Specialist inpatient rehabilitation or community rehabilitation? - - PowerPoint PPT Presentation

Specialist inpatient rehabilitation or community rehabilitation?

Prof Áine Carroll

Director, IFIC Ireland/IFIC, Prof Healthcare Integration and Improvement UCD/NRH

Answer?

• Both and..

– Given the diversity of presentation and rehabilitation needs, different patients require different types of services. – Moreover, the same patient will require different services at different stages in their recovery – And we still don’t know the full extent of the issues that will require rehabilitation!

What do we even mean by rehabilitation?

What we don’t need

• Post-COVID-19

rehabilitation services to further fragment the scarce rehabilitation services that are available

A ‘new’ paradigm

• Need to move from:

– Biomedical, disease-focused approach with Rehabilitation as occasional add-on after medical process

• To:

– Holistic, patient-centred approach with Rehabilitation fully integrated with medical care at all times (i.e. in parallel )

What is rehabilitation? An empirical investigation leading to an evidence-based description

Wade, D.T., 2020. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clinical rehabilitation, 2020, Volume 34, Issue 5

Rehabilitation after COVID-19: an evidence-based approach

Rehabilitation care pathways in the wake of Covid-19

Factors affecting the rehabilitation response

Coordinated networks Rich connectivity!

• Rehabilitation services planned and delivered in coordinated networks
• In view of the infectious nature of Covid-19, Covid-positive and Covid-negative

streams are required especially within the step-down/early rehabilitation stage after patients first leave the ICU setting.

• Close integration of hospital and community services with collaborative

commissioning arrangements.

• Primary care teams supported by outreach activity from secondary services

including (and more besides);

a) Cardio-pulmonary rehabilitation b) Sports and exercise medicine c) Neurorehabilitation and neurological disability services d) Vocational rehabilitation.

• Specialist rehabilitation should be delivered by coordinated multi/inter-disciplinary

rehabilitation teams

• Facilities that include specialist equipment, electronic assistive technology and
• rthotics.
• Joined up multi-agency long-term care from health, social services and the 3rd

sector where appropriate.

Both and..

• Rationalisation and reorganisation of services for

people into a coherent, comprehensive rehabilitation service from first contact with healthcare

• Provision of service in all settings from intensive care

through hospitals and care homes into the wider community, in parallel with medical services

• All ages and conditions
• Full integration between mental health services and

rehabilitation services

• Recognise that all rehabilitation requires expert

knowledge and skills

Concluding thoughts

• COVID-19 has challenged all healthcare systems and

specialties , including rehabilitation.

• It’s not going away any time soon and we will see the

consequences for many years to come.

• We have seen unprecedented innovation and adoption
• ver the last number of months that we wouldn't have

dreamed of pre-COVID

• “Rehabilitation” and the need for it has received great

attention but it has been siloed and fragmented

• If we come together in networks of rehabilitation in

partnership with patients and families and community

• rganisations, we might really achieve something magical

integratedcarefoundation.org/ificireland @IFICinfo IFICIreland@integratedcarefoundation.org Aine.carroll@ucd.ie