Intermediate Care and Reablement in Care Homes (England) Policy

Introduction

Intermediate care involves a range of services made available to people who are leaving hospital or to older people who are at risk of hospital admission without timely and focused intervention.

The emphasis of intermediate care is on promoting independence through active recovery as it aims to help to move a person receiving care from medical dependence to being more independent by providing a supported pathway between social, primary and acute care. The aim is to avoid unnecessary or inappropriate hospital stay.

It is recognised that intermediate care can be provided in a range of settings, ranging from hospitals to care homes to people’s own homes, and that intermediate care is only appropriate where older people are medically stable and no longer need acute medical care. People living with dementia are not excluded from receiving an intermediate care service if it meets their needs.

Policy Statement

This policy sets out the values, principles and procedures underpinning this care service’s approach to its intermediate care or reablement service provision. It seeks to:

establish clarity of roles and expectations between the service and intermediate care purchasers
ensure that it provides a high quality, safe and appropriate service with areas of risk addressed
provide the basis for a sound contractual agreement
provide a service that is consistent with the intermediate care provisions set out in the Care Act 2014 and meets the requirements for person-centred care in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Home’s Approach to Residential (Bed-based) Intermediate Care

In its approach, {{org_field_name}} follows the guidance issued by the National Institute for Health and Clinical Excellence (NICE), Intermediate Care Including Reablement (NG74) and aims to achieve Quality Standard QS173 (2018).

It recognises that this form of care is:

targeted at people who would otherwise face unnecessarily prolonged hospital stays or inappropriate admission to acute in-patient care, long-term residential care or continuing NHS in-patient care
provided only after a comprehensive assessment has been carried out, that has resulted in a structured individual care plan involving active therapy, treatment or opportunity for recovery
aimed at maximising independence and typically enabling people who have been receiving treatment to resume living at home
time-limited (normally no longer than six weeks and frequently less)
in line with integrated care policies, delivered by a multidisciplinary team and, wherever practical, with a unified assessment framework, single professional records and shared protocols.

The Home’s Intermediate Care Policy

Intermediate care at {{org_field_name}} aims to facilitate the transition from hospital care to independent living so that an individual can, after receiving the necessary support, return to their usual place of residence within a predefined time.

It is the home’s policy and view that residential intermediate care is intended to be built around active rehabilitation and is not appropriate for people with longer term continuing care needs.

The Home’s Admission Criteria

It is important that those admitted into intermediate care at the home benefit from the experience. The home, therefore, considers that comprehensive assessment, careful user selection and clear care planning are vital to achieve the sought outcomes for the individual.

The home insists that in each case of proposed admission for intermediate residential care there must always be clear, clinical and managerial accountability for each new person using services.

Admission to our intermediate treatment service will be based on individual need in line with the following criteria.

The home will appoint an intermediate care lead with the required qualifications and competence to be responsible for organising and co-ordinating the individual’s care plan in partnership with other professionals involved.
All contracts for intermediate residential care should be time limited and that time should be specified at the entering of an agreement.
The person receiving care must be registered with a GP, who could be their usual doctor.
No significant acute changes in medical management should be anticipated within the contracted period of intermediate care provision.
The assessed requirement for care must indicate that the person’s care can be safely and effectively provided outside of an acute hospital.
The assessed requirement for care should indicate that maximum independence is most likely and can be safely achieved in a residential setting with the appropriate support.
The person receiving care should initially be assessed as being likely to return home within six weeks of admission unless exceptional circumstances apply.

Intermediate Care Assessment

{{org_field_name}} complies with best practice guidance which states that an agreed assessment approach is crucial to the success of the intermediate care plan. The assessment process will be agreed between all parties. In this respect, the home has agreed to use local health/social services assessment tools which reflect the intermediate care provisions of the Care Act 2014.

Intermediate Care Procedures

{{org_field_name}} will appoint a named intermediate care lead with the required qualifications and competence to be responsible for organising and co-ordinating the intermediate care service.
The home will ensure that staffing arrangements reflect the ethos of a therapy-led service and that staff have relevant experience of a rehabilitative care environment.
The home will be responsible for:
– providing agreed, adequate levels of appropriately qualified staff
– maintaining staff competences through regular training and review
– checking that all qualified staff have current registration with the relevant professional registration bodies.
The home will ensure that the physical environment of the home reflects the purpose of the intermediate care programme and the distinctive needs of the people admitted for intermediate care.
The home will:
a. provide intermediate care facilities which are separate from long stay, standard accommodation so as not to cause disruption to permanent residents
b. provide dedicated accommodation for residential intermediate care users together with specialised facilities, equipment and staff, to deliver short-term intensive rehabilitation and enable people to return home at the end of their stay
c. designate therapy, kitchen and lounge areas for the sole use of people using intermediate care services and to provide them near to their bedroom areas
d. provide décor and furniture of a domestic style in those areas to be used for residential intermediate care
e. be person-centred in its care practice
f. have therapists and other specialists available with adequate facilities and support to undertake their work
g. employ intermediate care staff are qualified and/or trained and appropriately supervised to use techniques for rehabilitation including treatment and recovery programmes, promotion of mobility, continence and self-care
h. check individual progress daily with weekly review meetings attended by all involved in the individual’s plan of care
i. notify the local care plan co-ordinator where a person is making better progress than anticipated so that an early review of suitability for discharge can be undertaken, enhancing the opportunity for an early and successful return home
j. make suitable and immediate arrangements, where, in the judgment of the home staff, a person requires emergency treatment or admission (or readmission) to hospital
k. notify the case manager or local intermediate care co-ordinator of any re-admitted emergency action at the earliest opportunity
l. immediately notify the case manager or local intermediate care co-ordinator in the event of a significant deterioration in a person’s health status
m. arrange admission/readmission to acute care if necessary through a locally agreed acute admission/readmission policy.

Training

All staff involved in intermediate care programmes receive specialist training in line with their roles and responsibilities. Training follows the (NICE), Intermediate Care Including Reablement (NG74) guidance.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

CH169. Intermediate Care and Reablement in Care Homes