Islington - Joint Services Reablement Team

Mary Jamal

Head of Disability and Intermediate Care

Background • Contracts with eight external providers • An in house home care service specialising in users with dementia• A small rapid response and enabling service delivered by an external agency (in

operation since 2004)

Monitoring • All the contracts monitored with the exception of the home care team activity• Based on a small sample size activity from the rapid response agency, there was

evidence of 56% of clients had their home care hours reduced and 78% of clients discharged had no on going home care or a reduced package

Budget spend • Home Care budget was around 17% of the budget for Islington Adult Social

Services • Home care spend increased by 7% from the financial years 2005/6 (from 11.9

million to 12.7 million)• Was predicted to increase by 4% 2006/7 (from 12.7 million to 13.2 million)

Before Reablement…

Why set up a Reablement service?

Fit with government policyThe four key objectives of the White Paper ‘Our Health, Our Care, Our Say’:

• better prevention with earlier intervention• more choice• tackle inequality & improved access to community services• people with long-term conditions supported to manage their conditions

The National Service Framework for Older People:• Standard 3 Intermediate Care: “prevent unnecessary acute hospital

admissions, support timely discharge and maximise independent living”• Standard 8 The promotion of healthy and active life in older age.

2 out of 3 English Councils only deliver to users with ‘critical’ and ‘substantial’ needs - Islington continues to also see users with

‘moderate’ needs

In line with DoH recommendations for adult social care, based on evidence from

other councils, the key triggers to establishing a Reablement service were:

• Demand for home care had increased and was continuing to increase• People over 85 was predicted to increase by 12% by 2012 and 45% by 2022• People traditionally employed in the care industry are getting older – making

it harder to recruit care workers needed

There was commitment from SMT to implement the DoH recommendations, and

the following steps occurred:

• Reablement Project Team and Home Care Board established• Business Case prepared and approved (includes service model)• Home Care Project Board approves business case • Reablement implementation project commenced

4

How Reablement was launched…

What is the Re-ablement Service?

• The Re-ablement Service is an ‘intake’ service – the ‘Gateway’ to home care services in Islington

• Anyone you determine needs home care will go to the Re-ablement Service first

• The aim of a re-ablement service is to work with users and carers, intensely and for a short period of time, to enable them to live more independently in their own homes

• The service ill be delivered mainly by Enablers and will last for up to six weeks

• If service users have ongoing home care needs at the end of that period, they will be referred to the brokerage service, which will place hem with a home care provider

What does this mean for service users?

• If you have an existing home care package – no change arising from the Re-ablement Service

• Only new referrals to home care services will be directed to the Re-ablement Service

• Re-ablement is intermediate care and therefore free of charge for the first six weeks

• Vast majority of users will receive less than six weeks of re-ablement.

How will it work? - Overview

The Re-ablement Service is an ‘intake’ service.

Anyone you determine needs home care should go to the Re-ablement Service, unless they meet the exclusion criteria:

• the user has mental health or learning difficulty needs that would prevent them from participating in the Reablement process

• is not suitable because of particular care needs (e.g. terminal illness)

• is not old enough (i.e. less than 18 years old)

• is currently wearing a plaster of Paris cast and is unable to complete any day to day activities .

Throughout re-ablement service, user receives regular (at least weekly) reviews.At end of re-ablement period, IF ongoing home care is needed, user referred to brokerage service

Re-ablement service – organisation structure

Deputy Re-ablement Manager

(PO3)

Senior Enabler (PO1)

Enabler (scale 3 or 4) x 7

Occupational Therapists x 2.0 FTE

Administrators (Scale 5) x 3 FTE

Re-ablement Manager (PO6)

Senior Enabler (PO1)

Senior Enabler (PO1)

Senior Enabler (PO1)

Senior Enabler (PO1)

Director of Joint Services

Enabler (scale 3 or 4) x 7

Enabler (scale 3 or 4) x 7

Enabler (scale 3 or 4) x 7

Enabler (scale 3 or 4) x 7

Head of Disability & Intermediate Care

Director of Adult Social Services

Re-ablement service – number of staffPost FTE

Re-ablement Manager 1

Deputy Re-ablement Manager 1

Administrator 3

Occupational Therapist 2

Senior Enabler 5

Enablers 35

Re-ablement service – roles

Role Key tasks Reports to

Re-ablement Manager

•Service management•Staff management•Financial management•Performance management

Head of Disability and Intermediate Care

Deputy Re-ablement Manager

•Deputises for Re-ablement Manager•Supports the Re-ablement Manager above•Line manages Senior Enablers

Re-ablement Manager

Senior Enabler •As Team Leader, lead team of Enablers (8)•Receives assessment and care plan from Care Coordinator•Risk assessment•Re-ablement goal-setting, with input from OTs sets predicted discharge date•Assess for and issue basic equipment (all Senior Enablers are Trusted Assessors)•Continuous re-assessment reviews•Discharge users from re-ablement service•Care Coordinator liaison.

Re-ablement Manager & Deputy

Line managed by Deputy Re-ablement Manager

Re-ablement service – rolesRole Key tasks Reports to

Enabler •Work with service user in day to day re-ablement activities•Carry out home care tasks where user is unable•Update Re-ablement Action Plan•Discuss progress with users and carers.

Senior Enabler

CCA s .Input into multidisciplinary team meetings and final review if ongoing support is needed.

Detailed knowledge of FACS Criteria.

Supporting and advising Senior Enablers.

Liaison with social services teams.

Input into the development of Individual Budgets pathway for Reablement Services.

2 Support Advisors that are professionally supervised by social work team

Re-ablement service – rolesRole Key tasks Reports to

Occupational Therapist

•Develop and deliver induction and training to Enablers and Senior Enablers•Conduct regular audits of each team’s cases with the Senior Enabler and Enablers in the team•Set re-ablement goals and carry out re-ablement reviews with Senior Enablers •Support Re-ablement Manager in managing and monitoring the service’s strategic objectives.

Report to Re-ablement Manager when working in the service.

Line managed outside re-ablement Service

Administrator •Maintain Webroster•Support Senior Enablers in producing work programmes•Assign referrals to Senior Enablers•Produce and update team schedules/ work programmes

Support the Re-ablement Service in all administrative tasks.

Re-ablement Manager and Deputy

Re-ablement service – referral to discharge process…

Care Manager Re-able.Mgr/ Deputy Senior EnablerEnabler

Service User

1.Overview assessment, care plan & predicted re-ablement outcomes

2. Home care?

4.Receive & check referral

9. Review outcomes, agree goals & produce action plan and set predicted discharge date

8. Conduct risk assessment

14. Carry out tasks in plan

13. Hand over folder & plan to user. Allocate Enabler(s)

12. Assess for basic equipment & issue

16. Discuss progress

20. Inform Care manager

21. Re-ablement goal review (min. weekly)

23. Goal review & discharge planning

29.Complete questionnaire & post

24. Final tasks, inform user, hand over questionnaire to user

28.Statutory review & refer to other services

25. Other

services?

26.Statutory Review & discharge

7. Allocate Senior Enabler

6. Enter into SWIFT & Webroster

17. Discuss progress 18. Discuss progress

11. Agree goals & action plan and predicted discharge date

5.Determine if rapid response

Y

3. Refer to Re-Ab Service

19. Update action plan

20.Check progress (min. weekly)

15. Carry out tasks in plan

N

Y

OT

10. Review outcomes, agree goals & produce action plan and agree predicted discharge date

22. Re-ablement goal review

27.Statutory Review & discharge

Act as consultant to Enablers & Senior Enablers

Week before last

Details of current Reablement Service

When did the service become operational? April 2008

What are the current annual volumes? 2008/ 2009 Admissions = 401

2009 / 2010 Admissions Quarters (1 – 3) = 434

Intake & assessment / Hospital discharge model?

Yes

Selection / Deselection model? De - selection - The service has a minimum exclusion criteria

Entry subject to FACS? Yes - Islington responds to moderate level of need.

Service subject to charge? No the service is free of charge

In house / outsourced model? In House

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2009 / 2010 data Quarters 1- 3

No further homecare package required at end of reablement phase 64%

Reduced homecare package required at end of reablement phase 11%

Assessed homecare package at start maintained at end of reablement phase 2.%

Assessed homecare package at start increased at end of reablement phase 17%

User did not complete reablement phase 5%

Performance

Activity % of episodes exiting Reablement service type

% of EPISODES EXITING REABLEMENT (BY SERVICE TYPE)

0%

20%

40%

% of EPISODES EXITINGREABLEMENT TO HOSPITAL

% of EPISODES EXITINGREABLEMENT TO RESIDENTIAL /

NURSING CARE

% of TOTAL EPISODES EXITINGREABLEMENT & STARTING

HOMECARE

Q1

Q2

Q3

Q4

Activity – People exiting Reablement with home care need comparison with potential hours

PEOPLE EXITING REABLEMENT WITH HOMECARE NEED(COMPARISON WITH POTENTIAL HOURS)

0%

20%

40%

% PEOPLE EXITING REABLEMENTWITH HOMECARE NEED

REDUCED FROM POTENTIAL HOURS

% PEOPLE EXITING REABLEMENTWITH HOMECARE NEED

UNCHANGED FROM POTENTIALHOURS

% PEOPLE EXITING REABLEMENTWITH HOMECARE NEED

INCREASED FROM POTENTIALHOURS

Q1

Q2

Q3

Q4

Slide

Activity – AVLOS days

AVERAGE LENGTH OF SERVICE (DAYS)

27.328.6

25.9

0

5

10

15

20

25

30

35

Q1 Q2 Q3 Q4

Activity - Total difference in weekly home care hours needed following Reablement

DIFFERENCE IN WEEKLY HOMECARE HOURS NEEDED FOLLOWING REABLEMENT

-916 -931

-1441

0

-1600

-1400

-1200

-1000

-800

-600

-400

-200

0Q1 Q2 Q3 Q4

What worked well:

• Integration within the Intermediate Care Pathway

• Client consultation and feedback• Enabling model leading to reduction in

long term home care packages. • Facilitation of hospital discharges

reducing acute delayed transfers of care.

• Accurate monitoring of performance and mechanisms for auditing

• In House team benefitting from training packages investment into the process

• Reducing the no of home care

What didn’t work well:

• Embedding the enabling philosophy with members of staff who were used to a ‘home care’ philosophy

• Home Care and Reablement sharing same office accommodation

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Learnings

Reablement plans to further integration within Intermediate care services

to support the work related to:

• Poly systems • Urgent Care Centre• Prevention of admission • Health Promotion • Increase access to services by targeting hard to reach communities• Individual budgets and the personalisation agenda

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Future aspirations