Rehabilitation and Reablement

The Re-ablement Project gives short-term support to older people who have just come out of hospital or have been ill at home. They help people to regain skills for living independently and to increase their confidence. They also look at health needs and support carers.

A short period on the project - just up to six weeks can make all the difference and can help you stay at home.

The re-ablement team work collaboratively to ensure the continuing health and social needs to people referred, and addressed. The project takes referrals for people who are over 50 years who are able to participate in the re-ablement programme.

Referrals received and assessed by the multi-disciplinary team and individual re-ablement treatment plans are agreed. These have client centred goals, the re-ablement officers then undertake individual tasks with the service user enabling them to undertake the tasks themselves, most important is the continuity of treatment or therapy.

The evaluation of the project by UWIC indicates that users of re-ablement rate their health, mobility, attitude and satisfaction with the longer-term results, were positive. Participants were not made dependent on services, which is cultural shift for many users of services. The service users full potential is developed whether they are recently discharged from hospital or are in the community.

The project has given clear indication that re-ablement is a positive strategy in prevention of dependence and deterioration in the individuals ability to maintain their independence.

The driving force is linked to the all year problem of Delayed Transfer of Care. Patients who have had their rehabilitative input are risk of further deterioration if they are delayed inappropriately in hospital. The majority of these delayed patients end up in need of nursing care. The re-ablement bed aims at taking patients who have reached their optimum level of functioning and working with them to further develop their daily living and self care functional abilities.

The Multi Disciplinary teams assess the referred person and design a plan with the service user to re-integrate them from hospital back into the community. The critical element for success is ensuring that the individual is willing to participate in the programme. Re-ablement Officers are recruited to work specifically with the users of the re-ablement beds. Therefore the designated beds need to be in close proximity.

The project is an excellent example of partnership working between Health and Social Services and Housing.