What was the issue you were addressing or working on?
The facility was established to pilot a model that would:
- prevent unnecessary permanent admission to residential care
- prevent unnecessary admission to hospital.
- facilitate discharge from hospital and contribute to managing delays in discharge from acute or community hospitals.
- deliver support to ensure a safe and full re-integration into the Service Users home and local community.
- assist Service Users’ in setting and achieving their planned goals, placing the emphasis on the Service Users needs. Goals will be set with the service users and reviewed weekly or as required throughout their stay
- support Service Users to regain and maintain daily living skills.
- support carers in their role during a person’s stay in the unit and after the assessment period is complete.
- respond quickly and flexibly to the changing needs of the Service Users to support their return home.
What you did?
Fife Council Residential Care home staff, Social Work Service staff (including re-ablement home care services – change fund model), NHS Fife staff, voluntary sector Local Area Co-ordinators (funded by Change fund), all working together to improve outcomes.
Effectively delivered enabling care services which focussed on improving skills, confidence, resilience and skill improvement. Enabling 80% of those who were admitted to the unit over the pilot period, to return to live safely within their own homes.
Staff within the unit had been trained by the Home Care Re-ablement training staff (employed through use of Change fund), and home care service provision is now delivered utilising the re-ablement approach which encourages and supports independence.
What were the outcomes - benefits or otherwise?
As stated above, we saw 80% of those who went through the model returning to live within their own homes. In a number of cases the benefits were seen quickly, often within a few days; individuals had begun regaining their confidence and were beginning manage some of their own personal care needs. Within a few weeks they were often able to undertake most domestic and personal care needs with minimal support. Additionally, it was noted that most were far more positive about the future and were keen to return home to live independently. Consequently, those individuals who returned to live at home, generally did so with a relatively small home care package (particularly given they had been at risk of moving into a long term care facility). Through the links with the Local Area Co-ordinators, service users were encouraged to access local community resources as an ongoing support following discharge from the facility.
A Case Study is available here.
Contacts - to find out more
Martin Thom Martin.Thom@fife.gov.uk 03451 555555 ext 476902