Community Reablement
Short term multi-disciplinary intervention to enable Patient to become more independent in their own home, reducing the need for a long term package of care and preventing admissions to Hospital or Residential or Nursing Homes. Enabling people to become more integrated into community activities.
Who can refer to the service?
Can be referred by Health & Social Care Professionals both hospital & community based.
Patients & Carers can contact Common access point to discuss needs for possible referral through this point.
Referral criteria/Exclusion criteria
Patients need to be:
- Needing multi-disciplinary input ( see Therapists in Team below)
- Medically stable / managed
- Specific achievable goals
- Degree of motivation & compliance
- Adequate cognitive skills to respond to advice & instruction with carry over
- Supported discharge with intense focused professional follow up.
Not appropriate for:
- Acutely unwell / unstable medically
- Those with significant mental health needs that compromise their ability to achieve goals over a short time period
Who will they be seen by?
Can be seen by a variety of Therapists depending on need. This can include Dietitian, OT, Pharmacy Technician, Physiotherapist, SALT, Social Worker. May be seen by Nurse if need arises and no DN input. Also Care support workers who will follow plan put in place by Therapists.
Must need input from more than 1 Therapy to meet criteria for service
What can people expect from the service?
Assessment and intervention from any of the above Therapies needed. Linking with Patients and Carers to work towards patient centred goals to ensure they reach their full potential in the time period allowed. May liaise with GP, DN, Hospital Consultants if needed. Care support that will carry out Treatment plans set by Therapists to rehabilitate to be as independent as possible.
Who does the service signpost/refer to?
Can be referred on to various services as needed including Care & repair, Fire service ( home Safety Checks), National Exercise Referral Scheme (NERS), Telecare, Out patients Physiotherapy, Day Hospital, etc.
May be referred for ongoing support if needed ( will be a charge for ongoing support).
Contact details
Professionals can access via referral form below.
Carers /Patients would need to contact Common Access Point on 01656 642279, who will decide which is the most appropriate service for needs.
