When people leave hospital, they often need initial support to help them regain the abilities they had before they were in hospital, things like being able to wash and dress themselves, cook, shop, or take part in social activities. This support, known as ‘reablement’, can be provided in different ways. We have limited UK evidence on which of the different ways is best for the people who receive the support, and for those who give it. The new ‘Reablement Models for Better Outcomes’ (REABLE-M) study  is trying to fill this gap. We will look at the different types (models) of reablement to find out what works best for supporting people leaving hospital.

The study is led by the Care Policy and Evaluation Centre (CPEC) based at the London School of Economics and Political Science (LSE) and is funded by the NIHR Health and Social Care Delivery Research (HSDR) Programme.

What do we know about reablement?

Reablement services aim to work with people who have had an unplanned stay in hospital due to an accident or episode of illness, or people at risk of and with people who are at risk of becoming less able or unable to manage their usual activities. They aim to help people to pursue what is important to them in their daily life. It involves intensive work to meet a person’s goals, either in their own home, or (for a short time) in a care home. Personal goals can be very different for different people, such as getting dressed or getting back into one’s social life. Effective reablement services could reduce time spent in hospital, reduce how much is spent on adult social care and improve people’s quality of life.

Good reablement support for people leaving hospital can help people to regain skills to live their lives as they want to, while increasing the flow of patients through hospital and reducing the number of patients in hospital at any one time. Staying in hospital for longer than necessary can be risky for patients, increasing the chances of getting a hospital-acquired infection and of experiencing poor care. National Government policy has focused on improving processes for supporting people being discharged from hospital and increasing capacity in both social care and intermediate care (including reablement). Taking a ‘Home First’ approach, people are expected to leave hospital as soon as they no longer need acute hospital treatment so that they can recover and participate in rehabilitation (at home, whenever possible). This may be followed by assessment for longer-term services.  

What are the gaps in our understanding of reablement?

While we know that reablement is important to reduce hospital occupancy and waiting times, we still need to understand which arrangements make for an effective reablement model. Gaps in our understanding of how reablement ‘works’ have resulted from the variability in nature and limitations of previous studies and from the differences in approaches used to organise reablement. The REABLE-M study therefore sets out to investigate the following four areas:

• Which models of care are most effective? Reablement encompasses many different models of care, and we don’t know what works best. We also don’t know which approaches work best for whom.
• Do the people delivering reablement support and their training make a difference to its effectiveness? Not much is known on how different approaches to staffing reablement, and the professional and service-specific training of the staff delivering reablement affects how people get back to their daily lives after a hospital stay.
• What is the right length of reablement support? We do not know much about the impact of reablement support of different lengths. The National Institute for Health and Care Excellence (NICE) has recommended that research compares different models of home-based intermediate care and different lengths of reablement support (e.g. up to 6 weeks vs. longer duration).
• How are expectations and experiences of reablement related to how reablement is staffed and how long it lasts? The expectations of people using services and their carers about reablement may affect whether they take up the service in the first place, how they experience the service, and their continued participation in reablement. REABLE-M will explore the experiences and impacts associated with different approaches.

How will REABLE-M help to fill these gaps?

The REABLE-M study, led by Dr Catherine Henderson (CPEC, LSE) will evaluate which models or features of reablement models are associated with better outcomes for people leaving acute hospital. The study has two phases and uses a mixed-method approach. Over three years, we will:

• Gather information from people using reablement and their carers about outcomes like quality of life, daily living, and use of services.
• Explore the way reablement services for people leaving hospital are organised and staffed and the perceived helpfulness or unhelpfulness of reablement for different groups.
• Evaluate and compare costs and outcomes of four different staffing models of reablement identified in previous research.

Phase 1 will be conducted in five local authority areas in England. We will map the organisation and staffing of reablement approaches in these areas. Using interviews and focus groups we will explore the experiences and perspectives of frontline staff, managers, people who use the services, unpaid carers, and people who are offered the services but end up not receiving them. During Phase 1, we will also conduct a feasibility study to determine whether a large-scale evaluation of reablement outcomes (Phase 2) is viable. This will include testing questionnaires on outcomes with people who use reablement services and carers and exploring whether local authorities can provide social care records to link with the questionnaire data.

If it goes ahead, Phase 2 will involve eight local authority areas in England (adding three new areas to the existing five in Phase 1), and will include a survey of people who use different models of reablement. This survey, linked to information from local administrative records, will enable the evaluation of the effectiveness and cost-effectiveness of different models of reablement. 

Throughout the study, the research process will be supported by our Public Advisory Group, a diverse panel of people with lived experience of using or caring for a person using reablement and health and care services. They will help the team with making communications with participants and the public accessible, advise us on the practicability of proceeding to Phase 2, comment on our findings, and help shape the study’s dissemination strategy. We also hope to have members of the group writing up and presenting our findings.

What do we hope REABLE-M will achieve?

REABLE-M will produce new evidence on the relationships between features of reablement services and the experiences of people using and providing the services. This will help policy makers and practitioners to design and provide the better reablement services in the future.  

If we continue to Phase 2, we will produce evidence about the effectiveness and cost-effectiveness of different reablement models for people discharged from hospital, enabling more informed policy decisions about how money is spent on reablement. By working with those delivering and using reablement services, we aim to provide practical insights that can support social and health care practitioners, and the commissioners who decide where the money is spent, to further develop and improve effective reablement practice.

If you’d like to hear more about the REABLE-M project, get in touch with the team at Cpec.Reablem@lse.ac.uk