Purpose of Having Full Time Occupational Therapists (Ots)

Zaid Latif

Cost benefit analysis for Occupational Therapists (OT) in reablement

Reablement is actively part of the Putting People First agenda and self directed

support (SDS).They share the same goals of promoting independence, health and wellbeing of citizens while improving choice and control.Reablement therefore supports the prevention and early intervention agenda. This report will look at the contribution of the OT in intake reablement and the effects for the citizen, staff and department.

Currently there is a part time OT working across 6 intake teams. The OT attends weekly meetings to pick up referrals and liaise with Homecare Managers and staff. To do this effectively an increase in OT input would have better outcomes for citizens and save the department money.

The OT sees about 15% of citizens (about 2-4 per week - but this varies) Due to time constraints many have to be referred to the mainstream waiting list. These citizens do not receive timely reablement intervention and as a result become dependent on carers for activities of daily living.

The impact of OT on citizens

The impact of OTs has been recorded by use of the NottinghamCity’s person centred ladder (please see attachment). This shows how a citizen is managing with their personal care (functional score, figure 1) and more importantly how they feel about this (emotional score, figure 2). The tables below illustrate firstly that reablement is working and secondly that reablement with OT input is working much better.

(Figure 1)

(Figure 2)

From the above tables it can be seen that citizens do functionally better and actually feel better about their reablement journey, they have a better outcome. From the analysis of the ladder citizens who saw an OT did better at 4 weeks compared to citizens who did not see an OT over their entire rehab period. The person centred ladder has also been published on the ‘think local act personal’ website.

Impact of OT on staff

Having an OT in reablement has increased the skills and knowledge of the staff. The OT has undertaken hoist training, telecare awareness and the use of alternative techniques and equipment. The OT has also been working with the telecare team to address the issue of self medication of citizens on reablement. Addressing this would mean a considerable cost saving due to a reduction in care hours.

A questionnaire was sent out to rehab support workers and home care managers regarding the role of the OT in reablement. It was found that staff valued the OT,in particular stating that assessments were completed at the start of reablement, alternative techniques were given / practiced with the staff and citizensissues were discussed in team meetings and addressed. This up skilling of workers increased the quality of reablement.

Impact of OT on department (cost savings)

Reablement has been shown to deliver cost savings. Care services efficiency delivery (CSED) reports that reablement is cost effective mainly due to the reduction in care hours. In 2007 CSED found that after reablement 68% of citizens no longer needed a package of care and 48% continued to need no carer input 2 years later (CSED Homecare Reablement Work Stream 2007). In Norfolk county council the OT led reablement service found that long term care hours were reduced by 90% (Allen and Glasby 2010).

One study looked at provision of equipment and reduction in care package costs and residential care. Over an 8 week period cost savings to care packages was £60,000 (Hill 2007). In Somerset, of the 125 citizens assessed by an OT, 37% are now assisted by x1 carer with a saving of £270,000 (Mikel 2010). It was shown that in the first 2 years the cumulative saving after reablement was £2 million. Also 400 additional citizens had been diverted out of the social care sector

In NottinghamCitya random sample with OT input was taken and the average cost saving per citizen was over £780over the reablement period. This figure includes the hours saved over the reablement period and the money saved from the clients not having to wait on the mainstream waiting list. If all citizens had access to OT input at the beginning of reablement then this would equate to £150,540 saving over the reablement period of six weeks. Therefore the total cost saving for a year would be £1.3 million.

Similar to other authorities it has been shown that reablement in NottinghamCitywith OT input has achieved better outcomes than those without OT. Having an OT has not only reduced the waiting times for those on reablement but has reduced the amount of citizens on the mainstream OT waiting lists.

Conclusion

It has been shown that having OTs in reablement has had a positive effect for the citizen, staff and the department. It has been shown that having OTs at the start of reablement would mean more citizens being seen, therefore increasing throughput and capacity. The citizen’sjourneythrough reablement has been shown to be more effective. Having OTs has up-skilled the home care mangers and rehab support workers which has in turn increased the efficacy of reablement.

Having the goal of reducing the care hours to zero means that citizens are no longer FACS eligible, do not need to have an SAQ, do not need to wait for brokers and hence the current waiting list is reduced. Having OTs in intake reablement has been shown to have a significant cost saving to the department which is in line with national trends.

Zaid Latif

Appendix 1

Role of the Occupational Therapist (OT)

assessing whether equipment or an alternative technique are needed

setting of rehab ‘goals’ which are important to and for a citizen

referral for major / minor adaptations

washing and dressing assessments

kitchen assessments

a resource which is utilised by care staff - to ‘up skill’ rehab workers on equipment, alternative techniques, policy and procedures

To give more structure when keeping notes on how well a citizen is doing for audit purposes – person centred ladder

Liaise with the next part of the SDS process

Complete SDS referrals and could act as a broker

Different types of OT intervention for citizens of reablement

As can be seen from the chart below the majority of OT input is equipment, adaptations and OT advice. Along with this, an increase in OT input should look at increasing the percentage of activities of daily living tasks (ADLs). This would lead to a further reduction in care hours at the end of reablement.

References

Allen K et al (2010) ‘The billion dollar question’: embedding prevention in older people’s services – 10 ‘high impact’ changes. A paper from Health Services Management Centre, University of Birmingham.

College of Occupational Therapists (2008) Position Statement: The value of occupational therapy and its contribution to adult social service users and their carers. COT. London

Department of Health/CSED (2007) Research into the Longer Term Effects/Impacts of Re-ablement Services Elizabeth Newbronner , E., Baxter, M., Chamberlain, R.,Maddison, J., Arksey, H., Glendinning, C

Department of Health. (2008) Occupational Therapy in Adult Social Care in England: Sustaining a high quality workforce for the future

Heywood F and Turner L (2007) Better outcomes, lower costs: Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence. London: Her Majesty’s Stationery Office

Hill S (2007) Independent living: equipment cost savings. (Extract taken from the

COT in house Killer Facts database)

Somerset County Council (2009) project carried out by OTs investigated the prospectto substitute equipment for domiciliary carers assisting services users in their home (there were 2 carers assisting 1 service user). Held at COT Riverside Community

Health Care NHS Trust (1998) The Victoria Project: community occupational therapy rehabilitation service: research findings and recommendations. London: Riverside Community Health Care NHS Trust.

Cost benefit analysis of the Occupational Therapist’s impact on reablement in Nottingham city

Zaid Latif

0ctober 2011