Homecare Re-ablement
CSED's Homecare Re-ablement work seeks to improve choice and quality of life for adults who need care. Through the use of timely and focused intensive interventions, it will maximise long-term independence by appropriately minimising ongoing support required thereby minimising the whole life cost of care.
Discussion document: CSED has published a discussion document to assist councils to achieve their goals ... more
Approach: Our approach focuses on re-abling people so that they achieve their potential in terms of a stable level of independence with the lowest appropriate level of ongoing support or care. Various examples have been seen and reported whereby focused timely bursts of therapy, intermediate care or homecare can prevent hospital admission or post hospital transfer to long-term care, or appropriately reduce the level of ongoing home care support required. Benefits of reducing the long-term care needs of recipients to the lowest appropriate level are obvious:
- maximising independence
- minimising the whole life cost of care.
The need to ensure that best use is made of limited resources will always be present within social care and health. In addition, demographic projections indicate that an increasing demand will be placed on all modes of care and so an approach needs to be established to ensure that the lowest appropriate level of intervention is provided. Other initiatives including development of telecare services will have a significant part to play in supporting people in their ‘home', whether it be an individual residence, sheltered or extra care housing. These will require an active and ongoing assessment process to balance risk against ‘quality of life' for adults who need care.
This proposition focuses on one of the three forms of re-ablement, namely Homecare Re-ablement. This concentrates on individuals living at home who are entering the support systems through either an intake and assessment or hospital discharge support functions, and seeks to maximise their level of ability and independence. It can also be applied to existing service users who entered the support services prior to the implementation of re-ablement.
We were aware of a small number of schemes around the country, some of which have undergone an evaluation of their effectiveness.. Based on our work with CSSRs we published a Discussion Document that contains five case studies with supporting evidence plus further information from thirteen additional CSSRs (request this document) . These were launched at a workshop in January 2007.
Latest Update: May 2008
Prospective Longitudinal Study: Discussions are underway for this study to be funded by the Department of Health and it is hoped that these will be concluded shortly. Therefore, in anticipation of this, we are now seeking expressions of interest from CSSRs that would be willing to participate in the study.
Within this study we are seeking to work with a number of established schemes (intervention group) as well as others that have yet to implement a scheme (comparison group). It is possible that a CSSR that has implemented a homecare re-ablement scheme across only part of its geographic area may wish to participate in both groups.
This study will provide invaluable information and evidence to help CSSRs across England shape their service to maximise both outcome benefit and duration of benefit for those people that are in need of a homecare package. We propose to publish both an interim and final report so that all
CSSRs can share and benefit from the outputs of this study as they shape their local service.
In July 2007 CSED commissioned a retrospective longitudinal study that was completed by the Social Policy Research Unit (SPRU), University of York and the report was published and launched in November 2007. This initial study provided much valuable evidence as well as informing the specification for this second study. Thus, building on the first study, this new study would be undertaken by the SPRU and the Personal Social Service Research Unit (PSSRU), University of Kent.
CSSRs wishing to register their interest to participate in this proposed study are asked to contact CSED by Friday 16th May. We will seek to shortlist potential partners and identify those that are most able and willing to work within this study.
CSSR Homecare Re-ablement Scheme Update: An update to the summary included within the Discussion Document of information provided by CSSRs on their Homecare Re-ablement schemes has just been completed. (download the "Homecare Re-ablement CSSR Scheme Update May 2008" pdf). This includes details submitted by 136 CSSRs on their progress. We now have 34 CSSRs with a scheme, 60 extending or enhancing their existing scheme and a further 42 at various stages of implementing or planning a new scheme. This update also includes information on CSSR FACS levels and when these are applied, as well as information on those that charge for their service or not.
Outline of Proposed Direction for 2008/2009: Building on the work completed during the last comprehensive spending review to support councils with development of their homecare re-ablement services, CSED have identified four projects that it will undertake during 2008/09 and beyond. This document (download the “Outline of Proposed Direction for 2008/09” pdf ) provides an outline of these four projects.
Update: March 2008
Longitudinal Study: Building on the body of evidence contained within the Homecare Re-ablement Discussion Document published in January 2007 (download the ‘Homecare Re-ablement Retrospective Longitudinal Study' pdf)., a retrospective longitudinal study was commissioned by CSED with the Social Policy Research Unit, at the University of York.
Evidence from a study completed in Leicestershire by the De Montfort University showed that without homecare re-ablement, approximately 5% of people no longer require a homecare package at their first (six week) review whilst 71% have their initial package maintained. Anecdotally these proportions would not appear to be dissimilar in other councils or to change radically at subsequent reviews.
The De Montfort study also showed that substantial improvements were achieved by those undergoing a phase of homecare re-ablement. Similar orders of improvement were seen in other councils that operate homecare re-ablement services as detailed in the CSED Homecare Re-ablement Discussion Document.
The results of the retrospective longitudinal study are available from our website but the main headlines are as follows:
In 3 of the 4 schemes
- 53% to 68% left re-ablement requiring no immediate homecare package (4th scheme = 94%)
- 36% to 48% continued to require no homecare package 2 years after re-ablement (4th scheme = 87%
Of those that required a homecare package within the 2 years after re-ablement
- 34% to 54% had maintained or reduced their homecare package 2 years after re-ablement
Of those aged > 65 yrs that required a homecare package within 2 years after re-ablement
- In 3 of the 4 schemes the number that had reduced their package was higher after 24 months than after 3 months
- This was even more noticeable in 2 of the schemes for those aged > 85 yrs.
Whilst it is accepted that certain ‘health warnings' exist, principally because the study involved only 4 schemes and control groups were not possible within a retrospective study, it remains the case that the body of evidence clearly shows that homecare re-ablement releases significant benefits for a substantial proportion of people and that approximately 70% of them continue to benefit more than 2 years later.
In addition to promoting the results of this study, the knowledge gained is being used to refine the specification for a proposed prospective longitudinal study that would seek to identify those factors that maximise outcomes and duration of benefits.
The question now is why would any council not provide homecare re-ablement?
Update - November 2007
As a result of feedback from councils following the successful workshop held in January, attended by over 190 people from 100 CSSRs, a number of areas of work have been identified. All of these areas seek to provide further support to CSSRs as they implement new services or enhance existing services.
One specific topic relates to the completion of a longitudinal study to provide clarity and evidence on the duration of benefit enjoyed by those who have undergone a period of homecare re-ablement. During our previous work with councils we were unable to identify any such study although many felt it varies, on average, between one and two years.
CSED commissioned the first phase of this study with the Social Policy Research Unit, part of the University of York, to work with a range of councils to complete a ‘quick' retrospective study. This study builds on the findings within the Discussion Document and provides valuable evidence. that a substantial proportion of users continued to require no homecare package 2 years after re-ablement.
In addition to the evidence of duration of benefit, this first phase will also inform preparation for a longer study that will also seek to include an evaluation of the comparative benefits of operating mixed skill homecare re-ablement teams. The longer study will also seek to identify how CSSRs can maximise the duration of benefit for those people who undergo homecare re-ablement. .
Work to collate examples of the documentation and process used by CSSRs to complete an initial assessment of users for re-ablement and satisfaction surveys has now been completed (download the "Homecare Re-ablement Assessment Tools and Satisfaction Surveys" pdf). This brings together seven examples of assessment tools and documentation plus eight examples of user/carer satisfaction surveys. If any other CSSRs are willing to share details of either their assessment or satisfaction survey processes with us these will be included in a subsequent update.
To read about the work in your area please visit your region's page.
This workstream is led by Gerald Pilkington (020 7972 4161).
