HOMECARE RE-ABLEMENT

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HOMECARE RE-ABLEMENT

• Gerald Pilkington
• Care Services Efficiency Delivery
• Housing, Home Care and Community Health Services
  Enabling People to Stay at Home
• 2nd December 2008

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HOMECARE RE-ABLEMENT Objectives of this
Presentation

• To provide
• a summary of the body of evidence in England
• how CSED supports development of re-ablement
  services
• Questions

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HOMECARE RE-ABLEMENT CSEDs role

• To support CSSRs to achieve their cashable
  efficiency targets within adult social care in
  England during CSR07
• Working through 10 programmes
• Transforming Community Equipment
• Referral, Assessment and Care Management
• Homecare Re-ablement
• Care Pathway Planning
• Support Related Housing and Technology
• Better Use of Information
• Crisis Response
• Commissioning (including Better Buying)
• Planning
• Personalisation of Social Care,
• Engaged with CSSRs through programme leads and
  regional teams

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HOMECARE RE-ABLEMENT CSED Proposition
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Homecare Re-ablement What is it ? a
definition (1)

• Prevention
• Services for people with poor physical or mental
  health
• To avoid unplanned or unnecessary admissions to
  hospital of residential care
• Can include short-term and longer term low-level
  support
• Rehabilitation
• Services for people with poor physical or mental
  health
• To help them get better
• Re-ablement
• Services for people with poor physical or mental
  health
• To help them accommodate their illness by
  learning or re-learning the skills necessary for
  daily living
• Definitions from an evaluation report by De
  Montfort University

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Homecare Re-ablement What is it ? (2)

• Common principles and features
• helping people to do rather than doing to or
  for people
• outcome focused with defined maximum duration
• assessment for ongoing care packages cannot be
  defined by a one-off assessment but requires
  observation over a defined period
• Objectives are
• to maximise users long-term independence, choice
  and quality of life
• to appropriately minimise ongoing support
  required
• and, thereby, minimise the whole life-cost of
  care

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HOMECARE RE-ABLEMENT Does it work ? (1)
Homecare Package at First Review Homecare Package at First Review Homecare Package at First Review Homecare Package at First Review
Care package reqd post 1st review (6 wks) Matched service users (control group) Re-ablement Pilot (selective) Re-ablement Roll-out (intake)
Discontinued 5 62 58
Decreased 13 26 17
Maintained 71 10 17
Increased 11 2 8
Total 100 100 100
Leicestershire De Montfort study 2000
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HOMECARE RE-ABLEMENT Benefits
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HOMECARE RE-ABLEMENT Does it work ? (2)
Leicestershire Intake 1 Mod above Dudley Intake 1 Mod above Milton-Keynes Intake 2 Subs above Poole Intake 2 Mod above Salford Intake 1 Mod above Wirral Discharge 2 Subs above
no package 50 21 55 44 62 81
reduced package 18 to spec serv with 16 reduc 29 ongoing with 30 reduc 26 11 13 lt 4 hrs / wk 1 4 to 7 hrs / wk 1 gt 7 hrs / wk 31 9
main. Package 18 to spec serv with 16 reduc 29 ongoing with 30 reduc 23 11 13 lt 4 hrs / wk 1 4 to 7 hrs / wk 1 gt 7 hrs / wk 31 9
incr. package 18 to spec serv with 16 reduc 29 ongoing with 30 reduc 7 11 13 lt 4 hrs / wk 1 4 to 7 hrs / wk 1 gt 7 hrs / wk 1 9
to other care 13 33 41 5 9
Overall redn hrs 58 42 80
1 FACS applied at entrance to homecare
re-ablement 2 FACS applied at exit from
homecare re-ablement
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HOMECARE RE-ABLEMENT Retrospective Longitudinal
Study Duration free from homecare
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HOMECARE RE-ABLEMENT Retrospective Longitudinal
Study -Changes in level of need since re-ablement
for gt 65s
Exit users transferred to long-term care or died
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HOMECARE RE-ABLEMENT Comparing Conventional and
post Homecare Re-ablement packages

• Comparing the results of the De Montfort study
  and Retrospective Longitudinal study over a 24
  month period.

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HOMECARE RE-ABLEMENT CSED Documents

• As a result of its work with CSSRs, CSED
  has produced a body of evidence which is
  available via its website
• Executive Summary and Discussion Document
  published January 2007
• containing information from 5 case studies and 13
  additional information sites, supporting
  documents evaluations, evidence of benefits,
  example documents.
• Assessment tools and satisfaction surveys
  published August 2007
• 7 examples of functional assessment tools used
  within CSSRs
• Summary of outcome measures / standardised
  assessment tools
• 8 examples of satisfaction survey tools
• Retrospective Longitudinal Study published
  November 2007
• working with four CSSRs, tracks 2,441 people that
  underwent a phase of homecare re-ablement for 24
  months and quantifies the duration of benefit
• CSSR Status Directory Update published May 2008
• provides an update on 137 CSSRs

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HOMECARE RE-ABLEMENT Outline of Direction for
2008/09

• Focusing on 4 projects
• Continued roll-out of the Homecare Re-ablement
  model
• CSSR Homecare Re-ablement Scheme directory -
  completed
• Benefits of homecare re-ablement - underway
• Outsourced services
• Clients with mental health, physical, sensory and
  learning disability needs
• Prospective Longitudinal Study underway
• Working with nine CSSRs
• to identify the features of an effective and cost
  efficient service
• to maximise both outcome and duration of benefits
  and reduce variability between services
• to understand and reduce the demands on other
  formal care, including
• other social care services e.g. delay or prevent
  admission to residential care
• other council services
• delay or reduce demands on health
• Homecare Re-ablement for those on maintenance
  packages
• seek to provide evidence through case studies and
  supporting information of the benefits of
  homecare re-ablement for those who have been in
  receipt of a maintenance homecare package.

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HOMECARE RE-ABLEMENT Social Care in England (1)

• Department of Health has policy responsibility
• Delivery is responsibility of councils with
  social service responsibility (CSSRs)
• Councils report to Communities and Local
  Government department NOT Dept of Health
  locally responsible to elected councillors
• Gross spend on adult social care 2006/07 -
  16.5 bn (plus 5.6 bn on children
  and families services, and asylum seekers)

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HOMECARE RE-ABLEMENTSupporting Development (1)

• National
• CSED to provide national platform and subject
  matter focus
• CSED involvement to develop generic skills
• Promote joint work with other efficiency and
  change programmes e.g. Regional Efficiency
  Improvement Partnerships (REIPs), Care Services
  Improvement Partnerships, etc.
• Local
• Champion
• Dedicated and skilled project manager
• Project board
• Clear statement of vision
• Develop as is and to be models,
  prioritisation
• Consider capacity for change

Slide 16
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HOMECARE RE-ABLEMENT Supporting Development (2)

• CSED can support CSSRs in a range of ways
• Input to strategic thinking about nature of
  service
• Advice on key areas for consideration in
  pre-planning and implementation phases
• Subject matter advice based on work with CSSRs
  across England
• Linkage to other CSSRs at similar stage or
  advanced stage of service implementation /
  maturity
• Generic project management skills by regional
  team

Slide 17
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HOMECARE RE-ABLEMENT Contact with CSED

• Gerald K Pilkington
• CSED Lead
• Homecare Re-ablement
• gerald.pilkington_at_dh.gsi.gov.uk
• www.csed.csip.org.uk
• Telephone [phone]