How and why did we start providing intermediate care?
We began accepting people from hospitals on a 'discharge to assess' basis during covid, for anyone who was medically fit for discharge from hospital but not fit to go home. We were approached by the Director for Adult Social Services and Community Commissioning, Adrian Crook, to start providing intermediate care (IMC) for people who have the potential to be successfully rehabilitated to go home independently and 39 people have now used the service up to the end of November 2023.
Who have you worked with to bring the service and the care package together?
We are part of a multidisciplinary team (MDT) made up of social workers, occupational therapists and physiotherapists and we work alongside Killelea House and Heathlands Village, who also provide IMC. Referrals come through Killelea; they support people who have higher care needs and put any other referrals through to us or to Heathlands. We have occupational therapists and physiotherapists coming to see people every day.
What is involved in providing IMC and how is it different from the short stay care that Elmhurst staff already provided?
The aim of intermediate care is to support people with equipment, therapy and exercise to improve their confidence and get them home and living as independently as possible, with any necessary care packages or alterations to their home they need. Everything we do is aimed at building up people's confidence to go home, as it can be daunting to go home after an accident or an illness and to feel they have to do everything for themselves. This is different to our short stay service, where people come for a holiday, or to give their carer a break and we know they will be going back to an environment that already works for them. While we support everyone to be as independent as possible, some people have long term conditions which won't improve in the same ways that can be rehabilitated with intermediate care. At Elmhurst we make sure that people's carers and relatives are supported too; they are often scared about looking after their loved ones - we've got two gentlemen staying at the moment who've both probably been married 50 years and their wives are saying 'how will I cope when he comes home?'. We provide the best, adaptable care to everyone who stays with us, whatever their needs are; supplying the right care package, equipment and signposting signpost to other services that can support both of them, like Grundy Hub, so that carers get a regular break and support too.
We can support 13 people with intermediate care and any vacancies we have are regularly filled and come through quickly, so we need to be responsive. While people are staying, occupational therapists and physiotherapists work closely with us and share details of people's mobility or the exercises they can do throughout the day with us, so staff can continue to support them between therapy sessions.
Occupational therapists arrange any equipment people might need for their rehabilitation, whether it's chair raisers or a raised toilet seat and people can also use our training stairs to practise strength and co ordination if they have stairs at home. Often people need to take medication so we start by administering it for them and gradually work down to a dosette box so they can do it for themselves confidently, by the time they go home.We supported one gentleman who was using a wheeled Zimmer frame when he came to Elmhurst and now his mobility has improved so much that he's using a walking stick.
What have you learnt over the last six months and what has surprised you?
Ruth says: I'm amazed at how quickly the therapists can turn somebody around. It's great to see that people come in quite poorly and then go home well and able to look after themselves.
This MDT is amazing. We have weekly team meetings where we discuss each person - where they are, what the plan is for the next week, whether they're going to go home, whether they're looking at permanent care. Each person is then allocated to a social worker and everyone works to get equipment and therapy in place and organise home visits, to make sure everything's ready to support people's rehab and their next steps after intermediate care. It gives everyone a window to get things done quickly, so people aren't waiting for solutions.
We've had some great success stories; one gentleman was unable to get out of bed due to a fracture when he arrived, but with the work of the staff and therapists, he walked out of Elmhurst’.
What challenges have you had?
We've challenged people's perceptions of what we do; a lot of people are familiar with Killelea House and ask to go there. They don't realise that we offer a similar service and aren't always happy about coming to Elmhurst, so it's nice to be able to win them over and get thanks from them and their relatives when people leave intermediate care with us.
Staff have really embraced the changes but I think the hardest thing for us has been not 'over caring'. We're all learning new ways of working, going from 'let's help you to get dressed' to 'it doesn't matter how long it takes you to get dressed, let's get you to do it'. It takes more time for staff to support people to become increasingly independent in such short timescales, compared to a lot of people who come to short stay and who often have more direct support long term. We've learned to work closely with the therapists to ensure we're helping people to do for themselves rather than us doing things for them, to equip them to go home more independently.
Intermediate care is not for everyone and sometimes we get referrals based on incomplete, inaccurate or out of date information but it's early days. The MDT are all still building relationships and systems, learning how best to get and share information. For example, one lady who stayed with us was homeless. There was no housing for her to go to and she didn't want to do the rehabilitation being offered - she would have been better supported elsewhere. Another lady had intermediate care with us, then went home and later had to go into hospital again. We were asked to take her back, but we felt that she'd be better supported at Killelea House. It's a learning curve; it's still a very new type of service for us but we’re understanding more about who’s suitable for intermediate care, so we are able to challenge referrals a little more to ensure the service is right for everyone who comes. We're also sharing and requesting more information from our partners, for example therapists; asking their advice on whether they think someone might be better suited to us or another service.
Tell us about how people meet their outcomes – their goals for rehabilitation.
Here are stories from just a few people who've come to Elmhurst for intermediate care:
Louise* came to us after she'd had a stroke. She was initially cared for in bed and was later provided with an adjustable, rising chair. She loved to socialise; we shared a picture of her in the newsletter playing a basketball game. She has now gone home with a package of care and support from her family.
Bernadette* came to us a with a fracture to her hip. With support from staff and occupational therapists she returned home with a care package. She absolutely loved the staff and couldn’t thank us enough.
Maria* came to us after a fall and stay in hospital. She was initially looking at permanent care as she couldn't go home. However, with the support of staff, she built her confidence back up and went to live in sheltered accommodation at the age of 89.
Not everybody's achieved the goals they had when they came to us, either because their needs changed or because they just weren't able to go home, even after their 4-6 week programme. In these cases, we need to reassess and consider longer term care or 24-hour care. Also, while people who come to Elmhurst for intermediate care have been discharged from hospital, it doesn't always mean they're going to get well. For example, a lady came to us recently one Friday and we didn't know until she arrived that the hospital had given her two months to live. We did the best we could for her with the therapists' input; ensuring the district nurse came and that she had medication so she wasn't in any discomfort - she sadly passed away on the Monday morning. It's about us being adaptable and constantly checking what each person needs to live their best life.
What developments are you planning for the future of the intermediate care you provide?
We're about to complete installing our kitchenette, where people will be able to practise basic meal preparation. It's got a fridge, kettle, toaster and microwave and even though a lot of people will get their meals delivered, it's important they feel confident to put it in the microwave safely or make themselves a hot drink.
As part of our strategy we'll be focussing more on outcomes in the future; at the moment we can see progress as it's recorded in care control (our electronic recording system) but there's nothing on there at the moment to capture people's desired outcomes. We'll be asking people in more detail what their desired outcome is when they come to Elmhurst so we can track this better.
*names have been changed to protect people's privacy
To find out more about Elmhurst Short Stay and to refer yourself or someone you know, click here.