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Models of Reablement: a mixed methods evaluation of a complex intervention. The MoRe project.

Beresford, Bryony, Mann, Rachel, Parker, Gillian, Kanaan, Mona, Faria, Rita, Rabiee, Parvaneh, Weatherly, Helen, Clarke, Susan, Mayhew, Emese, Duarte, Ana, Laver Fawcett, Alison and Aspinal, Fiona (2018) Models of Reablement: a mixed methods evaluation of a complex intervention. The MoRe project. Health Services and Delivery Research (HS&DR). (In Press)

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Abstract

Background
Reablement is an intensive, time-limited intervention for people at risk of needing social care or increased intensity of care. Differing from homecare, it seeks to restore functioning and self-care skills. In England, it as a core element of intermediate care. The existing evidence base is limited.
Aims
Describe reablement services in England and develop a service model typology;
Conduct a mixed method comparative evaluation of service models investigating outcomes, factors impacting outcomes, costs and cost-effectiveness, and user and practitioner experiences;
Investigate specialist reablement services/practices for people with dementia.
Methods
Work package 1 (WP1), taking place in 2015, surveyed reablement services in England. Data were collected on organisational characteristics, service delivery and practice, and service costs and caseload.
Work package 2 (WP2) was an observational study of three reablement services, each representing a different service model. Data collected included: health- (EQ-5D-5L) and social care-related (ASCOT SCT-4) quality of life, practitioner (Barthel Index) and self-reported (NEADL scale) functioning, individual and service characteristics, and resource use. It was collected on entry into reablement (n=186), at discharge (n=128) and, for those reaching the timepoint within the study timeline, six months post-discharge (n=64). Interviews with staff and service users explored experiences of delivering or receiving reablement and its perceived impacts.
Work package 3 (WP3) interviewed staff in eight reablement services to investigate experiences of reabling people with dementia.
Results
201 services, located in 139 Local Authorities took part in the survey. Services varied in their organisational base, relationship with other intermediate care services, use of out-sourced providers, skill mix, and scope of reablement input. These characteristics influenced aspects of service delivery and practice. Average cost per case was £1,728.
Lower than expected sample sizes meant a comparison of service models in WP2 was not possible. Findings are preliminary. At T1, significant improvements in mean score on outcome measures except self-reported functioning were observed. Further improvements were observed at T2, but only significant for self-reported functioning. There was some evidence that individual (e.g. engagement, mental health) and service (e.g. service structure) characteristics were associated with T1 outcomes and resource use. Staff views on factors affecting outcomes typically aligned with, or offered possible explanations for, these associations. However, it was not possible to establish the significance of these findings in terms of practice or commissioning decisions. Service users expressed satisfaction with reablement and identified two core impacts: regained independence and, during reablement, companionship. Staff participating in WP3 believed people with dementia can benefit from reablement, but objectives may differ and expectations for regained independence inappropriate. Furthermore, practice (e.g. duration of home visits) should be adjusted and staff adequately trained.
Conclusions
The study contributes to our understanding of reablement, and what impacts on outcomes and costs. Staff believe reablement can be appropriate for people with dementia. Findings will be of interest to commissioners and service managers. Future research should further investigate factors impacting on outcomes, and reabling people with dementia.

Item Type: Article
Status: In Press
Related URLs:
Subjects: R Medicine > R Medicine (General)
School/Department: School of Health Sciences
URI: http://ray.yorksj.ac.uk/id/eprint/3460

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