Rehabilitation Settings
Original Editors - Kirenga Bamurange Liliane and Naomi O'Reilly and ReLAB-HS
Top Contributors - Naomi O'Reilly, Vidya Acharya, Kim Jackson, Tarina van der Stockt, Kirenga Bamurange Liliane, Oyemi Sillo, Lucinda hampton and Ashmita Patrao
Introduction[edit | edit source]
Rehabilitation is a multidisciplinary process that helps individuals to develop or strengthen their physical, mental and social skills. The World Health Organisation defines rehabilitation as a set of measures that assist individuals who experience or are likely to experience disability, to achieve and maintain optimum functioning in interaction with their environment.[1] It also reduces disability in individuals with health conditions in relation to their environment. Environments refer to the physical, social, and cultural contexts in which individuals and their communities live. [2] In the ICF Framework Model that is most commonly used within rehabilitation, the personal and environmental components play a big role as, together, they comprise a person's context that need to be considered in conjunction with rehabilitation.[3] As such we need to consider the range of settings in which rehabilitation takes place and consider the impact of the setting on rehabilitation.
The term healthcare or rehabilitation setting represents a broad array of services and places where healthcare occurs, including acute care hospitals, urgent care centers, rehabilitation centers, nursing homes and other long-term care facilities, specialised outpatient services (e.g., haemodialysis, dentistry, podiatry, chemotherapy, endoscopy, and pain management clinics), and outpatient surgery centers. In addition, some healthcare services are provided in private offices or homes. [4] Rehabilitation service availability and the settings in which they are provided varies dramatically both within and across regions and nations. Rehabilitation is highly person-centered, meaning that the interventions and approach selected for each individual depends on their goals and preferences. Medical rehabilitation and therapy are typically provided in acute care hospitals for conditions with acute onset. While follow-up rehabilitation at a sub acute, post acute can be provided in a wide range of settings, including specialised rehabilitation wards or hospitals; rehabilitation centres; institutions such as residential mental and nursing homes, respite care centres, hospices, prisons, residential educational institutions, and military residential settings; or single or multiprofessional practices (office or clinic). Longer-term rehabilitation may also be provided within community settings and facilities such as primary health care centres, schools, workplaces, or home-based therapy services.
Hospital[edit | edit source]
Hospitals primarily provide diagnostic and treatment services to patients who require intensive or immediate care. Most hospitals are in-patient facilities, requiring patients to stay under the supervision of specialized health care professionals until discharged.
Hospitals are generally classified by the type of ownership, treatment, facility size, and length of a patient’s stay. The majority of them are nonprofits, typically governed by a regional health authority.
Most people are familiar with a general hospital, which admits patients for all types of medical conditions. Depending on a patient’s diagnosis, a general hospital may refer him or her to an acute care hospital, such as a cancer treatment, children’s, or maternity hospital, or to a member of the hospital’s outpatient facility network.
Hospitals are the ultimate “catch-all” healthcare facility. Their services can vary greatly depending on their size and location, but a hospital’s goal is to save lives. Hospitals typically have a wide range of units that can be loosely broken into intensive care and non-intensive care units.
Intensive care units deal with emergencies and the most serious illnesses and injuries. Patients with imminently life-threatening problems go here.
Non-intensive care units include things like childbirth, surgeries, rehabilitation, step-down units for patients who have just been treated in intensive care and many others. Typically, most hospital beds could be classified as non-intensive care.
- General Hospital.
- A hospital that provides a range of different services for patients of various age groups and with varying disease conditions.
- Specialised Hospital.
- A hospital admitting primarily patients suffering from a specific disease or affection of one system, or reserved for the diagnosis and treatment of conditions affecting a specific age group or of a long-term nature.
- it is an important support for other health services and for health care in general in the district;
- –
- it provides wide-ranging technical and administrative support and education and training for primary health care;
- –
- it provides an effective, affordable health-care service for a defined population, with their full participation, in cooperation with agencies in the district that have similar concerns. [5]
Rehabilitation Center[edit | edit source]
Outpatient Clinic[edit | edit source]
An outpatient clinic, also known as an ambulatory care centres in some countries, is as the name suggest an outpatient setting for patients that provide medical care including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. Outpatient clinics provide access easier access to high-quality, non-emergency care including rehabilitation and can be provided across a number of different settings including within the hospital setting, specialised rehabilitation centre or with a stand alone outpatient clinic. [4]
Primary Health Care Centre[edit | edit source]
A centre that provides services which are usually the first point of contact with a health professional. They include services provided by general practitioners, dentists, community nurses, pharmacists and midwives, among others. [5]
Community Based Rehabilitation[edit | edit source]
Acute medical illness can be associated with a temporary reduction in our ability to carry out the normal activities of daily living. Therefore rehabilitation is often needed during recovery from an acute medical illness so that patients can return to the same level of functioning and independence. Community rehabilitation is a viable alternative to hospital inpatient treatment for selected patients, and would be the preferred option to maintain patients’ independence. Rehabilitation in the community should be offered to patients as an alternative to routine hospital inpatient rehabilitation, depending on their clinical condition and after discussion of risks and benefits.
Day Center[edit | edit source]
A day center is a non-residential healthcare setting that provides care generally for adults from across a wide range of population groups, that can include adults with a specific chronic condition like dementia or cognitive impairment, adults with a wide range of disabilities including stroke, limb loss , multiple sclerosis and for the older person, often who is living alone in order to support health, social and daily living needs. [6] These facilities most commonly provide a long term service for many individuals, in some cases respite care enabling caregivers to work or have a break from their caregiving responsibilities but also provide transitional care or short-term rehabilitation services following hospital discharge. [7][8]
Day centers can provide health promotion through a wide range of services and meaningful activities, of which rehabilitation is just one aspect, and often play a key role preventing re-hospitalisation following discharge and may help delay the need for admission in to residential long-term care settings. The focus of care within these centres can be based on either a social model (focusing more on peer socialisation and prevention services) or biopsychosocial model (including skilled assessment, treatment and rehabilitation goals) in order to improve participants health. For participants, who in many cases would otherwise stay at home alone, social stimulation and interaction with other people and recreational or rehabilitation activities have been shown to improve or maintain physical fitness, cognitive function and emotional well being, which can build up confidence and ability to maintain quality of life and an independent lifestyle.[9]
With an ageing population and increased numbers of people living with chronic health conditions demand for daycare centers is increasing worldwide, and provides a significant opportunity for ongoing rehabilitation services to support people to maintain quality of life.
Long-Term Care Facility[edit | edit source]
Long-term care facilities support people with short-term recovery, ongoing health conditions, or disabilities. They are designed to help patients complete daily activities as safely and as independently as possible.
According to a recent survey by Genworth, 7 in 10 people will require long-term care in their lifetime. Depending on their health, patients can receive in-home care through homemaker services or a home health aide. Community and assisted living facilities care for seniors who are still relatively independent, while nursing home facilities care for patients who need full-time care.
Hospice[edit | edit source]
Hospice is another type of health care facility. A hospice facility cares for the terminally ill or people nearing the end of life. Typically, hospice care is for patients who have no more than six months to live. A team of professionals, such as physicians, nurses, spiritual advisors, and counselors, supports both the patient and the patient’s family during the transition.
Depending on the care required and cost, hospice services can be accessed in a hospice facility, at the patient’s home, in long-term facilities, or in the hospital.
Hospice can be a particularly confusing title. It represents a package of insurance benefits that deals with an end-of-life trajectory. It also represents a philosophy of care provision for dying patients as well as official networks that offer hospice care. Hospice is also a designation for specific healthcare facilities that specialize in end-of-life care.
Hospice care is a model that provides not only medical support, but also emotional and even spiritual support for patients and their families. According to the National Hospice and Palliative Care organization, a patient with hospice care has a team of care providers made up of the patient's personal physician, a hospice physician, nurses, home health aides, social workers, clergy or other counselors and physical or occupational therapists, if needed.
Though patients can receive hospice care at home, if their medical needs are significant, they might live in a nursing home with hospice care, or a specified hospice home.
Telehealth[edit | edit source]
While not a specific rehabilitation setting, telehealth has grown exponentially within the realm of rehabilitation, particularly over the COVID-19 pandemic with restrictions on face to face intervention. As such telehealth can represent a digital form of rehabilitation setting and is likely to remain in clinical use even as we come out of the COVID-19 pandemic.
Telehealth is the delivery of health-related services and information via electronic communication. The terms telehealth and telemedicine can be used interchangeably, but they have different definitions. Telemedicine refers specifically to the remote delivery of healthcare services and clinical information using telecommunications technology, such as internet, wireless, satellite and telephones.[10] Telehealth is defined as the use of electronic communications to share medical information from one place to another with the intention of improving a patient’s health.[11] Telehealth is an expansion of telemedicine, but unlike telemedicine (which focuses on curative aspects of health) it encompasses preventive, promotive and curative aspects of health and many different healthcare professions are involved in its delivery.[4] It is a broad term and can include both patient and healthcare professional education, as well as public health initiatives and health administration.[12]
Telehealth is not a new concept. There are reports of its use since the early 20th century when providers used two-way radios for communication.[11] Then from the 1960s, health professionals used telephones to provide advice and guidance to patients. However, with the introduction of various new technologies, telehealth is now challenging the way healthcare is delivered.[11] Over time, new telehealth terminology has developed based on the field of health care (teleradiology and telepsychology) or the purpose of the intervention (telerehabilitation or telecare). Telehealth refers to the use of electronic communication technology such as telephone, tablets and computers to facilitate virtual health care and health education. Many people lack easy access to physicians and specialty clinics. Whether through their physical location, physical ability, living situation or transportation choices, many patients have a hard time getting to a medical practitioner face to face.
Those patient limitations, the push to lower costs in healthcare, and new technological capabilities have all come together to motivate telehealth applications. This might look like live video conferencing between patient and physician. Or a patient with an illness might wear a device to allow remote monitoring from their medical team.
For quick consultations, telehealth can be an ideal option even for patients with easy access to their doctors. “When you log into a web-based service, the doctor or nurse practitioner can prescribe medications, suggest home care strategies or recommend additional medical care,” the Mayo Clinic writes. [13]
Setting by Phase[edit | edit source]
Acute Rehabilitation[edit | edit source]
- General Medical Practice
- Primary Care Centres
- Hospitals
Subacute Rehabilitation[edit | edit source]
- Hospitals - Often in specialised rehabilitation wards
- Rehabilitation Centres
- Long Term Care Facilities
- Hospice
- Educational Facilities
- Workplaces
- Prisons
- Out Patient Clinics
Post Acute Rehabilitation[edit | edit source]
- Rehabilitation Centres
- Primary Heath Care Centres
- Day Centers
- Home-care Therapy Services
- Long Term Care Facilities
- Educational Facilities
- Workplaces
Long-term Rehabilitation[edit | edit source]
- Long Term Care Facilities
- Community Based Rehabilitation
- Primary Heath Care Centres
- Day Centers
- Home-based Care
- Education Facilities
- Workplaces
- Prisons
Resources[edit | edit source]
References [edit | edit source]
- ↑ World Health Organization. Concept Paper WHO Guidelines on Health- Related Rehabilitation (Rehabilitation Guidelines).
- ↑ Rehabilitation. Available from: https://www.who.int/news-room/fact sheets/detail/rehabilitation#:~:text=Rehabilitation%20is%20defined%20as%20%E2%80%9Ca,in%20interaction%20with%20their%20environment%E2%80%9D (Accessed 29/01/2021).
- ↑ Wottrich AW, Von Koch L, Tham K. The meaning of rehabilitation in the home environment after acute stroke from the perspective of a multiprofessional team. Physical therapy. 2007 Jun 1;87(6):778-88.
- ↑ 4.0 4.1 4.2 Christensen BE, Fagan RP. Healthcare Settings. InThe CDC Field Epidemiology Manual (pp. 341-362). Oxford University Press. Cite error: Invalid
<ref>tag; name ":0" defined multiple times with different content - ↑ 5.0 5.1 WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. Appendix 1, Definitions of health-care settings and other related terms. Available from: https://www.ncbi.nlm.nih.gov/books/NBK144006/
- ↑ Brown, E. L., Friedemann, M., & Mauro, A. C. (2014). Use of adult day care service centers in an ethnically diverse sample of older adults. Journal of Applied Gerontology,33(2), 189-206. doi:10.1177/0733464812460431
- ↑ Brown, E. L., Friedemann, M., & Mauro, A. C. (2014). Use of adult day care service centers in an ethnically diverse sample of older adults. Journal of Applied Gerontology,33(2), 189-206. doi:10.1177/0733464812460431
- ↑ Zarit, S. H., Stephens, M. A. P., Townsend, A., & Greene, R. (1998). Stress reduction for family caregivers: Effects of adult day care use. Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 53(5), S267-S277. doi:10.1093/geronb/53B.5.S267
- ↑ Georgiou, J., & Hancock, P. (2009). Assessing and improving quality of life indicators and assessments: A case study of an adult day care centre. Asia Pacific Journal of Health Management, 4(2), 46-56.
- ↑ Achenbach SJ. Telemedicine: Benefits, Challenges, and its Great Potential. Health Law and Policy Brief. 2020; 14(1). Available at: https://digitalcommons.wcl.american.edu/hlp/vol14/iss1/2
- ↑ 11.0 11.1 11.2 Neville CW. Telehealth: A Balanced Look at Incorporating This Technology Into Practice. SAGE Open Nursing. 2018; 4.
- ↑ Richmond T, Peterson C, Cason J, Billings M, Terrell EA, Lee AC, Towey M, Parmanto B, Saptono A, Cohn ER, Brennan D. American Telemedicine Association’s principles for delivering telerehabilitation services. International journal of telerehabilitation. 2017;9(2):63.
- ↑ Rasmussen University. Types of Healthcare Facilities Where Medical Professionals Provide Care. Available from:https://www.rasmussen.edu/degrees/health-sciences/blog/types-of-healthcare-facilities/ (accessed 30 June 2021)
