Intermediate care: what are service users' experiences of rehabilitation?

Abstract

The Department of Health's introduction of intermediate care recognised the need for rehabilitation following acute hospital care. The importance of rehabilitation was also stressed by a review carried out across England and Wales by District Audit. This article reports a phenomenological study carried out to explore service users' experiences of a 22‐bedded intermediate care service. Face‐to‐face, semi‐structured interviews were conducted with eight service users who were older people, with a further follow‐up interview two weeks later. Data was analysed using an open‐coding and theming approach. One of the six emergent themes is discussed in this article: service users' rehabilitation experiences. Data was themed into a rehabilitation framework of users' understanding, assessment and goal setting, interventions and transfer home. Intermediate care was found to provide support for service users between discharge from acute hospital and return to their own homes, but service users lacked understanding and awareness of the potential of the intermediate care service. They did not feel involved in their assessment and goal setting and so were unable to make individual contributions regarding their own rehabilitation needs. Interventions were subsequently not linked to their needs and transfer home experiences were variable. Users' experiences did not reflect the Department of Health's four principles that underpin the delivery of intermediate care: person‐centred care; whole system working; timely access to specialist care; promoting health and an active life. Recommendations are made to address these and to incorporate the recommendations from District Audit.

A review of the literature on patient participation in transitions of the elderly

“…Minimal participation in the discharge process was reported in several studies (Almborg et al 2008;Benten and Spalding 2008;Foss and Hofoss 2011;Perry et al 2011;Somme et al 2008). Swinkels and Mitchell (2008) focused on elderly patients' perceptions of effects of delayed transfer into the community, involvement in discharge planning and future community care needs.…”

“…Information was provided orally. In one study by Benten and Spalding (2008) (Perry et al 2011;Swinkels and Mitchell 2008) documented that some patients were not aware of their own formal discharge plan. One study (Foss and Hofoss 2011) revealed sparsely information to patients about discharge.…”

“…Not involving patients in decisions concerning their own treatment, care or discharge process may lead to disempowerment of patients (Benten and Spalding 2008). Swinkels and Mitchell (2008) reported patients' experiences of depression, change in functional ability, dependence on others, hopelessness, apathy, grief and loss of personal autonomy.…”

“…Lack of information concerning the discharge process was apparent in several of the studies exploring the patients' perspective on discharge planning (Benten and Spalding 2008;Ellis-Hill et al 2009;Foss and Hofoss 2011;McKain et al 2005;Perry et al 2011;Swinkels and Mitchell 2008). Information was provided orally.…”

“…This led to feelings of distress and several patients speculated about self-discharge. Benten and Spalding (2008) investigated the experiences of older people moving from hospital to intermediate care. The authors found that few participants felt they were involved or participated in the decision-making process.…”