The Intermediate Care Team (North) is a multi-disciplinary Rehabilitation team including:
We word towards the prevention of unnecessary hospital admissions, support for an earlier discharge from hospital and avoiding or delaying the need for long-term care. We do this by assessing the person's abilities, setting up a rehabilitation programme and monitoring the progress made. Individuals must consent to the referral and be medically stable before they will be taken on by the team.
We provide rehabilitative support to help individuals recover from illness/injury. This
is achieved by agreeing goals with people and by helping them to become as independent as possible in their own homes. Subject to assessment each person may have a package of homecare provided and will be expected to follow an individual rehabilitation programme to work towards mutually agreed goals. The service is for a maximum of 6 weeks, the length of input is dependent upon the patient's needs.
The individual can expect a holistic, team assessment to determine appropriateness of the ICT involvement. However, further specialist assessment may need to be completed by the professional members of our team. Confidentiality is a priority and the person will be asked first for their agreement to share information when necessary.
Once the assessment has been completed, a care plan will be developed to meet the person's particular needs and may involve any of the team members.
Care packages are initiated by either the Social Worker within ICT or the Social Worker based at the discharging hospital ward. ICT Support Workers work closely with the Care Agencies providing the Care Packages to enable patients to work towards independence where possible. Individuals will be given a copy of their initial assessment which will include a care plan and goals. The patients' needs will be reviewed by a social worker as progress is achieved.
Afterwards, and with the consent of the person, further referrals will be made to other services for support, with personal hygiene and nutritional needs. The Intermediate Care Team (ICT) is provided free-of-charge. However, if an individual requires care from Adult Services after the period of Intermediate Care, there may be a charge for this, dependent on a financial assessment.