Policy briefing

Taking risks may help regain independence

The latest guidelines from NICE and what they mean for healthcare professionals.

Instrumental activities of daily living such as cooking can aid recovery. Picture: Alamy

Essential facts

Health and social care staff should encourage people to take risks, such as climbing stairs, dressing themselves or cooking, if it will help them regain independence, according to new guidance.

Staff in intermediate care services should openly discuss risks and ensure they are managed safely says the National Institute for Health and Care Excellence (NICE).

The organisation says intermediate care is a vital service that helps speed up discharge and reduce hospital admissions.

It covers a range of programmes designed to help people recover from illness or to provide support when managing daily activities at home becomes too difficult. It is a free service, usually limited to six weeks, that can be provided as part of NHS services in hospital, at home or in care homes to optimise recovery, help people take control of their lives and regain as much independence as possible.

What's new?

NICE recommends that healthcare staff consider providing intermediate care to patients in their own homes wherever practical and offer reablement to people considered for or receiving home care if it could improve their independence.

People should not be excluded from intermediate care if they have a particular condition, such as dementia, or live in particular circumstances, such as prison, residential care or temporary accommodation.

Patients using services as well as their families and carers should be actively involved in assessments and in decisions such as the setting in which intermediate care is provided.

Bed-based intermediate care, for people who are stable but not fit for a transfer home, should begin within two days of referral or it is less likely to be successful. If there is an urgent increase in a person’s health or social care needs that can be safely managed at home or in a care home, a crisis response should start within two hours of referral.

Expert comment

  Deborah Sturdy is director of health and well-being at the Royal Hospital Chelsea

‘The NICE guidance on intermediate care should be welcomed. When an older person has an acute episode of illness or when they have been in hospital for a long period of time, it can have a significant effect on their functional ability to be independent. Intermediate care is a vital part of the recovery process and access to expert care and support as part of their recovery to independence is key.

‘Intermediate care is an important part of the NHS and social care landscape as it encapsulates hospital admission avoidance, expedites discharge and delays the need for admission to long-term care. It helps people to reach their potential and maximise independence, and helps the health and social care system work effectively and efficiently.’


Implications for nursing

  • When planning intermediate care, assess and promote the person's ability to self-manage, tell them what will be involved and explain it is a short-term service. Carry out a risk assessment as part of planning and then on a regular basis, as well as when something significant changes. 
  • Focus on the person's strengths and help them realise their potential to regain independence. Build the person's knowledge, skills, resilience and confidence. Learn to observe and guide and not automatically intervene, even when the person is struggling to perform an activity, such as dressing themselves or preparing a snack.

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