Promoting Client Independence: An Evaluation of the Reablement Program Delivered in Wiltshire, United Kingdom

Background & Purpose: The Wiltshire Reablement Service provides short-term support to people who require assistance to live independently in their own home. The service is provided to a range of individuals including older people, clients with physical disabilities, learning disabilities and mental health needs. The objectives of the service include: (1) working with clients to agree a package of care which helps them achieve maximum independence; (2) helping to prevent unnecessary admissions to the hospital; and (3) reducing the number of people requiring long-term domiciliary care services. The service is offered for a period of 6-10 weeks; if a client is not reabled by the end of the 10 weeks, they are referred to another service. The evidence base for Reablement services is in its infancy with two studies from the UK (Kent et al., 2000;Newbronner et al., 2007) and one from Australia (Lewin et al., 2006) finding an improvement in clients' independence and a reduction in number of care hours required. This evaluation of the Reablement service addresses the following research questions: (1) What is the profile of people using the Reablement service?; (2) What extent has client severity of need changed from entry to exit?; and (3) What are the clients' experiences and perceived impact of the service? Methods: A pretest-posttest design explored the severity of need from entry to exit. Client questionnaires consisting of open-ended questions provided data to examine the clients' experiences and perceived impact of the service. Wiltshire County Council provided the data for the quantitative analysis, which consisted of all clients (N=211) who entered the service from October, 2008-April, 2009. The data included client demographics, severity of need (i.e. hours of service per week at entry and exit), and destination at exit. A questionnaire was mailed to all clients after the service had ended. Data analysis included descriptive statistics, a paired-samples t-test, and the constant-comparative method (Glaser&Strauss, 1967). Results: Of the 211 clients, 36% were male and 64% were female. The average age was 79 years (SD=11.78) and the majority of the clients (97.1%) were White British and had a physical disability (51.4%) or were temporarily ill (46.2%). At exit, 45.6% of clients required no further services; 31.6% of clients required assistance through domiciliary services. A significant difference between hours at entry (M=6.99, SD=3.81), and exit (M=3.11, SD=7.83); t(210) = 7.39, p=001, revealed an improvement for clients in the Reablement program. The client questionnaires revealed the following emergent themes in regard to what the clients hoped would be achieved from the service: (1) help to live independently; (2) return to normalcy; and (3) live at home. Over 76% of clients reported the period of the Reablement service achieved what they wanted. Implications: This evaluation contributes to the growing body of evidence that the Reablement service promotes client independence and ability to remain in their home. The triangulation of the data through client questionnaires further supports this finding. The authors discuss the logistics of implementing this model and provide implications for practice and future research.