Quality statement 1: Discussion about intermediate care

Quality statement

Adults being assessed for intermediate care have a discussion about the support the service will and will not provide.

Rationale

Healthcare professionals in hospitals or the community who are assessing people for intermediate care should have a discussion, provide information and ensure that the person (and their family and carers, as appropriate) understand what intermediate care is and what it can and cannot achieve. This will ensure that people are involved in making decisions about their care and encouraged to engage with the rehabilitation process. It will also enable them to consider any further support they may need in addition to intermediate care.

Quality measures

Structure

a) Evidence that information about the support provided by the local intermediate care service is available.

Data source: Local data collection, for example, leaflets or booklets or pamphlets tailored to local services.

b) Evidence of local processes to ensure that adults being assessed for intermediate care have a discussion about the support the service will and will not provide.

Data source: Local data collection, for example, service protocol.

Process

Proportion of adults being assessed for intermediate care who have a record of a discussion about the support the service will and will not provide.

Numerator – the number in the denominator who have a record of a discussion about the support the service will and will not provide.

Denominator – the number of adults being assessed for intermediate care.

Data source: Local data collection, for example, audit of electronic records.

Outcome

Level of awareness of the support the service provides among adults assessed for intermediate care and their families and carers.

Data source: Local data collection, for example, survey of adults assessed for intermediate care and their families and carers.

What the quality statement means for different audiences

Service providers (such as hospitals, community providers, local authorities, care homes, home care agencies and not-for-profit social enterprises) ensure that staff carrying out assessments for intermediate care have the knowledge and materials to provide information and have a discussion with the person (and their family and carers, as appropriate) about the support the service will and will not provide. Service providers ensure that processes are in place for staff to record that the discussion took place.

Health and social care practitioners (such as nurses, discharge coordinators, trusted assessors, social workers and allied health professionals) ensure that, when they carry out an assessment for intermediate care, they give up-to-date information and have a discussion with the person (and their family and carers, as appropriate) about the support the service will and will not provide. They should provide information in a suitable format to meet individual needs and record that the discussion took place.

Commissioners (such as clinical commissioning groups and local authorities) ensure that services assessing adults for intermediate care have processes in place for staff to give information and have a discussion with the person (and their family and carers as appropriate) about the support the service will and will not provide. Commissioners should ensure that information is available about the full range of local intermediate care services, so that people know what options they have.

Adults being assessed for intermediate care discuss with their care team the type of support the service will and will not provide. Their family and carers should be involved if appropriate. Clear information (such as a leaflet or booklet) should be provided about what care is available. This discussion will help the person to make decisions about their care and to work with the intermediate care service to gain as much benefit from the service as possible.

Source guidance

Intermediate care including reablement (2017) NICE guideline NG74, recommendations 1.1.5, 1.5.1 and 1.5.2

Definitions of terms used in this quality statement

Intermediate care

A range of integrated services that:

  • promote faster recovery from illness

  • prevent unnecessary acute hospital admissions and premature admissions to long-term care

  • support timely discharge from hospital

  • maximise independent living.

Intermediate care services are usually delivered for no longer than 6 weeks and often for as little as 1 to 2 weeks. Four service models of intermediate care are available:

  • bed-based intermediate care

  • crisis response

  • home-based intermediate care

  • reablement.

[NICE's guideline on intermediate care including reablement, terms used in this guideline section]

Discussion about the support the service will and will not provide

The discussion should include:

  • the aims and objectives of intermediate care, in particular, that it is designed to support them to live more independently, achieve their own goals and have a better quality of life

  • any options for intermediate care services in different settings locally

  • how the intermediate care service works and the support it will and will not provide

  • information about other resources in the local community that can provide support

  • how to get further information.

[NICE's guideline on intermediate care including reablement, recommendations 1.3.4, 1.5.1 and 1.5.2]

Equality and diversity considerations

Service providers should not exclude people from intermediate care based on whether they have a particular condition, such as dementia, or live in particular circumstances, such as prison, residential care or temporary accommodation.

Discussions about the support provided by intermediate care may need to be adapted to meet the needs of people living with cognitive impairment, including dementia, and their family and carers. Healthcare professionals should ensure that the person living with cognitive impairment is supported by a relative or carer or an advocate (as appropriate) to ensure involvement in the discussion.