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Community Reablement. Commenced 2003Short term assessment/therapy interventionInitial assessment within 2-5 days of referral or discharge from hospitalReferrals from hospital
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1. Newport Reablement Service Community Reablement Team
Promoting Independent Living Skills Service
2. Community Reablement Commenced 2003
Short term assessment/therapy intervention
Initial assessment within 2-5 days of referral or discharge from hospital
Referrals from hospital & community
Average 70 referrals per month
3. Community Reablement Based with intermediate Care
Physio
OT
Reablement SW
Reablement Nurse
Reablement assistants
Admin
4. Community Reablement Initial screening assessment by professional
Specialist assessments
Goals set/programme planned
Supervised by reablement assistants
Reviewed weekly in team meeting
Discharged when reached goals & signposted to other appropriate services
Quality assurance/monitoring
5. Promoting Independent Living Recently expanded and developed.
Access route for all new referrals for packages of care.
Referrals from SW only
Provide short term care support whilst OT assessments carried out
Discharge to other support services
Extracare schemes
6. Promoting Independent Living Senior Locality manager
Locality managers
Care coordinators
OTS
SWA
Admin
Care assistants
7. Promoting Independent Living Assessed by OT for potential within 5-7 days of care starting
Goals set
Reviewed weekly in team meeting
Discharged to mainstream, private, outcome focus, other support or no care.
Quality assurance/ monitoring
8. Challenges Lack of budget to develop services
Lack of understanding regarding reablement ethos
Promotion of teams activity
Developing staff
Proving benefits of team activity.
9. Current & future plans Gwent Frailty Pathway
Development of Intermediate Care Service
Outcome focus pilot
Further integration of CRT & PILS
Evaluate services using SPICE tool
Expand staffing in PILS
Develop care staff and expand roles