Why occupational therapists are central to reablement services

Occupational therapists' unique skills and training make them ideal to deliver training for support workers and homecare staff

Reablement has been defined as helping people accommodate their illness or condition by learning or relearning the skills necessary for daily living and thereby reducing the need for homecare. The preventative nature of reablement is particularly valuable. It promotes independence and helps people to look after themselves. This is good for their overall well-being, reduces their current and future reliance on other services and helps them to lead continuing and fulfilling lives.

Reablement is often viewed as a relatively new, short-term intervention in social care. There has been a recent shift in homecare, from doing tasks for an individual to helping an individual undertake everyday tasks independently. For homecarers, this has been a huge culture shift. The shift has largely relied on occupational therapy staff training home carers in the range of techniques that they use to achieve the desired reablement outcomes. Occupational therapists' unique skills and training in all aspects of rehabilitation, recovery and enabling make them ideal to deliver training for support workers and homecare staff. For them, and others working in reablement, such as physiotherapists, these interventions are not 'new'. The rehabilitation techniques they use and teach are grounded in research gained over years of experience from their respective disciplines. Their role is vital in embedding a reabling culture and ethos in the daily practice of homecare.

For example, there are specific techniques that can be used to help an individual who has weakness in their muscles and who is finding it difficult to undertake essential tasks such as getting dressed. Techniques used by an occupational therapist would be tailored to the individual's personal needs and would take into account their potential recovery.

Occupational therapists have particular competence in assessment and goal setting. They also have a holistic knowledge of the medical, physical, emotional and cognitive impact of disability and injury. This means that they can ensure that reablement is personalised to the individual, and that it is used to maintain function and independence.

If the skills of occupational therapists are used appropriately; sustainable reablement can be achieved in many cases. Agreeing goals in partnership with service users; knowing what is important to them, understanding their responsibilities, roles and the occupations they wish to continue is an important element of goal planning and motivation if desired outcomes are to be achieved.

Prompt access to occupational therapy and the specialist support occupational therapists provide is essential to avoid delays in gaining independence. They provide support in breaking down an everyday task to a manageable level, building strength and confidence in undertaking tasks, learning how to do a task differently, goal setting, understanding the difficulties that a medical condition may impose and finding solutions, plus the assessment and provision of equipment and adaptations. Enabling self management of long term conditions or illness, building confidence and creating independence, making life worth living is the foundation of the occupational therapy ethos.

Promoting mental health and wellbeing and supporting people to return to the activities they once engaged in within their local community is an important aspect of sustainable reablement. Occupational therapists work with individuals to re-engage with their local networks, and leisure activities to reduce social isolation and maintain health and wellbeing - important factors if savings and recovery are to be sustainable. Many long term conditions are complex and there are occasions where reablement has stalled or not progressed as expected. In these situations occupational therapists are the experts in re-assessing the situation, identifying barriers, setting new goals and recommending specialised programmes to assist in improving recovery, independence and sustainable reablement.

There is much emphasis within the forthcoming care bill in England on prevention and assessment. There is concern that restrictive models that prescribe only one profession as competent to assess are being discussed when there are a multitude of professional skills with the competence to assess and deliver preventative services. If we are to succeed in providing the necessary services to a growing older population - a population with increasing incidence of long-term conditions and dementia - we need to be able to embrace the skills offered by a broad range of professionals and specialists that can offer support and advice to enable sustainable reablement within integrated service models.

Reablement services are an excellent example of where integration should be happening - models of reablement can be found within both health and social care services. Occupational therapists are the only allied health professionals that work in both health and social care. If our intention is to deliver outcomes that achieve greater independence for individuals and that reduce care costs and readmission to hospital, resources and skills must be used appropriately from within both health and social care sectors.

There are a range of reablement service delivery models across the country and in consequence more intelligence is required as to what a successful reablement service should look like. Although Care Services Efficiency Delivery established a benchmark for reablement services; further evaluation of reablement practice is needed to identify best practice and 'what works' that should include detailed metrics of service outcomes and some form of standardised assessment recording tool.

Clinical commissioning groups have recently been charged with drawing up plans by March 2014 on how they are going to plan and spend their allocated Integration Transformation Fund which includes a budget for reablement. Those responsible for drawing up these plans should talk to key stakeholders and be creative in how reablement is delivered to gain best impact, taking into account the skill mix required to deliver, research, desired outcomes and agreed metrics and recording tools. It is time to critically evaluate what reablement currently achieves and unlock the untapped potential to achieve more.

(Source: theguardian.com)