Several Norwegian municipalities have introduced home-based reablement. In his doctoral work, Tore Bersvendsen has researched whether it is profitable. It turns out that it is, but mainly for women.
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“Home-based reablement is an intensive rehabilitation programme that takes place in a patient’s home. It is implemented to increase or restore functional level. For example, a patient may have had an accident that makes carrying out daily tasks more difficult. The patient sets a goal, such as being able to pick up the mail, and a municipal team - such as homecare nurses, physiotherapists and the like - coordinates the municipality’s resources to achieve this goal”, says Bersvendsen.
The goal of this type of rehabilitation is to provide patients with short-term, intensive support, typically 4-6 weeks. In this way, the patient can reach a better functional level, which hopefully lasts longer than with traditional treatment, which is to care for the patient’s current needs and not the patient’s desired goals.
Many municipalities have reported good experiences with the scheme, and many tools and aids have been developed. Although home-based reablement is a widespread practice, there has not been much research on the scheme.
“More than 240 municipalities in Norway have introduced this now. When this scheme was first reported, which began in Denmark in 2008, there was talk of enormous savings. But few have investigated whether it pays off in the long run”, says Bersvendsen.
In the article ‘The health cost effects of home-based reablement: Empirical evidence from Norway’, which is included in the doctoral dissertation, he has collected and analysed data from several national health registers. Here he made an interesting discovery.
“It is primarily the hospitals that save money on this scheme. They have less cost with this patient group, which usually includes people over the age of 70,” says Bersvendsen.
Reablement services are funded by local authorities, whereas hospitals are funded by the state. So, the savings mainly occur elsewhere than where the expenses are incurred.
“I also calculated an estimated saving per patient. We are talking about around 6,000 kroner per month. This may not be the big amounts many municipalities envisioned when this was introduced. But it shows that home-based reablement provides a saving”, says Bersvendsen.
Anonymised health statistics about the users of home-based reablement gave him good insight into which users benefited from the scheme and which did not. One of the findings is that the savings from home-based reablement, on average, did not apply to men.
“It surprised me. I am not sure what the reason is, but I think it has to do with how the goals are set. Home-based reablement often focuses on basic household chores, and traditionally men in this age group are not the ones who do such work. But it also shows that there are new aspects of this form of rehabilitation that can be investigated further.”
Bersvendsen emphasises that the estimates are based on an average of many different users.
“There are also male patients who have cost savings, and there are women who do not. But the average effect for men is that there are no savings”, he says.
He suggests the services should be offered specifically to those who have a positive effect from them.
“If the goal is to reduce costs, these services could possibly be improved by taking some action. That might mean that the scheme won’t include as many as today, but that one must define the user groups that experience the greatest effect of the home-based reablement services”, says Bersvendsen.