Reablement

Comprehensive rehabilitation services at home and in the community

Persons experiencing functional decline, especially older people, have since the introduction of reablement received more comprehensive rehabilitation services at home and in the community.

Good experiences in the municipalities, but weak research evidence

Many municipalities express that they have good experiences with reablement. There is great enthusiasm concerning the service, and several local resources, tools and aids have been developed. Available research points in the direction of positive gains for both the user and the municipality, but the results are few, inconsistent and not conclusive.

Essential key factors when establishing and managing reablement services are:

• Commitment from political and professional leadership in the municipality
• Thorough planning phase, especially related to the choice of organizational model, identification of target groups, training of employees and information to users.
• Establishing of interdisciplinary rehabilitation teams. Employees in the regular home care services, participate in the rehabilitation services.
• There is mutual recognition between the different parts of the municipal health care services, including the reablement service, and respect for the distinctive differences between them.
• Awareness of the fact that the main target group is persons with functional decline. Diagnosis and age is less important, while the user’s motivation for training and coping is essential. Respect that not all users of home care services are candidates for reablement.
• Rehabilitation should start early after the functional decline (early intervention).
• A rehabilitation plan should be created together with the user, using his/her goals for mastering everyday activities as the starting point (user-controlled rehabilitation plan).
• Intensive follow-up of the user for a limited period of time.
• Health care staff advice, support and encourage the user’s own training and effort to gain skills, rather than doing tasks for them. They compensate when necessary, but try to avoid the “mistake of helping too much”.
• Health care staff cooperates also with the user’s family.
• Health care staff conducts follow-up visits after the end of the rehabilitation period.
• The results are documented in a way so that the user’s improvement can be evaluated.

Most of these key factors of reablement are the same as the general principals of rehabilitation. What distinguishes reablement is the political and professional commitment in the municipality, the close cooperation with the rest of home care services and that the home and community is the place of rehabilitation.

Increased emphasis on return of investment

The interest in reablement can be interpreted as an expression of a stronger concern with “return on investment” on the behalf of the municipalities. This is in line with national and international trends like “active aging” and “rehabilitating services”, as well as an increased focus on autonomy and independence (“independent aging”). This focus on “return of investment” can cause user groups that do not give a “return”, measured as increased ability to master everyday activities and self-reliance, to not be prioritized by the municipality.

More knowledge is needed

Reablement is a new service in Norway, and is not fully established among the municipalities yet. More research and experiences is needed, both related to useful models of organizing and to which elements and components of reablement are most effective and beneficial for different user groups. More knowledge about the financial consequences of the services is also needed, and whether it contributes to a strengthening of the total health care services in the municipality or cause unfavorable prioritizing.