IMC Patient Brief

The Intermediate care team is a short term rehabilitation service that can input for a maximum of 6 weeks.

There are a number of reasons why you may be referred to the team, the first being:

If, during your hospital admission, it has been identified that you have a potential for progression in your current level of functional ability upon your discharge home, yet may require support to do so, then that is why you have been referred to us.

The team is made up of Physiotherapists, Occupational Therapists, a nurse and rehabilitation support workers. On discharge a therapist will assess you at home, complete an initial assessment and identify with you the support you will require. This could be support with your personal care, meal preparation or preparation for bed.

Agreed goals will be set up with you for the team to support you in reaching these. We will promote and advise on means that will promote your independence with these tasks; this may include equipment, new techniques or merely practice. You may also require a physiotherapy programme to be arranged to promote mobility, stair practice or safe transfer techniques.

Within the time that the team input with you, your independence and confidence should increase to a safe level for you to manage on your own. Should it be identified that it is likely you will need support after the maximum of the 6 week intervention with the team, as your level of rehabilitation has reached a plateau or you are going to need further, longer term support, then it will be discussed with you. Should it be agreed, then a referral will be made to a longer term, more appropriate service.

If you have been referred for physiotherapy input then this will mean a physiotherapist will visit you at home to complete an assessment and gain your area of need, agree an exercise programme with you to support you to reach your personal goals, so long as this as realistic.

This may include increasing your mobility (indoor and out), stair practice or muscle strength.

Again this service is for a maximum of 6 weeks input and may require the rehabilitation support workers to visit you to encourage and support you with your exercise programme.

Should you be non-compliant or reach a plateau then you will be discharged from the service.

You may have been referred for equipment only that is required for safe discharge home from hospital. This will be ordered prior to your discharge and reviewed once you are home. No further input should be required.

If you have been referred to a rehabilitation bed, then this is because it has been agreed with you that you have a potential for further rehabilitation but need to do so in a supported environment, prior to you returning home.

The rehabilitation bed is available to you for a maximum of 6 weeks only.

Within your stay at the rehabilitation beds, you will receive input from Occupational Therapists, physiotherapists, nurses, social workers and support workers, whether carers on site or off site rehabilitation support workers.

This is to promote your independence with activities of daily living, such as your mobility and personal care. Within these six weeks you will liaise with many members of the team to ascertain whether you will be safe to return home either with support or without, or may possibly require a placement elsewhere for a longer term input. Either of which, the appropriate arrangements will be made with your consent.
Please note, we do NOT offer an intense rehabilitation programme, contrary to common belief.

Last updated: 11/05/2012

Update due: 11/05/2013