Occupational therapists can provide significant benefits and cost savings within reablement programs. Their training allows them to personalize reablement services based on an individual's medical, physical, and psychological needs. Multiple studies show that occupational therapist involvement leads to reduced home care needs, improved outcomes for patients, and healthcare cost reductions of up to 50%. If local authorities want to achieve the best results and cost benefits from reablement, they need to involve occupational therapists and their specialized skills.

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Why should organisations invest in reablement programmes?
Reablement has been shown to deliver cost efficiencies. A 2007 study for Care Services Efficiency
Delivery Programme (CSED) found that following reablement up to 68% of people no longer needed a
home care package and up to 48% continued not to need home care two years later (Care Services
Efficiency Delivery Programme, Homecare Re-ablement Workstream 2007).
Why should occupational therapists be involved in reablement programmes?
The added expertise and involvement of occupational therapists in reablement teams contribute to
successful reablement services (Rabiee and Glendinning 2010). Occupational therapists’ unique skills and
training make them pivotal to ensuring services are efficient and effective and reduce dependency i.e:
• Their training places them in the unique position of understanding the medical, physical and
psychological impact of disability or injury on an individual.
• Their knowledge of the effects and impact of disabling conditions ensures reablement is personalised
and specifically tailored for the individual through skilled assessment.
• They are trained in rehabilitative techniques and in restoring and aiding recovery.
• They have an extensive knowledge and understanding of the equipment and adaptations that are a
major part of reablement services (Rabiee and Glendinning 2010).
• They are able to address an individual’s broader goals that will help them integrate with their local
community and reduce depression and participate in the activities that are important to them.
• They have experience of working in both health and social care and return to work schemes.
• They are invaluable in integrated teams as they have an ability to understand both the health and
social care context.
• They can reliably measure improvement and outcomes using standardised assessment techniques.
• They have an evidence base that demonstrates considerable cost savings
• They are person-centred in approach.
If local authorities want to achieve the best outcomes for both their service users and
demonstrable cost benefit for their reablement services they need to involve occupational
therapists.
What is the added value of occupational therapists within reablement programmes?
Occupational therapists deliver personalised services that:
• Focus on an individual’s occupational needs in terms of leisure work and other activities that aid
mental and physical health and wellbeing.
• Use their skills in working across both health and social care bringing added knowledge of other
interventions that may aid recovery and reablement . They are therefore good at signposting service
users to other services.
• Utilise their knowledge of disabling conditions and their impact so that reablement is specifically
tailored to the individual and takes into account the likely progress of their condition.
• Make them well placed to provide enhanced training to home care staff to deliver efficient and
effective reablement services (Glendinning and Newbronner 2008).
Occupational therapists’ core skills are key to preventative services and are underpinned by
an evidence base that demonstrates clear cost benefits and successful patient reported
outcomes.
What is Reablement?
Reablement is becoming a more commonly used term within adult social care services across the UK to
describe services that maximise an older person’s potential within the recovery process. Reablement
either prevents the need for hospital admission or post-hospital transfer to long term care, or
appropriately reduces the level of ongoing home care support required and associated costs.
Reablement: the added value of Occupational Therapists

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The importance of the benefits of reablement has been recently recognised in England with the
announcement from Health Secretary, Andrew Landsley, of the release of £70 million to assist people
leaving hospital after illness or injury (Department of Health 2010).
Key benefits of reablement programmes delivered by occupational therapists are:
• Re-integration of the service user into community settings that meet their desired goals for leisure
and occupation (where measured this has reduced depression).
• Assisting individuals to return to work (either paid or unpaid) using a wide range of techniques,
commonly known as vocational rehabilitation (where paid work has been achieved there have been
added benefits of receiving a wage).
Evidence/Key Facts
Below are some examples of research that provide evidence of the efficacy of occupational therapists
within the context of reablement;
• Occupational therapists within social care services are in a unique position to respond to individual
needs through rehabilitation programmes which focus on improving people’s abilities and assisting in
engaging in the wider community through purposeful activities or leisure or vocational rehabilitation
(College of Occupational Therapists and Association of Directors of Social Services 1995).
• Targeted occupational therapy intervention at home increases outdoor mobility in people after
stroke (Logan PA et al 2004).
• A randomised controlled trial found that a single home visit by an occupational therapist reduces the
risk of falling after a hip fracture in elderly women (Di Monaco et al 2008).
• Occupational therapy- based rehabilitation offered in a one year period after stroke onset or
discharge from hospital reduced the risk of patient deterioration in ability to perform activities of
daily living for community dwelling patients (Campbell 2004).
• Providing ten sessions of occupational therapy to those with dementia over five weeks improves
functioning and reduces burden on the care giver. Effects remain significant after three months
(Graff et al 2008).
• The promotion of good health for older people reduces their need for more costly medical
interventions and improves quality of life. Occupational therapists have been identified as key to
promoting mental health and wellbeing in the NICE Public Health Guidance (2008).
Cost Benefit
• A randomised control trial in independent-living older adults (the Well-Elderly Study) found
significant health, function, and quality of life benefits attributable to a 9-month preventive
occupational therapy programme. This study aimed to evaluate the cost-effectiveness of this
preventive programme. It was found that there were reduced post intervention healthcare costs of
50% within the occupational therapy groups compared to the control group. Conclusion: preventive
occupational therapy demonstrated cost-effectiveness and a trend toward decreased medical
expenditures (Hay J et al2002).
• Norfolk County Council’s reablement scheme led by occupational therapists found that care hours
were reduced for those going on to longer term care by 90% (Allen and Glasby 2010).
• In one study, occupational therapists who reviewed care packages produced substantial savings. The
need for care was removed in 50% of cases reviewed (Riverside Community Health Care NHS Trust
1998).
• A study that explored the relationship between provision of equipment and reduction on care
package costs and residential care found that over an eight week period cost savings to care
packages through provision of equipment were over £60,000 (Hill. S (2007).
• Housing adaptations reduce the need for daily visits and reduce or remove costs for home care
(savings range from £1,200 to £29,000 a year) (Heywood and Turner.2007).
• Provision of additional moving and handling equipment by occupational therapists reduces the need
for two carers to assist with personal care needs. In Somerset, of the 125 services users who were
assessed; 37% (46) of them are now only assisted by one carer (instead of two), with savings of
£270,000 achieved. The average initial investment in equipment was £763 per service user (Mickel
2010).
• A fall at home that leads to a hip fracture costs the state £28,665 on average (£726 million a year in
total). This is 4.5 times the average cost of a major housing adaptation and over 100 times the cost of
fitting hand and grab rails to prevent falls (Heywood et al 2007).
• A one year project in Nottingham (quoted in DH 1999) investigated whether home care resources
were being adequately targeted. Following an occupational therapy assessment and intervention the
need for home care was reduced.
• It is estimated that just one year’s delay in providing an adaptation to an older person costs up to
£4,000 in extra home care costs (Care and Repair England 2010).

3. © 2010 College of Occupational Therapists
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• Postponing entry into residential care by just one year through adapting peoples home saves £28,080
per person (Laing and Buisson 2008).
Definition of Terms
Across health and social care the terms reablement, enablement, rehabilitation, and intermediate care
tend to be used loosely, and the boundaries between the services they refer to are often blurred.
Reablement- aims to help people accommodate their illness or condition by learning or relearning the
skills necessary for daily living (Care Services Efficiency Delivery Programme, Homecare Re-ablement
Workstream 2007).
Enablement – to provide someone with adequate power, means, opportunity, or authority (to do
something) (HarperCollins 1992).
Rehabilitation – A process aiming to restore personal autonomy in those aspects of daily living
considered most relevant by patients or service users and their family carers (Sinclair and Dickinson
1998).
Intermediate care– the primary function of intermediate care is to build up people’s confidence to
cope once more with day to day activities. It serves as an extension to specialist clinical care and
rehabilitation, but not as a substitute for it: quick access to specialist medical and other support when
needed is vital (Audit Commission 2000).
Recovery is about building a meaningful and satisfying life, as defined by the person themselves,
whether or not there are ongoing or recurring symptoms or problems. Recovery represents a movement
away from pathology, illness and symptoms to health, strength and wellness (Shepherd et al 2008).
Occupational therapy values
‘The occupational therapist values individual experience, cultural diversity, religious beliefs and lifestyle
diversity in her/his clients, within the occupational therapy profession and in colleagues. S/he accords
equal respect to all, acknowledging that each person has rights.
The expression of these values means that occupational therapy is essentially a flexible process in which
the therapist listens to the client in order to understand and respond to her/his needs, values, interests
and aspirations. For intervention to be integrated into the life and context of the individual, the family
and carers, it must be culturally sensitive and culturally relevant.’ (Creek 2003, p29).
Occupational therapists are regulated by the Health Professions Council, which ensures a high level of
protection for the public.
References
Allen K, Glasby J (2010) ‘The billion dollar question’: embedding prevention in older people’s services: 10
‘high impact’ changes. Birmingham: University of Birmingham, Health Services Management Centre.
Audit Commission (2000) The way to go home: rehabilitation and remedial services for older people.
London: Audit Commission.
Campbell HM (2004) Review: therapy based rehabilitation services reduce the risk of deterioration in
patients who have had a stroke. Evidence Based Nursing, 7(4), 117.
Care and Repair England (2010) Home adaptations for disabled people. Nottingham: Care and Repair
England.
College of Occupational Therapists; Association of Directors of Social Services (1995) Realising the
potential: occupational therapy in the community. London: COT; ADSS.
Care Services Efficiency Delivery Programme, Homecare Re-ablement Workstream (2007) [Homecare re-
ablement] retrospective longitudinal study November 2007. London: Care Services Efficiency Delivery.
Available at: http://www.dhcarenetworks.org.uk/_oldCSEDAssets/longit-study-bc.pdf
Accessed on 27.10.10.
Creek J (2003) Occupational therapy defined as a complex intervention. London: College of Occupational
Therapists.
Department of Health (1999) Community occupational therapy services: report of conference
programme, February - March 1998: linking the thinking: integrating practices. London: DH.
Department of Health (2010) £70 million support to help people in their homes after illness or injury.
London: DH. Available at: http://www.dh.gov.uk/en/MediaCentre/pressreleases/DH_120118
Accessed on 27.10.10 .
Di Monaco M, Vallero F, De Toma E, De Lauso L, Tappero R, Cavanna A (2008) A single home visit by an
occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-
randomized controlled trial. Journal of Rehabilitation Medicine, 40(6), 446-450.
Glendinning C, Newbronner E (2008) The effectiveness of home care reablement:- developing the
evidence base. Journal of Integrated Care, 16(4), 32-39.

4. © 2010 College of Occupational Therapists
106-114 Borough High Street, Southwark, London SE1 1LB
www.cot.org.uk Page 4
Graff M, Adang E, Vernooij-Dassen M, Dekker J, Jönsson L, Thijssen M, Hoefnagels W, Rikkert M (2008)
Community occupational therapy for older patients with dementia and their caregivers: cost
effectiveness study. British Medical Journal, 336(7636), 134-138.
Hay J, LaBree L, Luo R, Clark F, Carlson M, Mandel D, Zemke R, Jackson J, Azen SP (2002) Cost-
effectiveness of preventive occupational therapy for independent-living older adults. Journal of the
American Geriatrics Society, 50(8), 1381-1388.
Heywood F and Turner L (2007) Better outcomes, lower costs: implications for health and Dsocial care
budgets of investment in housing adaptations, improvements and equipment: a review of the evidence.
London: Stationery Office.
HarperCollins (1992) Collins softback English dictionary. Glasgow: HarperCollins.
Hill S (2007) Independent living: equipment cost savings. [Research report identified through the COT
Killer Facts Database].
Laing and Buisson (2008) Care of elderly people: UK market survey 2008. London: Laing and Buisson.
Logan PA, Gladman JRF, Avery AJ, Walker MF (2004) Randomised controlled trial of an occupational
therapy intervention to increase outdoor mobility after stroke. British Medical Journal, 329(7479), 1372-
1375.
Mickel, A (2010) A ticking timebomb. Occupational Therapy News [OTnews], 18(5), 38-39.
National Institute for Health and Clinical Excellence (2008) Occupational therapy interventions and
physical activity interventions to promote the mental wellbeing of older people in primary care and
residential care. London: NICE.
Rabiee P, Glendinning C (2010) The organisation and content of home care re-ablement services.
(Research Works 2010-01). York: University of York, Social Policy Research Unit.
Riverside Community Health Care NHS Trust (1998) The Victoria project: community occupational
therapy rehabilitation service: research findings and recommendations. London: Riverside Community
Health Care NHS Trust.
Shepherd G, Boardman J, Slade M (2008) Making recovery a reality. London: Sainsbury Centre for Mental
Health.
Sinclair A, Dickinson E (1998) Effective practice in rehabilitation: the evidence of systematic reviews.
London: Kings Fund.
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