This Insider Guide provides information on Convalescence, Rehabilitation and Respite Care. Please note that every individual’s situation is unique.
The term “convalescent” is defined as a person recovering from illness.
In a climate of long hospital waiting lists and delayed hospital discharges, hospital stays for many people are frequently so short that the recovery period has barely started before they return home.
Obviously an acute hospital is not the ideal environment to recover from an operation or illness but the harsh reality of returning home can be a very difficult time, particularly for the older person.
While most acute hospitals now have rehabilitation programmes, called intermediate care or re-enablement, limited resources frequently means that many people will not meet strict eligibility criteria for these and therefore will not qualify. Clearly there is a difference between the older person in need of active rehabilitation and the older person who simply needs a little support whilst regaining his or her strength.
Sadly, this is an area of care that is not adequately addressed in our current health and social care system.
The main sources of support for the older person in these circumstances are likely to be:
• Family member in the older person’s home
• A short stay at a family member’s home
• Visiting support from family, neighbours and friends
• Employment of a carer/companion through a Care Agency
• Convalescent stay in a Care Home
• Local voluntary organisations.
Convalescent Homes are few and far between and the older person may struggle to find a short-term vacancy in a Care Home at the time when support is required. However, there are a number of Care Homes and Care Homes with Nursing associated with particular professions or charities that may more likely to be sympathetic to the particular needs of their members. This level of short-term care is not generally funded by either the health authority or the local authority.
Rehabilitation is about restoring an individual to their fullest capacity - physically, mentally and socially. It requires a team of people working together with the individual and his or her family.
This team may include Nurses, Physiotherapists, Occupational Therapists and Speech Therapists. Their combined expertise should promote recovery and maximise independence.
Depending on the nature of the older person’s condition, within the NHS (or HSE in Ireland) they may be offered “Intermediate care” or “Re-enablement” on discharge from hospital. This is a short rehabilitation programme usually lasting for no more than six weeks.
Hospital staff will decide whether the individual is suitable for a programme such as this. It will usually involve members of a multidisciplinary team (MDT), such as an Occupational Therapist and/or a Physiotherapist, planning or supervising appropriate care, most commonly in the older person’s home, a Community Hospital or a care home. If at the end of this six-week period the older person is assessed as requiring ongoing care, they may be referred to Social Services depending on their own wishes and financial status.
Care from this point will be subject to a local authority means test. If the older person’s condition requires specific ongoing therapeutic treatment such as speech therapy or physiotherapy, for example following a stroke, this may continue on an outpatient basis for longer periods. This level of care is generally free of charge to the older person.
Respite Care is defined as ‘temporary relief’. It may be provided for the older person or their carer and may take the following forms:
• A short break away for the older person (holiday)
• Increased support in the home to allow the carer to pursue their own interests
• A short stay for the older person in a Care Home to enable the carer to take a longer break.
It may be for as little as an hour per week, for a day, or a week or two depending on individual circumstances. There are a number of organisations that offer help and support in this way eg care agencies, charitable and voluntary organisations.
If the older person has funds in excess of £23,250 in England and Northern Ireland (£28,000 in Scotland, £50,000 in Wales) they will generally not be entitled to assistance with funding from the Local Authority for this care.
In the Republic of Ireland, each individual situation will be assessed by the HSE and a financial plan determined. Carers can also ask for an assessment of their own care needs under the following Acts: Carers and Direct Payments Act 2002 - Northern Ireland
• The Care Act 2014 - England
• Social Services and Wellbeing Act 2014 - Wales
• In Scotland the Community Care and Health Act 2002 introduced carer’s assessments and further rights were introduced by the Social Care Act 2013.
The Carers (Scotland) Bill will supersede these and is expected to come into force in April 2018.
If the carer is assessed as needing respite care this can be arranged by the local authority but may still be subject to charging, dependent on the financial status of the older person, not the carer.