Reablement Paul Collinge Joint strategic Commissioning Manager – Older People

What’s it all about Individuals tell us of their; –Increased desire to retain and maximise independence, choice and control over their lives and not to be a passive recipient of care –Increasing desire to live longer and healthier with a good quality of life into old age. –To increase their self esteem and resilience or ability to care for themselves and manage challenges and opportunities as they arise

Context Significant increase in elderly population with similar potential increase in demand and costs – approximately 30 % increase in over 75’s in next 10 years – and a growing proportion of all elderly are anticipated to have dementia Unchecked the costs of domiciliary care provision alone could rise by £7.5 over same time period. Government and local policy to provide services which maximise independence and opportunities for recovery for older people including those with dementia Many other LA’s through reablement are impacting on demand for LT care Part of Devon’s development a range of integrated of health and social care services including Complex care teams Intermediate Care Equipment services Etc

Social care reablement service Available to support older people including those with dementia and younger individuals with disabilities or life limiting long term conditions. Offered to all individuals seeking personal care services for the first time or where there has been a sudden and significant increase in personal care needs. Where necessary provided alongside primary care, complex care teams and rehabilitation services. Represents a different basis for engagement with individuals and their carers It means we will; –Provide a full opportunity for recovery, to maximise independence and to support the carer before agreeing with you your longer term support needs. –Provide a full assessment is completed which will include the outcome of the reablement intervention

Anticipated Outcomes of reablement Individual and carer outcomes Improved abilities with personal care, mobility, medication and domestic routines Improved ability for self care (personal care and health care) Reduced carer stress Improved self esteem and well being Organisational outcomes Reduced demand for long term personal care services with reductions in the anticpated increase in personal care costs in future years Delay use of intensive services at home or in care home. NHS benefits in terms of reduced use of primary and secondary care services.

Case Study Mrs Smith 75 years of age lives alone Daughter lives nearby and is the main carer Mrs Smith is experiencing increasing periods of forgetfulness. She suffers with Arthritis and Diabetes. She has fallen recently and is now less mobile around her home. Mrs Smith and her daughter are becoming increasingly anxious about how she might cope with her personal care whilst at home. Mrs Smith appears to have lost confidence in her ability to care for herself. Prior to the fall Mrs Smith received no personal care services but her daughter provided some assistance with bathing.

Reablement What might happen next? Mrs Smith Daughter contacts care Direct Plus and discusses the case with an Occupational therapist (OT) – the OT also speaks to Mrs Smith – the OT also speaks with Mrs Smith GP to see if there are any health issues that should be addressed. They agree on what Mrs Smith and her daughter feel needs to improve (goals) to enable Mrs Smith to care for herself as much as possible at home. The OT devises a programme that captures those goals and instructs care workers how care should be provided to ensure they are met Mrs Smith is visited at home by a support worker who works with Mrs Smith to improve her walking, strength and balance through various exercises, and to improve her ability to transfer from bed and chair, initially assisted with appropriate equipment that has been ordered by the OT. The OT arranges bathing equipment to assist the daughter to bath her mother more safely and with less strain for the carer. The support worker works with the local pharmacist to introduce and train Mrs Smith in equipment that reminds Mrs Smith when to take prescribed medication. Failing to take medication being a critical factor in the original fall. Mrs Smith is issued with a fall detector which reassures Mrs Smith and her daughter that in the event of fall in future, help will get to Mrs Smith much more quickly.

Reablement – What Changes? Mrs Smith’s walking, strength and balance improve and with the help of a walking aid now feels fully confident getting around her house and transferring from bed, chair and toilet unaided Mrs Smiths daughter is reassured now her mother has a falls detector and now that she has suitable bathing aids and equipment that reminds her mother to take her medication Because the GP was alerted Mrs Smith has been invited into her GP surgery for an assessment of her forgetfulness, her bone health and her Diabetes and her medication has been reviewed. Mrs Smith is now attending a falls exercise class at her GP surgery. Mrs Smith and her daughter now attend their local Dementia Café for support. By week 6 Mrs Smith requires no personal care services ( where she may previously received 3 hours per week at £50 p.w.), she feels more independent and less anxious that at the start of reablement.