The Wirral Reablement service developed from the Wirral’s in-house homecare service in 2004. It is now an established service in the community taking referrals from intermediate care, hospital, and social work teams and helping people to live independent lives.
The Wirral Reablement service is a community based service that operates from hospital occupational therapy and social work team referrals to help people lead independent lives in their own homes.
The service developed from the Wirral’s in-house homecare service in response to observations from local occupational therapists. The therapists found that the care agencies were inadvertently undoing some of the rehabilitation work they were doing with people in their homes.
Service Development Manager, Anne Bailey, says, “The therapists were trying to help people become independent following discharge home from hospital, for example by helping them to regain their confidence with cooking skills, but care agencies had been already organised to go in and cook the meals for them.”
The Home Assessment and Reablement Team (HART) judge people’s needs on a case-by-case basis. As a short-term care service, people generally need to be able to achieve agreed personal outcomes in approximately six weeks to be eligible for the service.
A new type of caring
The team was given extra training, although Anne explains that delivering the new service was less about them learning new skills and more about them changing the way they worked.
“The main thing was a change in philosophy. Rather than people going in and doing things for people, it was about actually standing back and supporting.”
To reinforce this change of culture, homecare staff in the Wirral are now called ‘enablers’ rather than ‘carers’.
“You actually need to spend more time with people for reablement because you are showing people how to do things,” Anne says. “It is very easy to put in a lunch call for half an hour, the carer flies around each person, but if you’re standing there saying you make the lunch yourself, it takes more time.”
Improving people’s home environment
Once someone is referred, an occupational therapist will visit their home and look at what improvements they can make to their home and lifestyle to enable the person to lead a more independent life. The therapist works with an enabler to write an intervention plan with areas for improvement. They both work with the person to achieve these.
“It might involve just organising things differently because what worked when they were fitter may not work for them now. Very simple things can make a huge difference. It might just be moving the microwave from its usual position to one where it can be accessed more easily. And then people say yes, they can do that now, they don’t need to become dependent on other people,” says Anne.
In some cases, a person may need more specialist equipment, such as an alarm pendent or a fall detection system.
“Assistive technology stops a lot of ‘check calls’, where staff go in and check the person is alright,” Anne says. “They can check at 2pm but the person can fall at 2:15. If the technology is in place, then it can detect the fall at any time.”
Building people’s self confidence
People’s confidence can be affected after a serious illness or a stay in hospital and they may be daunted by the thought of having to do things on their own. The HART team work with people to improve their confidence and help them achieve the things they want to do.
“Lots of our service users can feel so vulnerable when they come out of hospital and it knocks their confidence a bit. The reablement team can go in and encourage them and get them back into a routine and build their strength up,” says Anne.
Even people with ongoing care packages may benefit from the service and become more independent.
“There was a gentleman who was an amputee who needed help with personal care,” Anne says. “At first it didn’t look as though he would be able to do anything for himself, but through reablement he could look after the personal care of the top half of his body. That’s a huge achievement.”
Over time, the team withdraw care. They start by coming in every second day and review how things are going, until the person feels confident to do things themselves and does not need visits.
“Even the smallest improvement can make a change in someone’s quality of life,” says Anne. “It might be putting a pair of socks on or making a cup of tea. It can improve their self esteem by being able to do something for themselves.”