Better at home: Substituting inpatient rehabilitation beds for home based multidisciplinary rehabilitation

Dr Lara Kimmel1,2, Ms Dina Watterson1, Ms Catherine Wolters1, Prof Anne Holland1,3, Ms Anegla Burge1,3, Assoc Prof Peter Hunter1, Ms Melanie Reed1, Ms Belinda Brookes1, Ms Victoria Lee1, Dr Ronald Leong1

1The Alfred, Melbourne, Australia, 2Monash University, , Australia, 3La Trobe University, , Australia

Introduction: Evidence suggests improved outcomes following home-based care, including lower odds of developing delirium, fewer hospital bed days and greater satisfaction regarding rehabilitation quality. Better at Home (B@H) is a bed substitution model of care aimed at transitioning inpatient rehabilitation care for appropriate patients to a home-based setting.

The aim of this trial was to review the B@H model of care by analysing the functional outcomes and patient experience and assessing the hospital response to this change in care delivery.

Method: A 12 week trial of 10 B@H “beds” commenced on 6 August 2018 for patients admitted to Alfred Health.  Outcome measures included admission and discharge functional scores including Modified Iowa Level of Assistance Scale (mILOA) – a mobility scale (range 0-36; lower = better), Functional Autonomy Measurement System (SMAF) handicap score which measures domains including activities of daily living, mobility, communication, mental functions (0 indicates no unmet needs) and Functional Independence Measure (FIM), a tool used widely in rehabilitation which measures 18 domains (range 18-126; higher =better). A patient satisfaction interview was also conducted.

Results: Fifty three patients (mean age 75 years) were seen in B@H. The average initial scores were: mILOA 10.5, SMAF -5, FIM 95, which were better than those expected for an inpatient rehabilitation admission.  None of the scores achieved a clinically significant level of change from admission to discharge.  All of the B@H pilot respondents (n=13) rated the quality of care received as very good or good.

Discussion: Establishing a home-based rehabilitation model of care is feasible but further work is needed to ensure that the cohort of patients is representative of those requiring an inpatient rehabilitation stay.  Cultural change is needed on behalf of the patients, carers, referrers and staff involved in the service delivery to ensure a true bed substitution model is achieved.


Lara is a physiotherapist at The Alfred Hospital in Melbourne  and has worked there for over 20 years.  She has extensive experience in the management of orthopaedic and trauma patients and a strong interest in research, having completed a PhD through Monash University in the area of discharge following trauma.

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