NICE publishes guidance on reablement
Draft guidelines on intermediate care including reablement produced by the National Institute for Care and Health Excellence
Published on 2nd May 2017
The National Institute for Care and Health Excellence has produced draft guidance on intermediate care, including reablement.
The guideline covers all adults using intermediate care, including reablement services between inpatient hospital, community or care home settings. It considers how person-centred care and support should be planned and delivered during the four phases of intermediate care and reablement.
The guidance highlights that in January 2015, 5246 patients were delayed in hospital, 3597 of which were acute patients. The proportion of delays occurring in an acute care setting had increased from 63.8% in January 2014 to 68.7% in January 2015. Emergency admissions to hospital are also increasing - there were 5.4 million emergency admissions in 2013/14 compared with 5.3 million in 2012/13, an increase of 1.5%. Hospital admissions statistics showed a greater increase of people in age groups 60–74 and 75+ in hospital admissions as a whole.
“Admission to hospital and delays in hospital discharge can create significant anxiety, physical and psychological deterioration and increased dependence. Therefore, multidisciplinary services, which help people recover, regain independence and return home, are vital,” the guidance states.
The new NICE draft guidelines state that regarding the core principles of intermediate care, teams should include staff from a broad range of disciplines with core practitioners including occupational therapists, social workers, nurses, physiotherapists, speech and language therapists and support staff.
Intermediate care staff should have the skills to support people to optimise recovery, take control of their lives and regain as much independence as possible.
Goals around intermediate care should be developed in a collaborative way that optimises independence and wellbeing and should be person-centred, taking into account cultural differences and preferences. Objectives of intermediate care should be explained clearly to patients, their family and carers.
Patients should be supported to recognise their own strengths and realise their potential to regain independence. People's social, emotional, communication and cognitive needs should be addressed as well as their physical needs as part of intermediate care.
Staff undertaking an assessment need to identify the person's abilities, needs and wishes so that they can be referred to the most appropriate model of intermediate care, avoiding the need for acute hospital admission where possible. People using services and their families and carers should be actively involved in assessments.
Professionals carrying out assessments should consider providing intermediate care to people in their own homes wherever practical, making reasonable adjustments where necessary to enable this to happen. If transfer from acute care takes no longer than two days, bed-based intermediate care should be considered for people who are in an acute but stable condition but not fit for safe transfer home.
Reablement should be offered as a first option to people being considered for home care, if it is judged that reablement could improve their independence. Reablement should also be considered for people already using home care, as part of the review or reassessment process, which may mean providing reablement alongside home care. Reablement should also be considered for people living with dementia, to support them to maintain and improve their independence and wellbeing.
People should be referred to crisis response if they have experienced an urgent increase in health or social care needs and their support can be safely managed in their own home or care home and they are likely to benefit from the service, the guidelines adds.
The intermediate care service should begin within two days of the referral being made. When planning the person’s intermediate care, professionals should tell the person how long the service will last, what will be involved and what is likely to happen afterwards. Staff should also make sure that family and carers are also given information about the service and how it works, including the service’s aims and the support it will and will not provide as well as resources in the local community that can support families and carers.
A risk assessment should be carried out as part of planning for intermediate care and then regularly afterwards, as well as when something significant changes. This should include:
- · assessing the risks associated with the person carrying out particular activities
- · assessing the risks associated with their environment
- · balancing the risk of a particular activity with the person’s wishes, wellbeing, independence and quality of life.
Flexible outcomes-focused approach
A risk plan with the person and their family and carers as part of the intermediate care planning process. Intermediate care goals should be discussed and agreed with the person and it should be recognised that participation in social and leisure activities are legitimate goals of intermediate care.
The guidance states that professionals should “take a flexible, outcomes-focused approach to delivering intermediate care that is tailored to the person’s needs and abilities. Goals should be reviewed regularly with the person. Subject to progress toward the goals the service might need to last longer than six weeks”.
Specialist support should be provided to people who need it, it adds.
Intermediate care should be provided in an integrated way by working toward the following:
- · a single point of access for those referring to the service
- · a management structure across all services that includes a single accountable person, such as a team leader
- · a single assessment process
- · shared goals that everyone in the team works towards.
Rapidly evolving landscape
Professionals should also consider contracting and monitoring intermediate care in a way that allows services to be flexible and person centred.
Mechanisms should be in place to promote good communication within intermediate care teams. The intermediate care team has a clear route of referral to and engagement with commonly used services including general practice, pharmacy, mental health and dementia services, social work and social care services and housing services.
Intermediate care staff need to be able to recognise and respond to:
- · common conditions, such as diabetes, mental health and neurological conditions, including dementia, physical and learning disabilities and sensory loss
- · common support needs, such as nutrition; hydration; and issues related to overall skin integrity
- · common support needs, such as dealing with bereavement and end of life
- · deterioration in the person’s health or circumstances.
The Department of Health asked NICE to produce this guideline on intermediate care, including reablement and the guideline was developed by a Guideline Committee following a detailed review of the evidence on intermediate care, including reablement.
“The guideline is for health and social care providers and practitioners delivering intermediate care and reablement, and for people who use the intermediate care and reablement services and their family carers,” said the guidance.
“This guideline has been developed in the context of a complex and rapidly evolving landscape of guidance and legislation, most notably the Care Act 2014. The Care Act and other legislation describe what organisations must do. This guideline focuses on ‘what works’, how to fulfil those duties, and how to deliver care and support,” it concludes.
The consultation closes on Friday 26 May 2017 at 5pm. It is expected that the guidance will be published in October this year.
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