Discharge to Assess and Intermediate Care (OTs)
Description of service
The intermediate care and discharge to assess bed-based therapy team work together to facilitate quicker acute hospital discharges, but the pathways differ.
The intermediate care team works with patients on an up-to 19-day rehabilitation or (approximately) 6-week non-weightbearing pathway to assess their function, improve their mobility and to provide appropriate equipment to maintain their independence. The assessment that this team completes, considers the patient holistically and includes areas such as pressure care, nutritional intake, cognition, risk assessment and manual handling. Goal setting is used with patients to inform their therapy and determine whether they have ongoing needs for the Discharge Home to Assess or Integrated Community Team Therapists to address upon their discharge.
The discharge to assess beds are used for assessment of a patient’s needs to support them in being discharged to the appropriate accommodation – their own home, care home, rehabilitation, etc. The process includes assessing the patient’s current level of function and whether there is scope for improvement. The therapist will then consider the patient’s past, present and future needs before offering a recommendation to the social worker, who decides the discharge accommodation and required care package.
Specialities covered
Generally, the patient group we work with consists of the elderly population (65+) who are considerably frail, but we do occasionally see younger adults with complex health needs.
Areas covered
|
Robertson House (Office Base) |
Knebworth Care Home |
Pinelodge Care Home |
|
Autumn Vale Care Home |
Martins House |
|
- Free parking available at office (with parking permit).
- On-street parking available on Longmead, Woolmer Green when visiting Knebworth Care Home
- Free car park at Pinelodge Care Home, Martins House and Autumn Vale Care Centre
Main contacts
Therapy Hub: 0300 123 7571
ACS Hub: 0300 123 4042
Dress code/uniform
Student uniform with comfortable, wipeable shoes and hair tied back. No long nails or jewellery. Keep below elbows bare.
Recommended pre-placement reading
- RCOT guidance on falls
- RCOT guidance on self-management
- Preferable to be familiar with the Montreal Cognitive Assessment (MOCA) or Middlesex Elderly Assessment of Mental State (MEAMS)
- NICE Guidelines relating to the care of Older People
- The effects of aging on biomechanics
- Diseases of older age
- Gerontological Occupational Therapy: Conceptual Frameworks, Historical Contexts, and Practice Principles. In K. F. Barney & M. A. Perkinson (Eds).
- Occupational Therapy with Aging Adults: promoting quality of life through collaborative practice.
- WHO Guidance: 10 facts on health and ageing
- WHO Guidance: Healthy ageing
- RCOT Guidance on Total Hip Replacement
If you require a quiet place to complete research/university tasks and do not wish to make use of the office space, there are various libraries you can access around Stevenage. The closest to our office is:
Stevenage Central Library
Southgate
Stevenage
SG1 1HD
Preparing for your placement
COVID-19 guidance:
- All PPE will be provided (face masks, aprons, gloves, visors, antibacterial/antiviral wipes and hand sanitiser)
- A face mask must be worn at all times when in care home buildings, unless you are eating or drinking or in an office space where social distancing/protective measures are in place
- NHS workers complete twice weekly lateral flow testing. It is a requirement to have an up-to-date lateral flow test in order to enter care homes.
- You will need to show proof of full COVID-19 vaccination status to enter care homes from 11th November 2021.
What to bring on your first day
- Please bring your lunch or money to buy lunch with you as we are community-based
- We would advise you purchase a tape measure (but we can supply one if required)
- We can provide notebooks, pens and other small things
Other information
Our working hours are Monday-Friday, 8am-4pm. A general timetable:
|
8AM |
9AM |
10AM |
11AM |
12PM |
1PM |
2PM |
3PM |
|
Handover for one hour |
Travel to care home and obtain handover from nurse/senior carer if possible |
Patient sessions (usually personal care ax) |
Patient sessions and notes |
Notes and lunch |
Patient sessions (kitchen ax, transfer ax, cognitive ax) |
Notes, equipment orders |
Finish up and travel home. Can also travel home earlier to write notes at home. |
Note: You will also have the opportunity to complete access visits and possibly discharge home visits during a placement with the IMC & D2A beds.
Our team structure:
In our service, we use the SOAP note format to document our patient contact notes. If you are not familiar with this format, please see the below guidance:
- Subjective = Everything that is said during the session. What is the patient’s perspective?
- Objective = Everything observable during the session.
- Analysis = This is the section you show your clinical reasoning. Summarise the most important aspects of S&O and provide your professional judgement.
- Plan = What do you plan to do following the session? Have plans changed?
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