Improving Independence

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Improving Independence can homecare re-ablement
make a difference in the longer term?

• Liz Newbronner

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CSED Homecare Re-ablement Workstream

• 2006 CSED study into the development of homecare
  re-ablement in England
• Working definition of re-ablement used by CSED
• Services for people with poor physical or
  mental health to help them accommodate their
  illness by learning or re-learning the skills
  necessary for daily living
• Study showed that
• 60 CASSR had a homecare re-ablement service of
  some kind
• Characteristics of these services varied
  considerably
• Main distinction was between intake and
  discharge or discharge support services

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Background to the Study

• Limited evidence base about effectiveness of
  homecare re-ablement
• Indications of reductions in use of homecare
  services following discharge from re-ablement
• But no evidence on
• - longer term duration of reductions
• - factors that impact on subsequent service use

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Aims of the Study

• 1. To use routine service data from CASSRs to
  examine changes over time in subsequent use of
  social care services following homecare
  re-ablement
• 2. To identify factors that may affect subsequent
  use of social care services following homecare
  re-ablement
• 3. To consider the focus and research design of a
  larger evaluation of homecare re-ablement services

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Methods

• Selected 4 CASSRs with re-ablement services (2
  intake and 2 discharge) established for at
  least 4 years. In each site
• Analysis of routine data for clients with an
  episode of homecare re-ablement in 2004-5,
  including subsequent social care provision
  (2005-6 and 2006-7)
• Interviews with homecare re-ablement service
  manager and colleagues
• Interviews with one or more care management team
  managers in each site

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The Study Sites

• Wirral Enablement Discharge Service (WEDS),
  Wirral Metropolitan Borough Council (discharge
  support)
• Homecare Assessment and Re-ablement Team (HART),
  Leicestershire County Council (intake)
• Short Term Assessment and Re-ablement Team
  (START), London Borough of Sutton (primarily
  discharge support)
• Intermediate Home Support Service (IHS), Salford
  City Council (intake)

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Profile of Re-ablement Service Users

• Four age groups used up to 64 65 to 74 75 to
  84 and 85 and over
• Percentage of service users in each age group
  broadly similar for all four sites
• Longer established services (Leicestershire and
  Sutton) had higher proportion in the 85 and over
  age group
• In all four sites 80 of service users were
  categorised as physical disability, physical
  illness or physical frailty

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Overall Pattern of Homecare and Re-ablement
Service Use

• Between a third and a half of service users in
  Salford, Leicestershire and Sutton had reablement
  only
• Percentage of users who had re-ablement followed
  by homecare was remarkably consistent across the
  sites at just over 40
• Two most mature services had the greatest
  proportion of service users who had homecare
  before re-ablement

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Time from Re-ablement to First Episode of Homecare

• Majority of service users who had homecare had
  their first episode within one week of leaving
  re-ablement
• For service users starting homecare later, there
  are two peaks in take up at the up to three
  months point at the over one year point
• Patterns may suggest re-ablement users fall into
  two broad groups
• - those gaining immediate but relatively
  short-term benefit avoiding need for homecare for
  a few months
• - those for whom impact is more sustained and
  which delays the need for homecare by a year or
  more

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Change in Homecare Use After Re-ablement

• Examined the changes in the use of homecare after
  re-ablement
• Used snapshot points of 3, 6, 12, 18 24 months
  after re-ablement
• In Leicestershire and Sutton, percentage of
  service users needing less homecare than they did
  on leaving re-ablement increased over the two
  years
• In Salford, percentage of service users needing
  less homecare than they did on leaving
  re-ablement fell after 18 months but percentage
  of service users needing progressively more
  homecare was only slightly higher at end of
  2-year period
• Wirral is very different but still appears to be
  a significant change at the 18-month point

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Change in homecare use all service users
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Change in homecare use over 85 age group
Excludes those who died or went into permanent
residential care
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Intensity of Homecare Use after Reablement

• Examined the intensity of homecare usage after
  re-ablement at the snapshot points of 3, 6, 12,
  18 and 24 months
• Based analysis on hours of homecare categories
  used in HH1 returns (2 hours or less 2-5 hours
  6-10 hours and 10 hours)
• Overall no marked changes in the proportions of
  service users in each category at the different
  snapshot points
• Leicestershire had the smallest proportion of
  users in the more than 10 hours group

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Factors Affecting the Longer-Term Impact of
Re-ablement

• Independent providers culture and contracting
  arrangements
• Culture
• Staff training
• Time and tasks commissioned
• Contracting system
• Frequency of review
• Re-ablement package duration and flexibility
• Service users understanding and attitudes
• Carers perceptions of risk and on-going support
• Signposting to other services and support
• Culture of re-ablement across social care services

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Key Lessons for CASSRs establishing Re-ablement
Services

• Staff attitudes, skills and training
• Communicating the re-ablement ethos
• Capacity and throughput
• Flexibility
• Access to the re-ablement service
• Skill mix and relationship to other professionals
• Relationships with carers
• Role in assessment/review
• A whole systems approach

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Key Lessons for CASSRs establishing Re-ablement
Services

• Staff attitudes, skills and training
• Communicating the re-ablement ethos
• Capacity and throughput
• Flexibility
• Access to the re-ablement service
• Skill mix and relationship to other professionals
• Relationships with carers
• Role in assessment/review
• A whole systems approach

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Contact Details

• Liz Newbronner liz_at_actonshapiro.co.uk
• Websites www.csed.csip.org.uk
• www.york.ac.uk/spru
• www.actonshapiro.co.uk