{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

Intermediate Care and Reablement Support Policy

1. Purpose and Commitment

The purpose of this policy is to outline how {{org_field_name}} delivers efficient, effective, and person-centred intermediate care and reablement support. This policy ensures that individuals receiving our services regain independence, confidence, and functional ability after hospital discharge, illness, or deterioration in health. Our approach promotes recovery, reduces dependency, and prevents unnecessary hospital readmissions.

We are committed to providing reablement-focused care that aligns with the Care Act 2014, the Health and Social Care Act 2008, NICE guidelines, and Care Quality Commission (CQC) standards. This policy ensures service users achieve their maximum potential through goal-oriented, time-limited support.

2. Scope

This policy applies to all employees, including care staff, administrative staff, volunteers, and contractors involved in intermediate care and reablement. It covers:

• Assessment and care planning.
• Delivery of intermediate care and reablement services.
• Monitoring progress and evaluating outcomes.
• Collaborative working with healthcare professionals and families.

The policy applies to all domiciliary care settings where service users require short-term, outcome-focused support aimed at regaining independence.

3. Policy Statement

{{org_field_name}} is committed to delivering intermediate care and reablement services that:

• Promote independence and self-care.
• Support recovery from illness, injury, or hospitalisation.
• Empower service users to achieve personal goals.
• Reduce reliance on long-term care services.

We achieve this through comprehensive assessments, tailored care plans, multi-disciplinary collaboration, and continuous progress monitoring.

4. Understanding Intermediate Care and Reablement

4.1 What is Intermediate Care? Intermediate care provides short-term support to individuals recovering from illness, surgery, or hospital discharge. It bridges the gap between hospital and home, promoting recovery and preventing unnecessary readmission.

4.2 What is Reablement Support? Reablement focuses on helping individuals regain skills, confidence, and independence in daily activities. It involves:

• Personalised goal-setting.
• Time-limited, intensive support.
• Promoting self-care and resilience.

Reablement differs from traditional care by encouraging active participation rather than passive care delivery.

5. Roles and Responsibilities

5.1 Care Staff Responsibilities Care staff involved in intermediate care and reablement must:

• Complete accredited training in reablement practices.
• Deliver care according to individual care plans.
• Encourage service users to engage in self-care activities.
• Monitor progress and report concerns promptly.
• Maintain accurate records of care and outcomes.

5.2 Manager Responsibilities Managers are responsible for:

• Overseeing service delivery and adherence to care plans.
• Conducting regular audits of reablement practices.
• Providing staff training and support.
• Reviewing care plans and progress reports.

5.3 Service User and Family Responsibilities Service users and families are encouraged to:

• Participate actively in care planning and goal-setting.
• Engage in self-care activities as guided by care staff.
• Communicate any concerns or changes in health promptly.

6. Assessment and Care Planning

6.1 Initial Assessment Upon referral, a comprehensive assessment is conducted to determine:

• Current abilities and limitations.
• Personal goals and preferences.
• Support required for reablement.

6.2 Individualised Care Plans Based on the assessment, an individualised care plan is developed, outlining:

• Short- and long-term goals.
• Required support and interventions.
• Timelines for achieving goals.

Care plans are reviewed regularly to ensure they remain relevant and effective.

7. Delivery of Intermediate Care and Reablement Services

7.1 Person-Centred Approach Our care delivery is tailored to each individual’s needs and preferences. This includes:

• Encouraging independence in personal care tasks.
• Supporting mobility and physical activity.
• Promoting safe use of adaptive equipment.

7.2 Multidisciplinary Collaboration We work closely with healthcare professionals, including physiotherapists, occupational therapists, and GPs, to ensure holistic care.

7.3 Encouraging Self-Care Care staff support service users to:

• Perform daily tasks independently.
• Build confidence in managing personal health.
• Develop coping strategies for long-term well-being.

8. Monitoring Progress and Evaluating Outcomes

8.1 Regular Monitoring Staff conduct regular progress reviews, including:

• Weekly progress assessments.
• Observations of daily activities.
• Feedback from service users and families.

8.2 Outcome Evaluation Outcomes are evaluated based on:

• Achievement of personal goals.
• Improvement in functional abilities.
• Reduction in care needs.

Progress reports are shared with service users, families, and healthcare professionals.

9. Transition and Discharge Planning

9.1 Preparing for Discharge As service users achieve their goals, we develop a discharge plan, including:

• Final progress assessment.
• Recommendations for ongoing support.
• Guidance on self-care and community resources.

9.2 Follow-Up Support We provide follow-up support to ensure sustained independence and well-being.

10. Safeguarding and Risk Management

10.1 Promoting Safety We prioritise safety by:

• Conducting regular risk assessments.
• Addressing hazards in the home environment.
• Providing guidance on safe mobility and self-care.

10.2 Responding to Concerns Staff report any safeguarding concerns promptly, following company safeguarding protocols.

11. Training and Competency

11.1 Staff Training All staff involved in intermediate care and reablement complete:

• Accredited reablement training.
• Regular refresher courses.
• Competency assessments.

11.2 Competency Checks Managers conduct regular competency checks, ensuring staff deliver care safely and effectively.

12. Record-Keeping and Documentation

Accurate record-keeping is essential for monitoring progress. Staff document:

• Daily care activities.
• Progress toward goals.
• Any challenges or concerns.

Records are stored securely and shared only with authorised personnel.

13. Communication and Collaboration

Effective communication ensures continuity of care. This includes:

• Regular updates to healthcare providers.
• Collaboration with service users and families.
• Participation in multidisciplinary team meetings.

14. Complaints and Feedback

We welcome feedback to improve service delivery. Service users and families can submit complaints or suggestions through:

• Direct communication with care staff.
• Formal complaints procedures.
• Anonymous feedback channels.

15. Quality Assurance and Continuous Improvement

15.1 Audits and Reviews We conduct regular audits to ensure:

• Compliance with this policy.
• Achievement of service user outcomes.
• Identification of areas for improvement.

15.2 Continuous Improvement Feedback, audits, and incident reports inform service improvements and staff training.

16. Compliance and Review

This policy is reviewed annually or following significant changes in legislation or best practices. Compliance is monitored through:

• Staff training and competency assessments.
• Regular audits and progress reviews.

Service user feedback and outcome evaluations.

---

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.