screened ut, as there is n pssibility that a reablement apprach will help them. Others wh may be accepted by reablement services in sme lcal authrity areas, but wh may be screened ut as ineligible r unsuitable by ther reablement services, include: peple with severe dementia, peple with learning disabilities, r peple under a certain age (fr example, peple under 65). By cntrast, the selective r targeted mdel fcuses n peple in a particular situatin, r wh are referred thrugh specific rutes. Fr example, the service may fcus n peple being discharged frm hspital, and may require a referral frm a specific, hspital-based team. Sme services f this kind will fcus n peple leaving hspital, and als thse living in the cmmunity wh are at high risk f needing t g int hspital r a care hme, if they d nt get reablement supprt. With this type f service, the apprach is t fcus n thse peple where the benefits f reablement are ptentially greatest, r n thse users where there is the highest chance f a successful interventin thrugh reablement supprt. Thus this kind f selective service will take n fewer users, with a mre tightly defined set f eligibility criteria. It will nly accept thse peple that are very likely t benefit frm reablement. Lcatin where the service is based and prvided Nt surprisingly, given the emphasis within reablement n supprting peple t cntinue living as independently as pssible, many reablement services are prvided in the user s wn hme. Hwever, reablement services can als be prvided in ther lcatins such as sheltered husing, extra care husing, residential care, and day centres. Fr example, a sheltered husing scheme might have several places kept especially fr reablement. Peple wh have been having difficulty cping at hme, r wh may have been in a hspital r residential hme, might cme t stay fr a defined perid f time, s that they can practise day-t-day activities with supprt frm reablement wrkers, t gradually increase their cnfidence and independence. The make up f the reablement team Reablement is ften prvided by teams f staff frm different prfessinal backgrunds, and with a range f skills and experience (multi-disciplinary teams). In sme cases, reablement teams will als be made up f staff emplyed by different rganisatins wrking tgether (multi-agency teams) fr example lcal authrity, NHS and independent sectr staff. 11

12 In ther areas, reablement may be prvided by staff frm a single rganisatin, such as a lcal authrity s in-huse hme care team, althugh they may wrk very clsely with clleagues in ther services such as NHS hspital discharge teams, ccupatinal therapists, and scial wrk teams. The exact nature f the reablement team will depend n what the rganisatins that have cmmissined the service have decided. Often staff will have special training t learn abut reablement and t be able t apply reablement appraches in their wrk. The kinds f staff wh may be invlved include: Hme care staff Reablement supprt wrkers Occupatinal therapists (OTs) Physitherapists & physitherapy technicians Scial wrkers District nurses Cmmunity psychiatric nurses (CPNs) Psychtherapists Peple with training and experience wrking with peple with dementia (EMI), fr example specialist hme care staff, ccupatinal therapists Staff frm third sectr rganisatins, fr example supprt wrkers emplyed by husing assciatins, r day centres wrking with lder peple. Time limits fr reablement supprt Reablement is always time-limited, with an emphasis n wrking twards clear gals agreed between the service user and reablement team, during the reablement perid. In many services, reablement is ffered fr up t six weeks. The perid f reablement can end earlier if the client has achieved their gals and n lnger needs nging reablement supprt. Research fr CSED fund that acrss 13 lcal authrities the average duratin fr the vast majrity f peple is between 3.1 and 6.4 weeks. 1 Sme reablement services ffer flexibility ver hw lng the service is available, based n the needs f the individual user. This is mre likely where the service is ffered t yunger peple with physical, mental r learning disabilities and lder peple with mild r mderate frms f dementia. Hwever, there will still always be clear time limits fr each user. CSED have said that a degree f flexibility shuld benefit clients wh may need a lnger perid f reablement. Sme reablement services are prvided fr up t 12 weeks, but these tend t be fr a mre specific targeted grup, such as peple wh have experienced a strke. Fair Access t Care Services (FACS) criteria What are FACS criteria and hw d they wrk? Gvernment guidance published in 2003 intrduced the Fair Access t Care Services (FACS) framewrk. 2 This apprach was cntinued when the guidance was updated in The principle behind FACS was that all English lcal authrities shuld use the same prcess fr deciding wh is eligible fr scial care supprt, based n the persn s level f need and the risks t their independence ver time. The aim was t create a system that was mre cnsistent, fairer, and easier t understand and cmpare acrss all the different lcal authrities in England. Lcal authrities have a legal respnsibility t assess everyne wh is referred t them, r appraches them directly, fr scial services supprt. As part f this assessment, the lcal authrity shuld find ut abut the individual s needs, their 1 Benefits f Hmecare Reablement fr Peple at Different Levels f Need, CSED, Jan Fair Access t Care Services: guidance n eligibility criteria fr adult scial care, Department f Health, Priritising Need in the Cntext f Putting Peple First: a whle system apprach t eligibility fr scial care, Department f Health,

13 physical and mental health, the family and supprt netwrks that they have, and their wider circumstances. The gvernment guidance says that, as a result f the assessment, lcal authrities must determine the persn s level f need fr scial services supprt, and the risk t their independence and well-being, using the FACS eligibility framewrk. This means putting the persn int ne f fur bands: Critical level f need Substantial level f need Mderate level f need Lw level f need. These are utlined n the next page. 13

14 A critical level f need, accrding t the guidance, is when: life is, r will be, threatened; and/r significant health prblems have develped r will develp; and/r there is, r will be, little r n chice and cntrl ver vital aspects f the immediate envirnment; and/r serius abuse r neglect has ccurred r will ccur; and/r there is, r will be, an inability t carry ut vital persnal care r dmestic rutines; and/r vital invlvement in wrk, educatin r learning cannt r will nt be sustained; and/r vital scial supprt systems and relatinships cannt r will nt be A substantial level f need, accrding t the guidance, is when: there is, r will be, nly partial chice and cntrl ver the immediate envirnment; and/r abuse r neglect has ccurred r will ccur; and/r there is, r will be, an inability t carry ut the majrity f persnal care r dmestic rutines; and/r invlvement in many aspects f wrk, educatin r learning cannt r will nt be sustained; and/r the majrity f scial supprt systems and relatinships cannt r will nt be sustained; and/r the majrity f family and ther scial rles and respnsibilities cannt r will nt be undertaken. sustained; and/r vital family and ther scial rles and respnsibilities cannt r will nt be undertaken. A mderate level f need, accrding t the guidance, is when: there is, r will be, an inability t carry ut several persnal care r dmestic rutines; and/r invlvement in several aspects f wrk, educatin r learning cannt r will nt be sustained; and/r several scial supprt systems and relatinships cannt r will nt be sustained; and/r several family and ther scial rles and respnsibilities cannt r will nt be undertaken. A lw level f need, accrding t the guidance, is when: there is, r will be, an inability t carry ut ne r tw persnal care r dmestic rutines; and/r invlvement in ne r tw aspects f wrk, educatin r learning cannt r will nt be sustained; and/r ne r tw scial supprt systems and relatinships cannt r will nt sustained; and/r ne r tw family and ther scial rles and respnsibilities cannt r will nt be undertaken. 14

15 Lcal authrities set their wn eligibility criteria, based n these fur bands. This means they can set the threshlds (cut-ff pints) fr deciding wh qualifies fr scial services supprt, taking int accunt the resurces they have and the wider needs within their cmmunities. Fr example, ne cuncil culd decide that its adult scial care services will nly be available t peple with substantial r critical levels f need. Peple assessed with lw r mderate levels f need may instead be given infrmatin abut ther services and supprt that they culd access in the cmmunity (i.e. be signpsted t ther services). Anther cuncil, in cntrast, culd decide that its adult scial care services will be available t peple with mderate, substantial r critical needs. Bth lcal authrities are required t use the same natinal FACS banding system t decide n peple s level f need, but the actual services they prvide t peple in the different bands can vary. Once the assessment is dne, a persn has been put in ne f the fur FACS bands, and a decisin has been made abut what supprt the cuncil can ffer, then an assessment f the persn s ability t pay any charges is made, and they are infrmed f any charges r cntributin that the cuncil will expect. Hw d reablement services use the FACS criteria? There are tw main ways in which reablement services can differ, in relatin t FACS criteria: Whether FACS criteria are applied t users at the start r end f reablement The eligibility threshld fr access t reablement services Reablement services can either apply the FACS criteria t users at the start f reablement, r at the end. If they apply FACS at the start f reablement, they will identify ptential users in each band f need, and the service may nly be available t thse with a certain level f need. Fr example, a particular reablement service might nt be available t peple assessed with a lw level f need, but nly be fr thse with mderate, substantial r critical levels f need. Research published by CSED in 2009 fund arund three-quarters (73 per cent) f reablement services apply FACS criteria at entry t reablement. 4 If a reablement service nly applies the FACS criteria at the end f reablement, then this means that they d nt take FACS int accunt when deciding wh t accept fr the service. This may be because the lcal authrity takes a universalist apprach, making reablement supprt available t a very wide range f peple, including thse with lwer levels f need. They may see this as a gd investment fr the future helping t prevent such peple frm develping greater needs in the lnger term. Instead, the FACS criteria are applied at the end f the reablement supprt, when the user is being assessed fr further nging supprt. Alternatively, a reablement service may nt apply FACS criteria at the start because it is a very targeted service, that nly takes peple referred frm a hspital discharge scheme, fr example. Anyne referred thrugh this rute may, by definitin, have a higher level f need and therefre the lcal authrity may decide FACS criteria d nt need t be applied until users have finished their perid f reablement, and are being assessed fr further nging supprt. Sme reablement services apply the FACS criteria t peple bth at the start and again at the end f reablement. This apprach recgnises that sme peple s levels f need may change as a result f reablement. Research published by CSED 5 suggests reablement can be effective and benefit peple with bth lwer and higher levels f need. As the sectin abve explains, different cuncils will set different eligibility threshlds fr access t reablement. Of thse that d have a threshld, sme are available t peple with mderate, substantial and critical needs, and thers just t peple with substantial r critical needs. It is rare fr a reablement service t nly accept peple with critical needs. 4 Hme Care Reablement CSSR Scheme Update, CSED, March Benefits f Hme Care Reablement fr Peple with Different Levels f Need, CSED, January

16 Charges fr services Mst reablement services are free t clients. CSED fund that arund ne-third f cuncils with reablement services reprted charging fr reablement in 2008, and the ther tw-thirds did nt charge. Sme reablement services prvide a few days r weeks f supprt free, and then start t charge, fr example after the first tw weeks. Sme charge a similar hurly fee t that charged fr hme care, and thers charge a flat fee, regardless f the number f hurs f care r supprt prvided. CSED fund that hspital discharge-based reablement services were mre likely t be free t users, cmpared t hme care based reablement services. This may be because such services are mre likely t be jintly funded by the NHS, whse services are free t users at the pint f need. Gvernment plans t penalise hspitals if patients are readmitted within 30 days f discharge are expected t lead t even mre hspitals becming clsely invlved in funding r prviding intermediate care and reablement services in future. users and carers in each lcal authrity shuld have persnal budgets by April Peple chsing a persnal budget will be given help t assess their needs and create an nging supprt plan, and given an indicatin f hw much mney they will receive. Peple can chse t have cash payments that they manage themselves, r that smene else manages n their behalf. Alternatively, they can chse t have services that the cuncil manages and arranges fr them. Once the cuncil agrees the supprt plan and amunt f mney, then arrangements can be made fr the persn r smene managing their mney t receive payments and pay fr the care and supprt that suits them best. If the persn prefers the cuncil t manage everything, then an nging care package may be cmmissined. Depending n the cuncil s cmmissining arrangements, this may be prvided by in-huse cuncil teams r by independent sectr prviders. In all cases, the nging care and supprt arrangements, and the user s needs, shuld be regularly reviewed. Sme reablement services ask users t cmplete satisfactin questinnaires r surveys when they finish reablement. These shuld help services learn what they d well and what culd be imprved r dne differently. What happens at the end f reablement? Twards the end f the reablement perid, a review is cmpleted with the user, and if apprpriate, their carers and family. An assessment is made f the user s nging needs. If the service applies FACS criteria at the end f reablement, this will be dne t. What happens next depends n this assessment, and whether the user is eligible fr nging help. If they d nt need nging care, they may be given infrmatin and signpsted t ther services and activities in the cmmunity. Sme peple will be frmally referred t ther services. Increasingly, peple needing nging scial care are being ffered self-directed supprt thrugh persnal budgets. The Department f Health requires cuncils t ffer persnal budgets t all new service users and carers by Octber 2010, and says at least 30 per cent f eligible 6 Putting Peple First, transfrming adult scial care: prgress measures fr the delivery f transfrming adult scial care services, Department f Health, ADASS and LGA, September

17 Hw reablement benefits users: the evidence Hw reablement services benefit staff Benefits t lcal authrities and the NHS Service users and staff in the Nrth East talk abut reablement Users and carers tp ten tips fr excellence in reablement The benefits f reablement There is an increasing bdy f evidence that reablement can generate real and lasting benefits fr users, including: imprving quality f life keeping and regaining skills, especially thse enabling peple t live independently regaining r increasing cnfidence increasing peple s chice and autnmy enabling peple t be able t cntinue living at hme reducing the need fr nging care and supprt. The sectins belw explain mre abut the evidence that reablement users have experienced these benefits. Hw reablement benefits users: the evidence Imprving quality f life Research suggests that reablement has a psitive impact n quality f life. One study lked at the impact f reablement acrss a number f areas f quality f life. 1 The table shws the net imprvements that is, the numbers wh imprved fllwing reablement, minus the numbers wh gt wrse. In all aspects f quality f life that were lked at, there was a net imprvement fllwing reablement. 1 Prspective Lngitudinal Study, Interim Reprt 1: The shrt term utcmes and csts f reablement services, CSED, Oct 2009 CSED summarised the study, saying that there was a significant impact n peple s perceived quality f life, and perceived health-related quality f life, fllwing reablement. In the pst reablement phase, service users were reprting fewer prblems with mbility, self care, usual activities, pain/discmfrt, anxiety/ depressin, and imprvements in their general health. General health 18% Mbility 9% Self care 21% Usual activities (health) 17% Usual activities (scial care) 8% Pain and discmfrt 13% Anxiety and depressin 7% Persnal care 11% Cntrl 10% Meals 11% Safety 14% 17

18 User satisfactin Reablement services als seem t have high user satisfactin rates. Fr example, research by the Scial Wrk C-perative fr a 2010 reginal reprt n reablement in the Nrth East fund that in Nrthumberland 94 per cent f users rated the reablement service as gd r excellent (cmpared t 69 per cent fr mainstream hme care services), and in Suth Tyneside 100 per cent f users rated the reablement service as gd r excellent (cmpared t 66 per cent fr mainstream hme care services). Increased independence, less need fr nging supprt Increasingly, research is shwing that reablement services are effective in increasing users independence and reducing their need fr nging supprt after reablement. Leicestershire Cunty Cuncil was ne f the first t intrduce reablement. In 2000, De Mntfrd University did an evaluatin. They lked at utcmes fr peple wh had received reablement, after the first six weeks, and cmpared these with peple wh d had a cnventinal hme care package. At the beginning, the pilt reablement service tk a selective apprach, nly taking selected clients by referral. The results were remarkable: Sixty-tw per cent f peple wh had reablement did nt need any nging care package at the six week review, cmpared t just five per cent f peple wh had cnventinal hme care. Twenty-six per cent f peple wh had reablement needed a decreased care package (i.e. fewer care hurs) after the six week review, cmpared t 13 per cent f peple wh had cnventinal hme care. Ten per cent f peple wh had reablement needed the same level f care after the six week review, cmpared t 71 per cent f peple wh had cnventinal hme care. And just tw per cent f peple wh had reablement needed an increased amunt f care after the six week review, cmpared t 11 per cent f thse wh had cnventinal hme care. Fllwing the successful pilt, Leicestershire develped and extended the service t becme an intake and assessment mdel, taking a much wider range f referrals than the pilt service. This was als evaluated, and the results are shwn in the final clumn f the table belw. Hme care package required after 6 week review Peple n reablement pilt (selective mdel) Peple wh had cnventinal hme care (cntrl grup) Care package 62% 5% 58% discntinued Care package 26% 13% 17% decreased Care package 10% 71% 17% maintained Care package 2% 11% 8% increased Ttal 100% 100% 100% Re-ablement rll-ut in Leicestershire (intake and assessment mdel) The results fr the intake and assessment mdel are nt quite as gd as fr the selective mdel, because the selective mdel nly takes peple very likely t benefit frm reablement, whereas the intake and assessment mdel wrks with a wider range f peple, including thse less likely t benefit, r fr whm the benefits might be smaller. It is imprtant t remember, hwever, that a small benefit in terms f reduced care hurs needed can still make a very big difference t a user s life. 18

19 The difference in utcmes frm the intake and assessment mdel cmpared t cnventinal hme care are still very significant. This demnstrates that bth kinds f reablement service are effective in increasing peple s independence and reducing their need fr nging supprt. Leicestershire s Hmecare Assessment and Reablement Team (HART) is nw very well established. It perates an intake and assessment mdel fr access and referrals. The FACS criteria are applied at the start f reablement, and the service accepts peple assessed as having mderate, substantial r critical needs, accrding t the FACS bands. Further research n users f the service in 2005/06 published by CSED fund that, at the end f the reablement phase: half f all users f this service did nt need any nging care package twenty-nine per cent needed an nging care package, but with an average reductin f 30 per cent in care needed eighteen per cent were referred t ther specialised services, but with an average reductin f 16 per cent in care needed. The research fund an verall reductin in care hurs f 58 per cent. Evaluatins f reablement services in many ther lcal authrity areas have fund results that ech thse in Leicestershire. There is nw strng evidence that reablement increases peple s independence and reduces their need fr nging supprt. The evidence als shws that these benefits apply t peple at all the different levels f need. Lasting impact Anther benefit f reablement is that the psitive impact is nt just shrt-term, but appears t last. In 2008, CSED published research lking at ver 2,000 peple wh had received reablement in 2004 and 2005, t see hw lng it was befre they needed any change in their hme care package, r needed t start hme care if they did nt have it when they finished reablement. The peple came frm fur different lcal authrity areas. In all fur areas, ver half f users did nt need any hme care at all, at the pint when they finished reablement. Tw years later, in three f the fur schemes, 36 per cent t 48 per cent still did nt need any hme care, and in the furth scheme 87 per cent still did nt need hme care. In ne area, 55 users wh had previusly needed hme care befre ging thrugh reablement cntinued t need n hme care package tw years after reablement. Of the peple wh did need hme care within tw years f reablement, at least a third in each scheme had maintained r reduced their hme care package, tw years after reablement. In ne scheme this figure was 61 per cent f users. Further studies are taking place t understand mre abut hw lng the benefits f reablement can last, fr which kinds f users, and frm which kinds f service. The evidence s far is that reablement des have lasting benefits fr many users. Hw reablement services benefit staff Benefits t staff Many staff find that wrking in reablement brings great jb satisfactin, and a sense f ding smething very wrthwhile. It can give peple a chance t learn and develp new skills, and t wrk in a way that allws increased prfessinal autnmy. Hwever, sme peple d find the transitin t wrking in new ways can be difficult, especially the need t stand back and encurage users t d things fr themselves. The Reablement fr All reprt by the Scial Wrk C-perative fr the Nrth East fund that: There were bth anecdtal and quantified benefits fr peple wrking in reablement services. Fr example a survey f reablement staff in ne authrity fund 98 per cent f staff felt extremely satisfied r satisfied as a result f their wrk in reablement. 19

20 Research fr CSED invlved talking t frntline staff and managers wrking in five reablement services 2. The researchers fund: Reablement wrkers acrss all five sites cnfirmed that they had fund it hard at first t change their attitudes and practice, but almst all felt that the reablement apprach had increased their jb satisfactin, cmmitment and mtivatin. Wrkers wh had recently jined a reablement team were mre cautius abut these utcmes, but they fund it encuraging seeing ther wrkers feeling s psitive abut the new apprach. Mst managers cnfirmed the increased jb satisfactin experienced by mst staff wh had started using a reablement apprach. In ne site managers reprted that the sickness levels f their wrkers had decreased. Interestingly, the researchers als bserved reablement staff at wrk, and fund: Wrkers identified by the reablement services as being less experienced were thse wh had spent less time wrking within traditinal hme care services. Hwever, in general, these wrkers appear t invlve peple a lt mre than thse identified as being mre experienced. This invlvement was bth in terms f decisin making (e.g. asking peple what they wuld want t d n the day) and hands n ding with invlvement in practical activities. Gd quality training and nging supprt fr staff is imprtant in ensuring they can realise the ptential benefits f high jb satisfactin and effective utcmes. Clear infrmatin and cmmunicatin with users, s that everyne invlved has a shared understanding f the nature f the service, hw it wrks and what it is trying t achieve, are als imprtant. Benefits t lcal authrities and the NHS The benefits t lcal authrities and the NHS f reablement are a direct result f the benefits t users and staff. Intrducing reablement has led t significant cst savings fr sme lcal authrities, thrugh reductins in the number and size f care packages needed after reablement, and reduced need fr care hme placements. Althugh n direct evidence is currently available, there is anecdtal evidence that such activity als has a knck-n impact in terms f fewer hspital admissins fr the NHS. The resurces saved in this way can be re-invested int care services. In sme areas, lcal authrities and the NHS have re-invested directly int their reablement services, and expanded these by increasing the gegraphical area they cver, fr example frm a lcality t a whle cunty. Sme have expanded reablement by widening the access criteria, fr example frm a hspital discharge based scheme t an intake and assessment scheme, allwing a wider range f peple t experience reablement. Reablement therefre has the ptential t create win-win-win situatins, with better utcmes fr users, higher jb satisfactin fr staff, mre efficient use f resurces and reduced csts. Isle f Wight The Isle f Wight decided t intrduce reablement as part f a wider set f changes t its adult scial care services. They intrduced free hme care fr everyne wh was eligible and aged 80 r ver. The aim was t supprt peple t live at hme, and reduce the use f care hmes. The cuncil s in-huse hme care service became a reablement services, and they als wrked with independent sectr hme care prviders t build capacity. As a result f the changes, in the first year new admissins t residential care reduced by 40 per cent and there were net savings f 2 millin. The reductins in the use f residential care cntinued in fllwing years. 2 Prspective Lngitudinal Study Interim Reprt 2 f 2: The Organisatin and Cntent f Hmecare Reablement Services, CSED, Oct