The Home Cure? The role of social housing providers in delivering reablement

The project  Working with Midland Heart, Demos explored the ways in which social housing providers could have a role to play in home care reablement  Carrying out interviews, focus groups and reviews of reablement evaluations, we launched “The Home Cure” in June 2012

Why?  21% of people over 65 and 24% of people aged 75 or over live in social housing.  45 per cent of general needs lettings in social housing are made to people identified to have at least one element of vulnerability (disability, risk of homelessness, substance abuse etc)  Housing staff have unique trust relationships and in-depth knowledge of their tenants through frequent in-the-home contact  50% of the sector already providing care and support services alongside accommodation

What we found…  The evidence we gathered as part of this project, including speaking to local commissioners, reablement providers and older people with experience of reablement, suggested home care reablement could be improved in three ways:  It could be more personalised. The physical and emotional support needed in reablement differs from individual to individual.  It could focus more on activities outside the home, building people’s confidence to reengage with their community and not just tasks such as dressing and cooking  It could do better in smoothing the cliff edge when support is withdrawn, by building people’s resilience and support networks to step in after the 8 week period and re-affirm “reablement ethos”.

Is housing the answer?  There are many ways these areas might be addressed - Providing standardised training for existing reablement teams which includes activities outside the home is a simple one.  But as the commissioning of reablement shifts from local authorities to health commissioners, there is a good opportunity to think more radically about how reablement might improve.  To think not just about how it is delivered, by who delivers it.

Ways in which social housing could help  Delivering a more flexible and personalised response to reablement, thanks to these on-going relationships and the fact that most RSLs already provide a very varied range of support services responding to tenants’ needs  Focusing on a person’s neighbourhood and community, and the wider activities social landlords are already often involved in coordinating and encouraging  Sustaining the reablement ethos after reablement has finished, thanks to on-going housing staff presence who are able to reinforce reablement messages over the longer term  Improving access to equipment, technology and adaptations – another key factor in successful reablement.  Being a source of earlier (community) referrals among their tenants who might benefit  These benefits can be realised by housing providers working in partnership with reablement teams or as a direct deliverer of reablement

Partnership or delivery?  RSLs should actively pursue reablement contracts and challenge CCGs to think more creatively about the “who and the how” of reablement  Not every RSL will be able or willing to deliver reablement, but can be potentially hugely valuable partners to existing reablement teams.  That requires far better communication between reablement services – and care services more generally – and their housing counterparts.  Hospital discharge planning - housing staff must be informed by health and care services when one of their tenants are hospitalised, when they are being discharged  Housing staff should be briefed on what that person’s reablement priorities are – case management meetings – and co-opted to the cause  Reablement teams and housing providers need channels of communication above individual case level

The bigger issue  There needs to be further evaluation of reablement practice to identify ‘what works’ in achieving the best outcomes, and greatest cost efficiencies, over the longer term  There needs to be a more coherent and consensual understanding of what reablement entails.  Reablement would benefit from greater standardisation when it comes to training, accreditation, team composition and good practice on what reablement should seek to achieve  As part of this standardisation, there needs to be a wider, more holistic approach to reablement embedded as best practice. Such an approach strives to achieve independence in one’s community, not just in one’s home.

Concluding thoughts  We don’t have the evidence base to assert conclusively that working more closely with RSLs will make reablement more cost effective, or reduce the risk of hospital readmission.  The evidence on what works is limited. But that’s no reason to stick to the status quo.  Because we do know that building people’s social networks, getting access to the right home based equipment, and sustaining a focus on enablement and independence does improve older people’s health outcomes and reduces the risk of emergency admissions.  It certainly makes housing with care providers an interesting possibility when it comes to rethinking reablement.  And as commissioning for reablement changes, now is the time to re-evaluate what reablement currently achieves and what potential is untapped to achieve more. 