Community medicine

Question 1

Define rehab?

Answer 1

a process aiming to restore personal autonomy to those aspects of daily life considered most relevant by patients and service users, and their family carers

Question 2

Principles of rehab?

Answer 2

 Should begin during the initial contact with the patient
 Emphasis of rehab is to restore the patient in independence or pre-illness or pre-injury level oif function in as short a time as possible
 Must be an active participant
 Must motivate the patient and help him to attain social independence

Question 3

Types of rehab?

Answer 3

Medical - Help a person better in all his daily physical and ental activities. Relates to increasing potential capabilities and correction o deformities, and restoration of functions
o Social rehab = Implies social life – restoration of family, social interactions or relationships
o Psychological rehab = Psychological restoration of personal dignity and confidence of the disabled
o Vocational rehab = help patients who have difficulty getting employment
o Also: Cardiopulmonary, physical, speech, occupational rehab

Question 4

List alternatives to acute hospital settings?

Answer 4

Hospital at home - – includes care led by Secondary care physicians and Primary care (GP and nurse)
o	Step up/down schemes
o	Rapid response schemes
o	Rehabilitation schemes
o	Stroke schemes
o	Community hospital schemes
o	Miscellaneous schemes: ED assessment team, twilight nursing team, long-term behaviour support team
o	Virtual wards

Question 5

Aim of hospital at home?

Answer 5

 aims to provide short-term post-discharge care at a more intensive level than would normally be provided by professionals such as District Nursing

Question 6

Aims of Stepup/down schemes?

Answer 6

 provide care in a setting other than an acute hospital and this can include a residential or, more usually, a nursing home
 users require more intensive therapy or continuous monitoring than could be provided in their own home

Question 7

Aims of rapid response schemes? Interventions available?

Answer 7

 aim to support a user in their own home or other location either as a means of preventing admission or as a means of facilitating discharge from the acute hospital sector

 Can cover a wide range of interventions including administration of intravenous therapies, peg tube and catheter replacement, crisis psychiatric care and provide enhanced care to palliative care patients.

Question 8

Areas that cna deliver rehab?

Answer 8

community hospital, residential home or within patient’s own home

Question 9

Community hospital purposes? Aimed at?

Answer 9

 provide acute hospital ward type care
 under the management of GPs rather than consultants
 provide nursing, rehabilitation or step up/down type care

 generally aimed at those users who require a high level of supervision or the administration of medicines or interventions which would not be suitable for a nursing home or a users’ own home setting.

Question 10

What is the Continuing Healthcare?

Answer 10

o When people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS

Question 11

What is the discharge to assess process?

Answer 11

o a concept whereby patients are transferred from acute hospital at the point where they no longer require acute hospital care through one of three pathways;
 either at home with support (Pathway 1)
 in community based sub-acute bed with rehab and reablement (Pathway 2)
 or in a care home sub-acute bed with recovery and complex assessment (pathway 3).

o Thereafter any further health or social care assessments are delivered outside of the acute hospital environment.

Question 12

What are the range of specialist teams and care services available to support the older person at home with complex comorbidities and long term conditions?

Answer 12

o Single named care coordinator – involed in assessment process
o Community pharmacist
o PT/OT
o Mental health social worker or psychiatrist
o Community-based services liaison

Question 13

Define continuing care?

Answer 13

= Continuing healthcare = When people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS

Question 14

Define Nursing home care? eligibility?

Answer 14

NHS-funded nursing care is when the NHS pays for the nursing care component of nursing home fees. You may be eligible for NHS-funded nursing care if:
 you’re not eligible for NHS continuing healthcare but have been assessed as needing care from a registered nurse
 you live in a nursing home

Question 15

Define residential care?

Answer 15

o Residential care – A residential setting where a number of older people live, usually in single rooms, and have access to on-site care services. A home registered simply as a care home will provide personal care only.

Question 16

Define intermediate care?

Answer 16

Services that provide support and rehabilitation to people at risk of admission to, or who have been in, hospital and offer short-term support to people living at home who find daily activities difficult.

Question 17

Define interim care?

Answer 17

for people who are not able to return home immediately – for example due to waiting for home adaptation to be put in place. Local care homes can provide care for a short period of time.