Home care re-ablement services: investigating the longer-term impacts (prospective longitudinal study)
Individual budgets sit at the heart of government policy for improving choice and control for people needing social care support. Individual budgets bring together a number of different funding streams and offer a transparent way of allocating resources to individuals. There are 13 pilot areas for individual budgets. Evaluating these pilot projects is fundamental to a future decision by government about whether this approach will be rolled out more widely.
- Julien Forder, Personal Social Service Research Unit (Kent)
- Karen Jones, Personal Social Service Research Unit (Kent)
- Lesley Curtis, Personal Social Service Research Unit (Kent)
Adult social care services were increasingly developing specialist home care re-ablement teams that worked intensively with new service users to increase their skills, confidence, and ability to live independently. Our previous research, in the project ‘Investigating the longer-term effects of home care reablement services (retrospective longitudinal study)’ suggested that the benefits of home care re-ablement may be significant and sustained, possibly delaying subsequent needs for services by up to two years. A major prospective longitudinal study was therefore commissioned by the Care Services Efficiency Directorate.
The study aimed to:
- examine the immediate and longer-term effects of home care re-ablement
- identify factors affecting the level and duration of benefits for users of home care re-ablement services (e.g. features of the service, types of services used subsequently)
- describe the content and costs of home care re-ablement services and their relationships to service outcomes
- identify any impacts on, and savings in, the use of social care and other services that can be set against the costs of re-ablement services.
Design and methods
The study followed users of home care re-ablement services in four different local authorities with established home care re-ablement services. It compared their outcomes and their use of health and social care services up to a year later with service users in four other local authorities without home care re-ablement services. Data on the unit costs of home care re-ablement services were collected and calculated for the first time. The study included an investigation of the organisation and delivery of home care re-ablement teams through interviews with managers; focus groups with front-line staff; and observations of re-ablement interventions. Small subsamples of re-ablement service users and carers were interviewed in depth about their expectations and experiences of the service.
Home care re-ablement was associated with a significant decrease in subsequent use of social care services, although any cost savings were almost wholly offset by the initial costs of the re-ablement intervention. Re-ablement had positive impacts on users’ health-related quality of life and social care outcomes; the probability that re-ablement is a cost-effective service was therefore very high.
The study also identified the organisational and wider environmental factors that appeared to contributed to effective and efficient re-ablement services.