SCOPE OF THIS CHAPTER

The Reablement Service provides short term support to people to help them learn or re-learn skills for daily living. It will take the majority of customer initial contacts who appear to need social care support and will carry out an initial assessment of need or will facilitate access to self assessment. This initial assessment will identify whether the person is likely to benefit from a reablement service or whether they need a long term support service.

RELATED CHAPTER

Reablement

1. Principles

The reablement team will offer an initial response and assessment to the majority of customers who need social care support. Some will be placed on the reablement pathway and some on the long term support pathway. It is vital to establish and communicate which pathway the customer is on at the outset as those on the long term support pathway will be subject to charges as soon as support is provided.

Reablement is an intermediate care service which is up to six weeks in duration. Its primary aim is to help someone regain skills for daily living in order to reduce or eliminate their long term dependency on social care support. This part of the service does not attract a charge. Support is provided across the full 24 hours, dependent on customer need. The emphasis is on facilitating self-care; giving people time, encouragement and confidence to do things for themselves.

The team also provides an initial response and assessment to people who have longer term needs and enables the planning of and access to long term support by assessing need and determining the customer’s level of entitlement. A direct payment will be offered and if it is declined, support will be commissioned to meet needs. Subject to financial assessment, this service will generate a charge from the outset and this must be established and communicated to the customer at the commencement of support.

The Reablement service will take a holistic approach for the wellbeing of the whole family and will draw upon information from the customer and all relevant parties to identify and determine the level of need and support required. Technology and Telecare solutions will be explored as an integral part of delivering outcomes, and signposting to universal information and advice and community based solutions will be prioritised.

2. Procedural Steps

Step Action By Whom
1. Each referral will be assessed either by a worker led or a self assessment and will then be considered against the nationaleligibility criteria (to follow).

If the person is not found to be eligible to receive care and support, the Reablement Team will provide information and advice about other sources of support. In such cases, the reasons for the decision should be sent to the individual concerned in writing, and a written record made. The letter should include advice that the individual should come back if their circumstances change, at which point their needs may be re-assessed. A contact number in the council should be given.

If the person needs long term support, this must be communicated to the customer at the outset of that support and an explanation given that subject to financial assessment, this will generate a charge from the outset.

Social worker/ assistant/ occupational therapist/ sensory worker
2. Consent should be gained by the customer prior to completing the assessment.  If the customer appears to have a lack of capacity the worker will carry out an assessment under the Mental Capacity Act and determine whether completion of the assessment is in the person’s best interest Social worker/ assistant/ occupational therapist/ sensory worker
3. The assessment should be completed with personalised goals and outcomes set or agreed by the customer. The customer should be made aware of the potential for a charge for support immediately if they are on the long term support pathway or following the six weeks of their Reablement support. If the customer is on the long term pathway,  their personal budget must be established using the resource allocation system and a financial assessment carried out to establish the level of contribution. Social worker/ assistant/ occupational therapist/ sensory worker
4. Support responses should be agreed with the customer which achieve the outcomes agreed above. If the person needs other services, they should be signposted to the relevant agency or organisation and, where appropriate, contact made on their behalf. Social worker/ assistant/ occupational therapist/ sensory worker
5. During the period the customer receives support from the Reablement Team weekly reviews will be held to ensure the support meets the agreed outcomes. Reablement worker
6. For people on the reablement pathway, the discharge date from the reablement programme will be agreed with the customer during the fourth week.

If a customer who has been on the reablement pathway then needs ongoing support, their needs will be assessed and their level of entitlement determined.

They should be asked if they want to receive support via a direct payment or a budget managed by the Local Authority and if they wish to take a direct payment, they will be referred to the Long Term Support Team who will carry out or facilitate the assessment. if they wish to have a managed budget, they will be referred to the Reviewing Team who will carry out or facilitate the assessment.

Social worker/ assistant/ occupational therapist/ sensory worker
7. The amount of money the Local Authority will provide to meet the person’s needs will be explained to the person, and the potential for a charge to be levied will be explained.

The completed Resource Allocation System tool will be forwarded to the Fairer Charging Team.

Social worker/ assistant/ occupational therapist/ sensory worker
8. If the customer wishes to take a direct payment, they will have been referred to the Long Term Support Team. Services from the Reablement Team will continue to be provided for a maximum of six weeks until services commissioned by the Direct Payment are in place.

If the customer does not wish to take a Direct Payment, they will be referred to the Long Term Support Team and services commissioned to meet their needs. Services from the Reablement Team will continue to be provided for a maximum of six weeks until these services are in place.

Social worker/ assistant/ occupational therapist/ sensory worker
9. Where no further needs are identified, the customer will be discharged from the Reablement service, and transferred or signposted to other support in the community if needed. Reablement worker