Intermediate Care Lets People Live Independent Lives

Sam Poddar, Chairman of Lambhill Court Ltd, argues that intermediate care lets people live independent lives and receive care in their own homes

The government talks about partnership, inclusion, choice and integration but, in many cases, refuses to acknowledge the importance the private sector plays in the provision of good quality care and fails to include them in the planning process.

Older people want to live independent lives and receive care in their own homes rather than be forced into care homes. With this in mind, Scotland’s first commune for senior citizens has been launched to help older people remain in their own homes by providing an intermediate care unit fully equipped with all necessary rehabilitation equipment and staffed by the NHS.

Intermediate care aims to promote the independence of older people by providing enhanced NHS and council services to prevent unnecessary hospital admission and hasten the rehabilitation and discharge of older people from hospital. It aims to reduce premature or unnecessary admission to acute and long-term residential care by focusing on, responding to, and averting a crisis, as well as active rehabilitation following an acute hospital admission and where long-term care is being considered.

There needs to be more ‘responsible risk-taking’ to help older people who want to stay at home to be able to do so. Putting people into care homes is a ‘quick, safe option’ and there is a need for more ‘good support services’ if people are to be placed back in their own homes.

Risk plays a part, but a lack of resources and fines for bed-blocking also influence decision-making. With one hospital bed costing between £300 and £1,000 per day, a major advantage of providing intermediate care beds is significant cost saving for the NHS.

A hospital is not the right environment for the rehabilitation of an elderly person. There is a high risk of obtaining infections, such as MRSA, in hospitals, which cause unnecessary pain. By providing an assessment and rehabilitation centre, problems of bed blocking in hospitals can also be reduced.
Targeted at people who would otherwise face unnecessarily prolonged stays or inappropriate admission to an acute hospital or care home, intermediate care is provided on the basis of a comprehensive assessment, resulting in an individual care plan that involves active treatment and rehabilitation. Direct transfer of people from hospital to care homes is wrong. It is simply unacceptable for people to be asked to decide where they want to live while they are still in their hospital bed.{mospagebreak}

Stay in an intermediate care unit is planned to maximise independence and, typically, to allow patients to return home. It will be time-limited, normally lasting no longer than six weeks, and frequently as short as one to two weeks, meaning that it can essentially be termed as a rest period for clients.

Intermediate care services should be designed to rehabilitate and improve mobility in order to make a real and lasting difference to people’s lives. These services will be provided by a team of professionals including General Practitioners and hospital doctors, nurses, physiotherapists, occupational therapists, speech and language therapists and social workers with support from care assistants and administrative staff.

Intermediate care gives the elderly an opportunity to not only recover physically, but mentally too. With falls representing more than half of hospital admissions for accidental injury, it is unsurprising that the NHS spends an estimated £981m on treating people who have falls.

When an elderly person is admitted to hospital as a consequence of a fall and then discharged back to their own home, they have often lost their confidence, which increases the chances of a fall reoccurring. In an intermediate care unit, elderly people are given a chance to regain their confidence before being discharged.

Some form of intermediate care should be offered to all older people who need it on leaving hospital to give them time to make decisions about where they want to live. This can involve placing people in intermediate care beds, where they receive help from physiotherapists and occupational therapists on how to get themselves more mobile, or people living in their own homes but with a substantial care package that gradually becomes less intensive.

Care homes need to provide more rehabilitation services that prevent people becoming institutionalised and enable them to return home. There is a long way to go to transform services for people to be really flexible, rather than just offering a straight alternative between residential or home care.
More beds are required in hospitals for rehabilitation. Independently run intermediate care centres would provide the kind of care and attention one might need after surgery and, although respite care is provided for in care homes, beds should be allocated to hospital patients needing intermediate care.