Admitted rehabilitation

Admitted rehabilitation is proactive and goal oriented. It targets people with loss of function or ability from any cause, either congenital or acquired. It aims to improve function and prevent deterioration of function to bring about the highest possible level of independence - physical, psychological, social and economical.

Admitted rehabilitation is aimed at providing care to maximise independence and quality of life for people with a disabling condition, while minimising the long-term care and community support required.

Rehabilitation care defined

Rehabilitation care is:

• managed by a clinician with specialist expertise in rehabilitation
• specialist care that is goal focussed
• interdisciplinary/multidisciplinary coordinated care
• individualised discharge planning
• person-centred
• optimising function and independence focussed.

Admitted rehabilitation and the subacute planning framework

In Victoria, admitted rehabilitation is provided by 26 Level 3 and 4 health services. Ambulatory rehabilitation is delivered by 39 Level 2, 3 and 4 health services across the state. Specialist acquired brain injury, spinal cord injury, burns and paediatric admitted rehabilitation services are delivered as statewide (Level 5) services.

The rehabilitation patient

Rehabilitation services are available to people of any age who have a physical disability, are frail, chronically ill or recovering from traumatic injury or illness.

The majority of patients are older, with 70 percent of those receiving inpatient rehabilitation aged 65 years and older, and 66 percent in community rehabilitation.

Rehabilitation patients present with a diverse range of primary diagnoses. However, primary impairment groups include orthopaedic, stroke and neurological conditions and account for around 60 per cent of inpatient separations and bed days.

Rehabilitation for children and young adults

Victoria has a statewide network of specialist rehabilitation services for children and young people with complex rehabilitation needs. While the relationship of these patients with the Victorian Paediatric Rehabilitation Service (VPRS) may extend over a significant period of time, they may only attend the VPRS for bursts of treatment at developmentally appropriate phases.

Elements of the service model

Rehabilitation is a well-established model and there are a number of aspects to a person’s rehabilitation journey that culminate in an optimal rehabilitation outcome and safe discharge.

There are seven key principles in the delivery of Victoria’s rehabilitation services.

Key principles

• Equity of access - people receive equitable access to rehabilitation services in the most appropriate setting and in a timely manner.
• Goal directed intervention - goals are set with the person through a collaborative process and care planning establishes how these goals will be met through a range of interventions.
• Person-centred care - the person and their family and carers receive rehabilitation services that place the person in the centre of their care. A collaborative and respectful partnership exists between the rehabilitation provider and the person.
• Interdisciplinary approach - rehabilitation involves the successful and productive interaction of many stakeholders with expertise specific to a patient’s needs. Therefore a rehabilitation model of care should be based on an interdisciplinary approach to patient care.
• Evidence-based care - to ensure optimal rehabilitation service is effective and efficient, services should be delivered on the best available evidence.
• Care coordination - a person’s rehabilitation journey often involves care across a number of disciplines, settings and timeframes. Care across the rehabilitation team, settings and services needs to be well coordinated to support effective intervention and optimal outcomes.
• Intensity - the onset, setting, intensity, frequency and content of rehabilitation support the care plan and progression towards patient-centred goals, considering patient status and capacity.

Setting of services

Admitted rehabilitation services are delivered across the following settings of care.

In reach of acute care

Where rehabilitation services can be provided in acute care environments, it is in a person’s best interest to commence rehabilitation intervention. However, their medical status may prevent them from being transferred to inpatient or community services.

Inpatient

Where a person requires intense, multidisciplinary rehabilitation intervention and their status prevents them from residing in their usual accommodation.

Following inpatient rehabilitation, most people are able to be discharged home and manage in their own community. Many will still require community-based rehabilitation to achieve their best level of recovery.

The physical environment

The environment in which rehabilitation operates should be designed to encourage independence. It should also promote an interdisciplinary team approach.

Enhancing interactions with family and carers is essential, so private spaces and communal areas should be available.

During rehabilitation, people need to actively participate in their therapy program. They should be encouraged to be as physically active as they can. The ward environment needs to be set up to promote this independence. Communal areas for dining and leisure are essential. People are expected to be dressed and remain as active as possible during the day.

Access to outdoor spaces may be considered therapeutic, especially for people with cognitive impairment.

Location of services

Admitted rehabilitation services are located across Victoria at the following health services.

Metropolitan:

• Alfred Health
• Austin Health
• Calvary Health Care Bethlehem
• Eastern Health
• Melbourne Health
• Mercy Public Hospitals Inc (Werribee)
• Monash Health
• Northern Health
• Peninsula Health
• Royal Children's Hospital
• St. Vincent's Health
• Western Health.

Barwon - South Western Region:

• Barwon Health
• South West Healthcare
• Western District Health Service.

Gippsland Region:

• Latrobe Regional Hospital
• Bass Coast Health
• Bairnsdale Regional Health Service
• Central Gippsland Health Service.

Grampians Region:

• Ballarat Health Services
• Wimmera Health Care Group.

Hume Region:

• Albury Wodonga Health
• Goulburn Valley Health
• Northeast Health Wangaratta.

Loddon Mallee Region:

• Bendigo Health
• Dhelkaya Health, Castlemaine
• Echuca Regional Health
• Mildura Base Hospital.