PARTNERSHIP IN REABLEMENT

1
PARTNERSHIP IN RE-ABLEMENT

• Dr Sheila Begley PhD
• Intermediate Care Services Manager
• Milton Keynes

2
The Current Situation

• Nationally councils spent 14 Billion on adults
  in 2006/7
• 61 (8.6 Billion) on Older people
• 4/5 of adult care is provided in the home
• 49 of costs are spent on home care
• People funding their own care are disadvantaged,
  isolated and alone in accessing the right
  services
• The state of social Care in England 2006-07 CSCI

3
Our Health Our Care Our Say DOH 2001

• Emphasises the need to make progress on
• Promoting independence through integrated health
  and social care services multidisciplinary teams
• Developing capacity through partnerships with a
  wider range of services
• Shifting services and resources into the
  community from acute hospitals
• Promoting personalisation of services and choice
  to stay in own homes
• Responsive services with fast convenient access

4
Re-ablement - What are we Talking About?

• CSED Study End 2006 60 Authorities had Home
  Care Re-ablement service of some description
• CSED Concluded terms such as
• Intermediate Care
• Re-ablement
• Rehabilitation
• Are used interchangeably?
• ??Prevention, Re-ablement, Rehabilitation are
  functions of Intermediate Care

5
Defining Functions

• Prevention - as part of Health and well being
  agenda (National Standards Local Action DH 2004)
• 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
• Secondary prevention is interventions to stop a
  known problem becoming worse
• Proactive process
• Risk reduction
• Rehabilitation from the Latin Habilitas to make
  better
• Services for people with poor physical or mental
  health
• To help them get better
• Therapeutic measures to help return to normal
  activities/health or adjustment following illness
  or disease
• 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
• Render capable or able for some task (enable)
• Opposite of disable when a function is
  significantly impaired relative to original
  function

6
Direct Payment

• 1996 Community Care Act (Direct Payments)
  extended in 2000 to include Older People
• Nationally take up slow
• DH placed duty on LA to increase take up
• Re-ablement needs to take place before DP
  assessment to ensure the right level of care is
  being funded
• Potential reductions in DP costs should be used
  to fund re-ablement services to reduce costs of
  long term care
• Financial assessment should be undertaken while
  re-ablement services are being provided to reduce
  funding gap
• Individual Budgets ? Encourage more re-ablement

7
Re-ablement Vision

• WORKSHOP SESSION
• WHAT DO WE NEED TO HAVE IN PLAVE TO ACHIEVE THE
• RE-ABLEMENT (INTERMEDIATE CARE) VISION OF
• RIGHT TIME
• As soon as the person needs support without them
  having to wait until services are available
• RIGHT PLACE
• In a setting as near to the persons own home as
  possible, by the people with the most appropriate
  skills to help
• RIGHT CARE
• To support people to adjust to changes in health
  and wellbeing
• To help to regain or maintain independence

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What do we need to Have?

• RIGHT TIME
• PROACTIVE IDENTIFICATION
• SINGLE POINT OF ACCESS
• NO WAITING LISTS
• RIGHT PLACE
• AS CLOSE TO HOME AS POSSIBLE
• EVERY ONE ASSESSED BEFORE CARE STARTED
• RANGE OF SERVICES TO MEET DIFFERENT NEEDS
• FLEXIBLE
• RIGHT SERVICE
• CASE MANAGEMENT RESPONSIBILITY
• SKILLED INTERDISCIPLINARY TEAMS
• PERSONALISED ASSESSMENT AND ACHIEVABLE GOALS
• EFFECTIVE CARE PLANNING.
• WHOLE SYSTEM REABLEMENT APPROACH
• QUALITY METRICS

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MK Community Based ServicesIntegrated via Joint
PCT/LA manager since 2004

• RAIT
• 8 Nurses
• 2 Physiotherapists
• 3 OTs
• 2 Social Workers
• 3 Rehab Assistants
• 7days/week 9am -9pm
• Carry Caseload of 150 pcm

• CARE TEAM /RAPID RESPONSE
• 23 Carers
• 4 Team Leaders
• 24/7
• Caseload of 175 pcm

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Bed Based Services

• ORCHARD HOUSE
• 14 flats
• 10 carers
• 4 team leaders
• 1 OT
• 1 Physio
• Pharmacist
• Visiting GP 1 x weekly
• RAIT nursing input
• 24/7 7-10 new admissions/month

• WICU
• 21 ensuite rooms
• 14 nurses
• 13 rehab assistants
• 2 physio
• 2 OT
• RAIT Social Workers
• Pharmacist
• Visiting GP 1x daily
• Nutrition assistant
• Speech and Language (visiting)
• 12 new admissions per month

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Milton Keynes Joint Services
Rapid Response
Support people as close to own home as possible

• Home based rehabilitation
• and care services
• Joint Care Team
• RAIT
• Rapid Response Team

• Sheltered Housing
• Care and therapy
• Orchard House

• Community Hospital
• Nursing and therapy
• Windsor Intermediate Care Unit

HOSPITAL
HOME
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ACCESSING RIGHT CARE RIGHT PLACE RIGHT TIME
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Ensuring Success

• Training Staff training is essential
• Communication - of the culture and values of
  re-ablement is essential across a wide audience.
• Capacity it is essential to ensure there is
  capacity to provide effective re-ablement in a
  structured way
• Flexibility The service must be able to
  flexibly respond to progress against individual
  care plan and review goals in response to this.
• Realism - Care plans must be realistic and
  support people to have achievable goals.
• Manage Expectations- People should be made fully
  aware that intense nature of the service is short
  term. This also applies to partner organisations
• Maintenance - Developing a System Wide Culture of
  Re-ablement This needs to permeate independent
  providers, lunch clubs, day care and other
  provider services
• Transformational leadership at all levels

14
Summary

• Intermediate Care incorporates a re-ablement
  approach
• Emphasis is on promoting choice, self directed
  care , independence and autonomy
• Rapid access to the right services essential
• Integration of services and a range of trained
  staff to provide a range of re-ablement options
  for people
• Early financial assessment to support effective
  on going service provision
• Maintenance depends on all staff adopting the
  principles and working practices of re-ablement

15

• Thank you for your time
• I hope it was useful
• sheila.begley_at_milton-keynes.gov.uk