Hospitals in all developed countries get under increasing pressure discharging patients from their wards earlier. While for some – and mainly younger – patients “early supported discharge” can be arranged, for example with home IV antibiotic or wound services, many elderly patients struggle following an acute illness. On discharge many may only need support in their activities of daily living (ADLs), which can often be provided at home, but there are also those who need assistance or supervision with their mobility or help during the night.
Traditionally elderly patients, who are unable to return home safely, get referred to Geriatric Assessment and Rehabilitation (ATR) wards to facilitate their recovery, and can spend several weeks there. It is often difficult to predict how much input from therapists a patient needs, and whether their admission is truly rehabilitative or simply recovery with adequate supports.
There are also patients where an acute illness may have worsened chronic conditions or their frailty, to a point where they need to be assessed for aged residential care (ARC). Often these assessments happen on acute or ATR wards.
We have developed an Intermediate Care (IC) program with several workstreams tailored to the needs of our health service serving a population of 72,000 people. Eligible patients get a comprehensive geriatric assessment by our multidisciplinary team (MDT), including a geriatrician. The team decides whether a patient should be considered for inpatient – and intensive – rehabilitation, or for slow stream rehabilitation on IC in an ARC. This involved an individual rehabilitation plan to be executed by the patients themselves and trained ARC staff with supervision from and regular visits by our MDT. Other patients may be eligible for a period of recovery only with little input from our MDT, or may not have resolvable medical problems and only require ARC. We offer IC assessments on all wards and our Emergency Department.
Intermediate Care has proven to be a particular good tool for patients recovering from subacute delirium, slow stream and low intensity rehabilitation following fractures of pelvis or spine, and those who would likely qualify for aged residential care but no longer need inpatient hospital care while waiting for assessment and service coordination. This has resulted in an overall reduction of hospital length of stay of eligible patients.