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Position statement reablement
British Association and College of Occupational Therapists
Nov 22, 2010
Health & Medicine
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Transcript of "Position statement reablement"
1. © 2010 College of Occupational Therapists 106-114 Borough High Street, Southwark, London SE1 1LB www.cot.org.uk Page 1 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
© 2010 College of Occupational Therapists 106-114 Borough High Street, Southwark, London SE1 1LB www.cot.org.uk Page 2 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).
© 2010 College of Occupational Therapists 106-114 Borough High Street, Southwark, London SE1 1LB www.cot.org.uk Page 3 • 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.
© 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. Director of Professional Operations UK Publication date: Lead group: Country Relevance: November 2010 RReevviieeww DDaattee December 2012