The UK has been at the forefront of developing, piloting, and rolling out reablement – time-limited home-based intermediate care provided by local authorities to help older adults regain independence. However, significant inconsistencies challenge the core notions of reablement, its fit with practice, and ultimately its sustainability. This paper is part of an investigation into user engagement in reablement. It acts as a critical review of UK reablement policy design and implementation, based on an empirical study but involving a more comprehensive engagement with reablement policy and practice worldwide. Five research sites were selected across England and Wales, representing different models of service organisation and delivery and broader contexts. Data were collected through focus groups with reablement staff (n=78) and interviews with service users (n=12) and families (n=5) between April and August 2022. Thematic analysis was applied. Drawing primarily on the experiences of service staff, four paradoxes were identified. The widespread misunderstanding of reablement in society has hindered this paradigm shift. Regarding service organisation and delivery, the increasing number of low potential referrals has undermined the goal of independence. Families as key players have been more of a barrier to engaging seniors with reablement activities, leading to constant multi-stakeholder negotiation that compromises the pursuit of independence. The unintended user dependency on staff companionship caused by the functionality-focused model contradicted efforts towards independence. Reviewing and ensuring policy coherence and compatibility is essential for welfare reform, especially fragmented care. Methodologically, this paper provides a two-dimensional framework for policy analysis: (1) the policy lifecycle dimension, i.e. (in) coherence across policy design and implementation; and (2) the system dimension, i.e. (in)compatibility between reablement and the wider system. Empirically, the paradoxes uncovered in this paper reveal a conflict between high aspirations in reablement policy discourse and its low priority and deviations from the ideal, requiring policy rethinking and resource reallocation.

Reablement, Ageing, Independence, Sustainability, Policy Design and Practice