SCOPE OF THIS CHAPTER

The Reablement Team provides people with short term support to help them learn or re-learn skills for daily living. When a person who appears to need social care support contacts Hull City Council, the Reablement Team will carry out an initial assessment of need or will facilitate access to a self-assessment. The initial assessment will identify whether the person is likely to benefit from a reablement service or whether they need longer term support.

RELEVANT INFORMATION

Roles and Principles of Reablement (SCIE)

Intermediate Care (including reablement) (NICE)

1. Introduction

Reablement is a strengths-based, person-centred approach that promotes and maximises independence and wellbeing. It aims to ensure positive change using goals which have been agreed with the person, and is designed to enable people to gain, or regain, their confidence, ability, and necessary skills to live as independently as possible, especially after an illness, deterioration in health or injury (Scie)

Reablement will be offered to people who meet the criteria for such a service, free of charge for up to six weeks. It is important to identify those who qualify for the service prior to commencement. Support offered to people who do not meet the eligibility criteria for reablement will attract a charge from the outset.

2. Essential Elements which Define Reablement

Reablement:

  • actively helps people to do things for themselves, rather than doing things to, or doing things for, people;
  • involves setting and working towards specific goals agreed between the person and the Reablement Team;
  • assumes that something should change by the end of the reablement intervention; the person is working towards positive change;
  • aims to reduce or minimise the need for ongoing support after the period of reablement;
  • is time limited; the maximum time that the person can receive reablement support is decided at the start. For most people, this will be six weeks or less.

3. Eligibility for Reablement Services

To be eligible for reablement:

  • The person has a need for support which meets the national eligibility criteria for social care support (see Establishing Eligibility for Adult Social Care chapter);
  • The need for support has arisen from a crisis such as an accident or illness which leads to a temporary impairment;
  • The assessment of need supports a reasonable belief that following reablement, the person will regain full independence.

3. Essential Elements which should be present in all Support Services

All services should be outcome focused; the overall goal is to help people maximise their independence and wellbeing. This means that the level of support offered may reduce as outcomes are achieved and individual resilience grown.

All services should adopt a very personalised approach; the kinds of support given are tailored to the person’s specific goals and needs.

Assessment of need should be regarded as something that is dynamic not static. This approach means that decisions about the person’s care or support package cannot be decided on the basis of a single, one off assessment, instead the assessment should recognise that people’s needs and abilities will change over time and respond accordingly.

All support services should build on what people currently can do, and support them to regain skills to increase their confidence and independence.

Assessment and support planning should explore the use of appropriate equipment and / or assistive technology.

4. Procedure – Providing Reablement

When a person who appears to need social care support contacts Hull City Council, the Reablement Team will carry out an initial assessment of need or will facilitate access to a self-assessment. Following the initial assessment of need, some people will be placed on the reablement pathway and some on the long term support pathway  – depending on their needs. It is vital to establish and communicate which pathway the person is on, as those on the long term support pathway will be subject to charges as soon as support is provided.

Reablement  support does not attract a charge. Support is provided across the full 24 hours, dependent on the person’s needs. 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 person’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 person at the commencement of support.

The reablement team will take a holistic approach, and consider the wellbeing of the whole family and will use information from the person 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

4.1 Procedural Steps

Step Action By Whom
1. Each referral will be assessed either by a worker or a self-assessment, and will then be considered against the national eligibility criteria (see Establishing Eligibility for Adult Social Care).

If the person is not 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 person in writing, and also added to their electronic case record. The letter should include advice that the person should come back if their circumstances change, at which point their needs may be re-assessed. If the person needs long term support, this must be communicated them from the beginning, and an explanation given that subject to financial assessment, this will generate a charge.

Social worker/ assistant/ occupational therapist/ sensory worker
2. The person must give their consent to completing the assessment.  If the person appears to lack mental capacity, the worker will carry out an assessment under the Mental Capacity Act to determine whether completion of the assessment is in the person’s best interests. Social worker/ assistant/ occupational therapist/ sensory worker
3. The assessment should be completed and personalised goals and outcomes set or agreed by the person. They 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 person 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 their contribution. Social worker/ assistant/ occupational therapist/ sensory worker
4. Support responses should be agreed with the person to achieve their identified goals and outcomes. 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 person is receiving 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 them during the fourth week.

If a person 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. If they wish to take a direct payment, they will be referred to the Long Term Support Team who will carry out or facilitate an 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 them, and the potential for charges 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 person 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 person 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 person will be discharged from the Reablement service, and transferred or signposted to other support in the community if required. Reablement worker
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