Reablement – what’s the evidence on outcomes?

Caroline GlendinningEmeritus Professor of Social Policy

Social Policy Research UnitUniversity of York

College of Occupational Therapists/Skills for Care 22nd July 2014

Background and early evidence

Major studies SPRU (York)/PSSRU (Kent) 2008-10

Perth (W Australia) 2005-07

Concluding remarks

Outline of presentation

Background – growing interest in re-ablement

England 2000 onwards: development home care re-ablement services in most councils

Scotland 2013: Joint Improvement Team survey

25/30 councils had home care re-ablement services

17 of these planning to expand

From selective to inclusive services

Australia, New Zealand – growing provider interest

High proportions receiving re-ablement needed no further, or less, home care on discharge than those who received standard home care 63% needed no further home care on discharge 26% needed less home care than comparison group

But would they have recovered anyway? … and how long do the effects last?

Early evidence on outcomes of home care re-ablement services

Aimed to investigate longer-term impacts of home care re-ablement services, including:

Compare home care re-ablement vs standard home care

Assess user outcomes and use of NHS and social care services for up to 12 months

Estimate unit costs home care re-ablement services Assess cost-effectiveness home care re-ablement Describe organisation and content of home care re-

ablement services Examine user and carer experiences

SPRU (York)/PSSRU (Kent) study 2008-10

Study design

5 re-ablement councils, 5 conventional home care councils

Users recruited on referral – baseline interviews Re-interviewed after 9-12 months

Data collected on: Users’ health, quality of life, social care outcomes at

baseline and follow-up, using standardised measures

Social care and NHS etc services used by both groups

Costs of re-ablement services (staff, overheads etc)

How re-ablement services organised and delivered

Experiences of users and carers

Results: impacts and costs of home care re-ablement services Re-ablement had positive impacts on health-related

quality of life and social care outcomes Compared with conventional home care service use

Typical re-ablement episode (39 days) cost £2,088 More expensive than conventional home care

But 60% less use of social care services subsequently Over full year, total social care services used by re-

ablement group cost £380 less than conventional home care

Re-ablement group – higher health service use and costs Effects of recent hospital discharge?

Was home care re-ablement cost-effective?

CE = compare improvements in outcomes against costs NICE threshold £20-30K for each outcome gain

Re-ablement was cost-effective in relation to health-related quality of life outcomes

Re-ablement may be cost-effective in relation to social care outcomes Depends on £ threshold Higher healthcare costs of re-ablement group

Probability of cost-effectiveness only

User and carer perspectives Poor initial understanding of re-ablement

Previous experiences of standard home care Context of referral - crisis, hospital discharge Value of repeated information

Appreciated frequent visits, monitoring Quality of relationships crucial

Reported greater independence improved confidence, relearned self-care skills

People discharged from hospital/recovering from accident/illness reported greater gains than those with long-term/progressive conditions

Felt shortcomings More help with mobility/activities outside the home Anxiety about end of re-ablement Potential for greater carer involvement?

Assessed impact of ‘restorative’ home care on subsequent service use for 2 years

750 older people randomised Restorative home care Standard home care

Service use records Home care A+E attendance Hospital admissions - number and duration

Calculated costs of all services used

Perth (W Australia) study 2005-7

Compared to standard home care, restorative home care group:

Less likely to use on-going personal care services

Used fewer hours of home and (especially) personal

care services

Less likely to be assessed as needing residential care

30% less likely to have attended A+E

31% less likely to have unplanned hospital admission

Had lower total (health + social care) service costs

(average £1574 - £2380 less)

Outcomes after 2 years

Growing body of evidence that re-ablement reduces service use and costs in short and longer terms.

But outcomes and cost-effectiveness depend on: How services are organised

Specialist service vs generic/extended assessment Delays in onward referral

Who receives re-ablement Inclusive vs selective services Eligibility thresholds

What’s included in re-ablement interventions Home care only vs wider range of skills/inputs Rapid access equipment/AT

How long intervention lasts

Reflections....

caroline.glendinning@york.ac.uk

www.york.ac.uk/spru

http://php.york.ac.uk/inst/spru/ research/summs/reablement2.php

R esearch W orks

Home care re-ablement is a relatively new, short-term intervention in English social care. It aims to reduce needs for long-term support by helping people (re)learn daily living skills. A large-scale study examined the longer-term impacts of home care re-ablement; the cost-effectiveness of re-ablement; and the content and organisation of re-ablement services. People receiving re-ablement were compared with those who received conventional home care; both groups were followed for up to one year.

SPRU: Caroline Glendinning, Kate Baxter, Parvaneh Rabiee, Alison Wilde, Hilary Arksey PSSRU: Karen Jones, Lesley Curtis, Julien Forder

2011-01 H om e care re -ab lem en t se rv ices: investigating the longer -term s im pacts

Key findings ● There were no net cost savings to health and social care in the first year of re-ablement, compared

with conventional home care. However, home care re-ablement is almost certainly cost-effective because of improved outcomes for users.

● Re-ablement was associated with a significant decrease in subsequent social care service use. The costs of the social care services (excluding the cost of re-ablement itself) used in the 12-month study period by people in the re-ablement group were 60 per cent less than the costs of the social care services used by people in the conventional home care group. However, these lower costs were almost entirely offset by the higher cost of the re-ablement

intervention. The average total (including re-ablement) cost per person of the social care services used by the re-ablement group was just £380 lower than the costs of the social care services used by the comparison group.

Re-ablement resulted in improvements in users’ health-related quality of life and social care-related quality of life up to ten months after re-ablement, in comparison with users of conventional home care services.

● Taking into account any differences between the two groups at the start of the study, there was no significant difference in the average costs of healthcare services used by the re-ablement and comparison groups over the full 12 months.