Transition care programmes (TCP) provide older adults with goal-oriented rehabilitation after hospitalisation. However, limited research has focused on understanding older adults' experiences when undertaking TCP. Using a phenomenological approach, we explored the lived experience of older adults undertaking a TCP at a transition care facility in Australia. A purposive sample (N = 33 participants: 16 older adults, four family members and 13 staff) was recruited. Semi-structured interviews were undertaken at three time-points during admission and inductive thematic analysis was utilised. Older adults reflected on their TCP experiences through an emotional lens through which they deliberated, ‘is my destination home?’ Fear of losing independence and uncertainty about their discharge destination strongly influenced older adults' perspectives regarding their TCP experience. Emotional responses, both positive and negative, were influenced by expectations prior to admission, level of family support and staff behaviour. Staff and family concurred that many older adults were confused about their admission to the facility and initially were unprepared to engage in the rehabilitation provided. Older adults experienced TCP as a time of great uncertainty and feared the unknown when discharged from hospital to transition care. They expressed grief at the loss of existing life roles and anxiety about the possibility of being unable to return home. Health professionals need to inform and tailor rehabilitation for older adults to better support this transient time of life.

Background: An intermediate care unit opened in 2008 aiming to relieve pressure on beds in the local general hospital. Its goal was to provide rehabilitation for people recovering from physical illness who had coexisting psychiatric symptoms, including from delirium, but for whom assessment suggested that discharge home might be achieved. As an experimental unit, it warranted evaluation. We aimed to identify clinical factors associated with higher rates of discharge of the patients to their own homes.

Methods: A naturalistic retrospective exploratory cohort study of 100 consecutive admissions to the intermediate care unit. A backward logistic regression analysis was performed.

Results: Discharge home was associated with better scores on the Barthel Index of Activities of Daily Living at the time of discharge, a shorter duration of stay, and a psychiatric diagnosis other than delirium.

Conclusions: At the time of pre-admission assessment, clinical factors which were likely to predict discharge home were unclear, suggesting a need for further studies to determine who might best benefit from this sort of intermediate care placement.

This research paper is a realist review on the effectiveness of medical care for older people in the geriatric day hospital (GDH), based on trial data from a Cochrane review published in 2008. The Cochrane review indicated no overall difference between GDH care and alternative services. However, health care management and policy interventions are quite complex and methodologically more diverse than clinical treatments. Hence a ‘realist review’ is a more suitable explanatory analysis, aimed at discerning what works for whom, in what circumstances, in what respect, and how. This realist review on GDH care provides an explanatory analysis and has aimed to identify where GDH care is and is not effective.

The status of the geriatric day hospital within the National Health Service (NHS) in the UK has changed significantly over the past fifty years. We conducted a literature review starting from the inception of the geriatric day hospital, when it was viewed as the ‘shop front for geriatric services’ and was subsequently replicated in many western health systems, to the present uncertainty surrounding the model in terms of outcomes and cost effectiveness. The article also highlights the input of the Royal College of Physicians and the British Geriatric Society to the management and development of day hospitals. The geriatric day hospital has become one of the many service models under the umbrella of intermediate care services, offering comprehensive geriatric assessment and care to older people in the community. However, with the current practices of commissioning of services and ‘payment by results’, the future of this precious health resource remains uncertain.

The government intends to invest heavily in intermediate care services by the year 2004. The term ‘intermediate care’ de. es precise definition, but is said to include a number of community-based services, including those provided by district nurses. Enhanced district nursing may be one solution to providing care for many elderly patients who are thought to be inappropriately admitted to acute hospitals. The feasibility of this option has yet to be tested, but district nursing enjoys public confidence and is well placed within the primary care framework to ensure continuity of care. This paper describes a national postal survey of district nursing provision within all community trusts in England conducted in 1998 to explore a picture of the structural and organizational factors which impinge on the delivery of intermediate care by district nurses. The Handbook of Community Nursing was used to identify those with designated responsibility for district nursing within trusts. A response rate of 83% (n = 148) was attained. The majority of responding trusts reported a lack of resources to deliver more intensive levels of care. When trusts were ranked according to their performance on six key variables thought to be related to the delivery of intermediate care only two achieved the maximum score. Over half of the trusts scored 3 or less. The findings from this survey indicate a curious neglect of the district nursing service and suggest that considerable investment is needed if district nurses are to deliver an intermediate level of care.

This paper presents a section of the findings of a case study of a newly established community rehabilitation team (CRT) comprising physiotherapists, occupational therapists and nurses. The findings reported here address issues of interdisciplinary teamwork that arose during the project. All eight members of the team were interviewed as well as three ex-team members. The data were collected by semi-structured interviews and analysed using thematic content analysis (Strauss and Corbin, 1990). The findings suggest that when recognized barriers to teamwork are eradicated, such as geographical separation and different employers, teams such as the CRT can achieve high levels of teamwork. A problem that took longer for the CRT to resolve, however, was that of flexible working across traditional professional and hierarchical role boundaries. The paper concludes that the difficulties that need to be overcome when a new team and new service are established concurrently, should not be underestimated.

The Australian health care system is frequently portrayed as being in crisis, with reference to either large financial burdens in the form of hospital deficits, or declining service levels. Older people, characterised as a homogeneous category, are repeatedly identified as a major contributor to the crisis, by unnecessarily occupying acute beds while they await a vacancy in a residential facility. Several enquiries and hospital taskforce management groups have been set up to tackle the problem. This article reviews their findings and strategic recommendations, particularly as they relate to older people. Short-term policy responses are being developed which specifically target older people for early discharge and alternative levels of care, and which, while claiming positive intentions, may introduce new forms of age discrimination into the health system. Few of the currently favoured proposals promote age-inclusivity and older people's rights to equal access to acute care.

Objective: The aim of this paper is to examine the costs of introducing a nursing-led ward program together with examining the impact this may have on patients' outcomes.

Methods: The study had a sample size of 177 patients with a mean age of 77, and randomized to either a treatment group (care on a nursing-led ward, n = 97) or a control group (standard care usually on a consultant-led acute ward, n = 80). Resource use data including length of stay, tests and investigations performed, and multidisciplinary involvement in care were collected.

Results: There were no significant differences in outcome between the two groups. The inpatient costs for the treatment group were significantly higher, due to the longer length of stay in this group. However, the postdischarge costs were significantly lower for the treatment group.

Conclusions: The provision of nursing-led intermediate care units has been proposed as a solution to inappropriate use of acute medical wards by patients who require additional nursing rather than medical care. Whether the treatment group is ultimately cost-additive is dependent on how long reductions in postdischarge resource use are maintained.