Select Committee on Health Appendices to the Minutes of Evidence


APPENDIX I

EXAMPLES OF REHABILITATION IN INTERMEDIATE CARE: OLDER PEOPLE

COMMUNITY REHABILITATION SERVICE, HALIFAX GENERAL HOSPITAL

  An integrated rehabilitation service, based in four local community settings in Halifax, ensures patients have access to rehabilitation, including physiotherapy, in their own homes, in local day centres and health centres. The service also provides a residential rehabilitation unit for elderly people, run by social services, and an early discharge rehabilitation at home scheme.

  A close partnership between the local authority, the local primary care group and health authority underpins the development of community rehabilitation services in the area.

INTERIM DISCHARGE PROJECT, KETTERING GENERAL HOSPITAL

  Pressure on acute beds led to a project in Kettering which helps patients who need a period of recuperation after a stay in hospital or treatment in A&E. The majority of patients who need this type of help are older people (the average age is 72), but people who have had an orthopaedic operation and don't have support at home also benefit from the scheme. The project has 10 beds in a nursing home where nursing is provided for up to four weeks. After treatment in the unit, 64 per cent of patients are discharged home without need of further help.

THE SHEFFIELD ASSESSMENT AND INTEGRATED CARE UNIT

  The Sheffield Assessment and Integrated Care Unit provides elderly people admitted into A&E departments after a fall, with a rapid response health and social service support team. The scheme aims to provide an immediate assessment of needs for people not requiring hospitalisation following an acute or traumatic illness, but who do require some social care or rehabilitation.

  The team liases across agencies to draw up a package of support for each patient. Multi-agency team meetings maintain a seamless service. Collaborative care notes are faxed between agencies to access immediate follow on services and to minimise duplication of patient details.

CRISIS ASSESSMENT RAPID REABLEMENT INTERVENTION FOR THE ELDERLY (CARRIE) TEAM,

TORQUAY

  CARRIE aims to provide a seamless model of care to elderly people, with multidisciplinary assessments, rehabilitation, social care and crisis intervention placement at nursing homes. When a referral is received, an assessment is made as to whether the older person can remain safely at home. If the client cannot cope, he/she has the option of spending up to five days (free of charge) in a local nursing home to receive relevant medical investigations, multidisciplinary assessments and the rehabilitation necessary to return home. All clients receive a home visit prior to discharge from the nursing home and the team follow up the client at home until the rehabilitation goals have been achieved.




 
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Prepared 29 July 2002