Introduction, Purpose and Tools (Reablement)

Despite reablement being a bespoke service, the purpose of the reablement assessment is the same as the purpose of any assessment under the Care Act:

1. to provide a full picture of the person's needs, with a particular focus onthe impact that those needs have on their wellbeing and the outcomes they want to achieve in their day-to-day life; so that
2. the Local Authority can put in place appropriate, proportionate and timely arrangements for that person, in order to meet their needs and promote individual wellbeing. This response might range from offering guidance and information to arranging for services to meet the needs.

There should not be any assumptions made prior to an assessment that the provision of a reablement service will always be the appropriate response to the presenting need, and practitioners should be mindful to identify all of the needs that a person has.

The assessment conversation should also:

1. support people to understand their strengths and capabilities within the context of their situation;
2. support people to understand the support that may be available to them within the community or through other networks, technology and services; and
3. support people to consider some of the different ways that the Local Authority may be able to support them (other than through a formal service).

The assessment must also establish whether the reablement service is appropriate.

Reablement provides a bespoke function to directly support people with a disability, who have a mental health issue or who are recovering from illness to:

1. learn the skills of daily living to enable them to live independently (or with as little support as possible);
2. re-learn lost skills of daily living (either fully or to a point where independence is increased as much as it can be);
3. learn to 'live well' with a condition and develop strategies to be as independent with daily living skills as possible, for as long as possible;
4. build confidence across any other areas of life that are important to the person, so as to increase their independence (for example, building social skills).

To determine whether or not a reablement assessment is appropriate, you need to establish the following as part of the assessment:

1. Does the person appear to be open to being supported in an enabling way?
2. Does it appear the person wants to become as independent as possible?
3. Does it appear the person would be able to 'carry over' things from one day to the next.

If the answer is 'no' to these questions then a reablement service may not be appropriate.

It is important to identify all of the needs that a person has, including those that cannot be prevented, reduced or delayed by the provision of a reablement service.

Once identified you will need to ensure that appropriate steps are taken so that any eligible needs are met. For example, through a referral to Occupational Therapy, a health service or a social work team.

As part of the assessment of the person, you must establish:

1. whether there is a carer providing support;
2. whether the carer has the appearance of a need for support in their own right; and
3. if so, whether the carer is being supported through a Support Plan; and
4. if there is no Support Plan, whether the carer wishes to have a carer's assessment.

The Local Authority has a duty to identify and support carers, and reablement is often an opportunity to do so at an early stage.

The Care Act does not require that a specific tool (or any tool at all) is used to support or shape the assessment process, but it does acknowledge that a good tool can be helpful. However, any tool should:

1. facilitate and ensure the person's involvement;
2. support the information gathering process;
3. be flexible and adaptable; and
4. be appropriate and proportionate to the situation and needs of the person being assessed.

See below for details of the tools that are available for you to use as required.

The process of establishing needs involves having a skilled conversation about:

1. wellbeing and outcomes;
2. needs; and
3. risk.

You should consult with the person and/or others when arranging the assessment to understand the specific communication needs that the person has, so that any assessment tool you use will ensure their involvement in the conversation.

If you do not feel that the assessment tools available to you will be appropriate, you should speak to your manager about how they can be adapted.

Sometimes you may need to supplement the available tools with more bespoke tools to support the specific communication needs of the person. For example, you may need to use photographs or pictures. This is entirely appropriate under the Care Act as it will ensure the involvement of the person and will also support you to meet the duty to provide information in an accessible way.

All health and care professionals should be aware of frailty and identify where people would benefit from assessment and planning that minimises the impact of frailty on people’s wellbeing.

Triggers are:

1. Are you older than 85 years?
2. Are you male?
3. In general, do you have any health problems that require you to limit your activities?
4. Do you need someone to help you regularly?
5. In general, do you have any health problems that require you to stay at home?
6. In case of need, can you count on someone close to you?
7. Do you regularly use a cane, a walker, or a wheelchair to move about?

A person hitting three or more of the seven triggers should be referred to their primary care team to request a full frailty assessment is undertaken. This referral should be made using the Lincolnshire Frailty Pathway Letter, which is available via Mosaic.

For more information about the Lincolnshire Frailty Pathway, including resources and a practice toolkit, see: Lincolnshire Frailty Pathway.

Lincolnshire Adult Care has adopted the PRISMA-7 Frailty Screening tool, embedded within its needs assessments to help practitioners identify when someone is experiencing frailty.

PRISMA-7 is an internationally recognised basic seven question screening tool to identify people likely to be categorised as frail, who would benefit from a full frailty assessment, undertaken by either the person’s primary care or neighbourhood working team.

tri.x has also developed a range of person centred tools that can support a person or family member to think about:

1. what matters most to them, now and in the future;
2. wellbeing; and
3. needs and what a good day/bad day looks like.

See Resources for Person Centred and Strengths Based Conversations.