1. CLINICAL SERVICES PLANNING GROUP REHABILITATION AND INTERMEDIATE CARE SUB- GROUP THE FUTURE OF IN-PATIENT REHABILITATION SERVICES

2. Next 20 years 17% increase > 65 years 60% increase > 80 years

3. The Hospital Casemix 2/3 Hospitalised patients have needs beyond “standard medical and nursing” Dependency of hospitalised patients is increasing Complexity and frailty of hospitalised patients is increasing Increasing demand for rehabilitation and interdisciplinary approaches to care

4. Complex Medications MX N Supporting Patients/Carer s through Life Changes REHABILITATION Medical treatments MX of 2º complications Ethical issues End of life Feeding Specialist MDT working Complex discharge planning (including CHC). Medical problems/ Diagnoses Functional Problems Managing cognitive impairment/ behavioural problems alongside physical illness Decision making around risks vs benefits of medical interventions Nutrition Feeding Family liaison/ negotiations (prognosis, treatment, Placement) CHC issues Rehabilitation is not the domain of one profession. It encompasses a range of activities:-

5. General Ward Acute Care (Medical/Surgical Admissions Ward), Rehabilitation (In-Patients - Non acute sites ) Intermediate Care Services  Day Hospitals  Reablement Teams  ART Current care pathway for acute admissions

6. Non Acute Rehabilitation Beds Cardiff and Vale Rookwood 20 West Wing 119 St Davids 50 Barry4 (Llandough23 Stroke)

7. Acute Admissions (UHW/Llandough) Acute Geriatric Assessment Unit (including rehabilitation) General Ward Rehabilitation within Community Hospital – Complex Frail Elderly Other Intermediate Care Services Elective Stream Home Revised pathway of care for inpatients

8. Cardiff and Vale NHS Trust have relatively few Rehabilitation beds compared with peers Cardiff and Vale community appears to have a smaller Care Home capacity compared with other parts of Wales

9. Wales Care Strategy Group 2003 2001-2010 10% increase demand social care services 2010-2020 10-15% increase demand for social care services

10. Recommendations Increased rehabilitation within acute and community hospital based care Community rehabilitation beds to be located on a minimum number of sites Community rehabilitation beds to provide step down for complex frail elderly from acute hospital and step up for those in community Community rehabilitation beds to be colocated with diagnostic services and rapid assessment services Stroke Rehabilitation wards to be merged into one community based unit with a small number of acute stroke beds at both acute hospital sites Commissioning of Respite Care within Care Home Sector Support majority of CHC patients within Care Home Sector/Own Home via outreach/community teams

11. Would not support…… Care Home Rehabilitation as a substitute for hospital (acute and community based) rehabilitation Stepup beds to Care Homes unless front ended with appropriate comprehensive assessment

12. Education, Training, Research, Governance and general sustainability…….. Centre of Health care for the Older Person………