Outcomes of reablement and their measurement: Findings from an evaluation of English reablement services

Abstract

Reablement – or restorative care – is a central feature of many western governments’ approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority – to develop an evidence base on models of delivery – is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare‐ and social care–related quality of life, functioning, mental health and resource use (service costs, informal carer time, out‐of‐pocket costs). In contrast with the majority of other studies, self‐report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow‐up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self‐report outcome and resource use measures in evaluations of reablement.

<p>Control as a Core Component of User Involvement in Reablement: A Qualitative Study</p>

“…Limited user involvement in the goal-setting process has been seen in other studies, and other researchers attribute this to users' lack of understanding of the intervention or that users are passive or unmotivated. 13,15,18,20 We however did not perceive that the participants here were passive or unmotivated. Instead, we suggest that perhaps the importance of user-set goals in reablement might be over-emphasized.…”

“…16,17 The purpose of a hands-off approach is to prevent users from becoming passive help and care recipients and instead enable active participation and regained independence through optimized functional ability. Still, some researchers find that users can have problems setting goals, 13,18,19 linked to users' lack of motivation or ability to understand the purpose of an intervention 12,13,15,18 or limited professional communicative competence. 20,21 Users' difficulties with goal-setting can lead to goals being set by professionals.…”

Enabling and constraining successful reablement: Individual and neighbourhood factors

“…Despite some positive overall results, studies also show that not all clients become more independent following reablement, and that some clients tend to benefit more than others [7,14]. We know little about the overall effectiveness of reablement, and even less about the types of clients that might benefit most, or least, from such programmes [3,19], and there is scant evidence about broader socio-economic and neighbourhood factors that likely confound or facilitate successful reablement outcomes.…”

“…Compared to the provision of on-going homecare, reablement programmes have been shown by some studies (almost all of which are based on analyses of reablement for older people) to provide better outcomes for some clients in many areas including: subjective perceptions of quality of life [ 7 , 11 , 15 – 17 ] and mental health [ 18 ]; dementia [ 19 – 21 ]; increased independent coping with everyday activities [ 4 , 17 , 22 , 23 ]; increased likelihood of remaining living at home rather than admission to hospital or institutional care [ 15 , 17 ]; and a subsequent decrease in the levels and hours of on-going care provided by professional care workers [ 7 , 11 , 16 , 17 , 24 , 25 ].…”

“…This paper employed a strict test, namely full reablement towards self-care. While this approach carries the advantage of robustness compared to more relative outcome variables, future studies could also measure factors such as rates of improvement, maintenance, and deterioration of care needs, consider domain specific outcomes, and also employ more subjective evaluations based on quality-of-life indicators such as the EQ-5D-5L [19].…”