Patients admitted to our hospice in-patient unit (IPU) are increasingly requiring comprehensive multidisciplinary rehabilitation programmes with complex discharge planning prior to returning home. We had developed a robust framework of patient-centred goal setting and reablement programmes however we felt that the ward environment did not always adequately support the latter stages of the rehabilitation/discharge process and so the idea of creating a self-contained flat as an integral part of our hospice in-patient facility was developed.
Our vision was to provide an environment that could facilitate patients becoming more functionally active and independent to meet the particular challenges they would face at home, where management strategies could be practiced, tested and tweaked, and where we could mirror any planned community care package. This would give patients (and their carers) an increased confidence and sense of empowerment that is essential for making informed choices and achieving a truly successful discharge.
Each patient's reablement programme/support need within the flat would need to be clearly identified with the patient and understood/supported by ALL staff and so developing effective communication and documentation was also recognised as an essential element for success.
Stakeholder engagement in the flat development project was crucial at every stage. Following a successful application for a Department of Health grant, the two flats (one within each IPU) were completed and successfully commissioned June 2014.
The alternative environment has already enhanced the patient/carer experience in accordance with our original vision. The flats' positioning within the IPU means that support can be flexed according to individual need and now used at even earlier stages of patients' rehabilitation programmes than anticipated. Staff who had been more used to 'caring' than 'enabling' have been inspired to proactively engage more fully with the discharge preparation process and the need for community support post discharge has been reduced.
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