A new era for Reablement
The pressure on health and social care services has led to a pivitol change in how we care and support individuals. Proactive care becomes the norm with assistive technology at the forefront.
Reablement is a term increasingly used in both health and social care contexts and is generally used to describe the convalescence process between a hospital stay and your discharge back home. Other factors are crucial to regaining your independence, even if you are clinically fit for discharge.
The goal of reablement is for care recipients to restore abilities and find new ways to perform daily living activities, be active, socialise, and participate in the community. Reablement is time-limited, person-centred, and typically delivered by an integrated team of mixed health professionals such as care workers, nurses, occupational therapists, physiotherapists, and other specialists. Reablement services are increasingly offered to everyone who meets local eligibility criteria for home-care services. Still, older adults (65+) are the most typical recipients of reablement. The care recipients are people with various mortality and morbidity risks, multimorbidity, diverse prognostic outcomes, symptoms and disabilities. Exclusion criteria are generally advanced cognitive impairments and end-of-life care. Reablement represents a shift from reactive home care services to preventative and proactive models based on early intervention and active engagement.
The main concern of care recipients and their caregivers is challenges in everyday life. The challenges of care recipients include daily living activities, frailty, loneliness, medication compliance, working with multiple health professionals, use of assistive technology and environmental obstacles. The challenges as caregivers include navigating numerous health agencies’ involvement in an over-stretched, time-and-task-based care delivery system. Care recipients’ ability to manage their daily routines well in their homes emerges as the primary concern.
This main concern is harmonious with the goal for the reablement service, though the focus is on independence. It involves managing critical daily activities such as maintaining personal hygiene, preparing meals, and moving safely inside the home. Managing everyday life is also about doing activities outside the home.
A generation of blind faith
Many feel obliged to accept the reablement service as the offering has some choices and flexibility. Messaging in the media builds on the impression of how hard it is to receive proper care, which generally leads to acceptance without question for everything being offered. However, it doesn’t mean other forms of care should not be considered during a heightened emergency.
Regaining lost confidence
Confidence means trusting your own ability to manage daily living tasks—confidence increases due to physical strength and environmental adaptation due to social support, knowledge, and safety. The loss of confidence occurs from several factors. The traditional view of ageing is resting and withdrawing from daily activities, which leads to an expectation that this is the best life and course of recovery. Grief from a loss of movement contributes to a lack of confidence. Building confidence is, therefore, a way of thinking that involves an acceptance of the reablement practitioners’ encouragement and repetitive daily support in various forms, meeting the care recipients where they want their life enjoyment to be. Confidence building is conditioned by social support such as reablement practitioners, family, a partner, friends, or volunteers. The value of building confidence empowers care recipients to be able to take control over their own lives.
Effective from 1 April 2022, guidance has been released for hospital discharges into community settings to help health and social care organisations provide and establish assistive equipment in people’s homes to provide efficient, timely and person-centred care.
The Department of Health and Social Care’s (DHSC) new guidance is for NHS organisations, including commissioning bodies and local authorities in England, about hospital discharge and community support. The guidance details how the health and social care sectors can work together to plan and deliver affordable hospital discharge and recovery services within current budgets.
There is a considerable focus on ensuring a local approach when planning hospital discharges. The aim is to enable care recipients to recover and rehabilitate at home before their long-term health and care needs and options are assessed and agreed upon. Only in exceptional circumstances can discharging care recipients permanently into care homes for the first time should occur. The home-first approach helps free up vital hospital space, notably since NHS England reported that it experienced its busiest winter ever in 2021 with record ambulance call-outs.
The guidance details that all local discharge and community support processes should be person-centred, consider the care recipients and any unpaid carers’ views and maximise the individual’s independence.
Free up resources
Our research shows, on average, in the UK, over 13,600 patients per day are medically fit to go home yet cannot be discharged due to staffing shortages in social care. This includes people waiting for spaces in care homes and needing care in their own homes. On average, 10% of daily general and acute beds were occupied by a patient who was medically fit to leave. Over the winter of 2021, the number of people deemed fit to leave the hospital but not discharged grew faster than those successfully discharged.
If a person’s preferred placement or package is not available when they are clinically prepared for discharge, they should be offered a reasonable alternative while they await the availability of their preferred choice. People do not have the right to remain in a hospital bed if they do not need acute care, including waiting for their preferred option to become available. The NHS does not have the space for this privilege.
Assistive technology takes centre stage
As Alexa has demonstrated, designed for a purpose, robotics or any other assistive technology can provide practicality in the home. Different types of assistive technology products can be simultaneously used in an individual’s own home:
- enabling care recipients to live a healthier, independent life for longer
- enabling care recipients to live safely at home
- preventing or delaying unnecessary hospital or care home admissions or readmissions
- supporting care recipients to return home from a hospital or care setting where possible
- providing technology-based solutions to complement other community services
Unsurprisingly, many health and social care providers are increasingly committing to assistive technology, even though actual deployments are in their infancy. At this point, the resource gap and the scope for improvement with assistive technologies are enormous.
Remote and hybrid care – you heard it here first!
It is now accepted that a course of personalised, well‐planned support services for up to six weeks can prevent or delay the need for an older adult to receive long‐term home care and other labour‐intensive community services. Remote and hybrid care can play an essential role in managing the risks, both during the reablement period and in the months following service delivery, irrespective of whether the individual needs long‐term home care.
Our own platform, GenieConnect®, aims to maintain or improve a care recipient’s safety and independence to facilitate participation, enhance overall wellbeing, and prevent or reduce the impact of impairments and secondary health conditions. Remote and hybrid care can be effective across health and social care, including reducing care provision, admission, and the need for admission into a care home and improving health and wellbeing.
A tech-first approach
Service Robotics is working with Shropshire Council, alongside their Practitioners and Care Providers, to identify users that could benefit from using technology to help manage their reablement and longer-term care needs. Speaking with the CEO at Service Robotics Ltd, Rob Parkes told us, “Our GenieConnect® platform has been designed to enable remote care delivery, offering valuable support for a range of daily living tasks and easy access to speak to a carer – all through our companion robot Genie.”
Technology needs to be considered in every assessment before any care is commissioned or existing packages are increased. Shropshire Council’s tech-first approach ensures that care and support delivery includes assistive technology wherever possible and is embedded into practice when considering an individual’s care and support needs.
Following a successful deployment in supported living for those with Learning Disabilities, Shropshire Council has extended their partnership with Service Robotics Ltd to deliver remote care to enable people to get home and release some care capacity. Rob Parkes added, “this partnership with Shropshire Council shows how we can use technology to support people to live independently and have a more proactive approach to their care needs.” Shropshire Council will maximise features such as medication prompting, wellbeing and daily living task reminders, mood check-ins and virtual care support via Genie video- calling.
“We are working with our clients to help them deliver more flexible and better-quality care to increase independence and reduce demand on our country’s health and social care providers.”
The Better Care Fund (BCF)
On 22 September 2022, the government announced its Plan for Patients. This plan committed £500 million for the rest of this financial year to support timely and safe discharge from the hospital into the community by reducing the number of people delayed in hospital awaiting social care. The focus will be on, but not limited to, a ‘home first’ approach and discharge to assess (D2A).
- Funding should only be used on permitted activities that reduce flow pressure on hospitals, including in mental health inpatient settings, by enabling more people to be discharged to an appropriate setting, with adequate and timely health and social care support as required.
- Funding should prioritise the most effective approaches in freeing up the maximum number of hospital beds and reducing the lost bed days with
The policy framework is intended for use by those responsible for delivering the Better Care Fund at a local level (such as integrated care boards, local authorities, health and wellbeing boards) and NHS England:
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