Adult Social Care Glossary, v 0.6

2.12 There is a tendency for the terms 'reablement', 'rehabilitation' and 'intermediate care' to be used interchangeably. The National Audit of Intermediate Care categorises 4 types of intermediate care:

- crisis response - services providing short-term care (up to 48 hours)
- home-based intermediate care - services provided to people in their own homes by a team with different specialities but mainly health professionals such as nurses and therapists
- bed-based intermediate care - services delivered away from home, for example, in a community hospital
- reablement - services to help people live independently which are provided in the person's own home by a team of mainly care and support professionals

2.13 The term 'rehabilitation' is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

2.14 'Intermediate care' services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live independently - as such they provide a link between places such as hospitals and people's homes, and between different areas of the health and care and support system - community services, hospitals, GPs and care and support.

11.17 Intermediate care services are usually provided to patients, often older people, after leaving hospital or when they are at risk of being sent to hospital. The services are a link between places such as hospitals and people's homes, and between different areas of the health and social care system - community services, hospitals, GPs and social care. 'Reablement' is a particular type of intermediate care, which has a stronger focus on helping the person to regain skills and capabilities to reduce their needs, in particular through the use of therapy or minor adaptations. There is a tendency for the terms 'reablement', 'rehabilitation' and 'intermediate care' to be used interchangeably. The National Audit of Intermediate Care categorises 4 types of intermediate care:

- crisis response - services providing short-term care (up to 48 hours);
- home-based intermediate care - services provided to people in their own homes by a team with different specialities but mainly health professionals such as nurses and therapists;
- bed-based intermediate care - services delivered away from home, for example, in a community hospital; and
- reablement - services to help people live independently, provided in the person's own home by a team of mainly social care professionals (see chapter 2 - preventing, reducing or delaying needs).

11.18 Three of the 4 types of intermediate care have historically been clinician-led and provided by health staff, with reablement being provided by local authorities. However, these are not concrete, mutually-exclusive categories - and, furthermore, with greater integration and co-operation between health and local authorities, there should be greater use of qualified staff from health and social care working together to provide intermediate care.

A range of integrated services that: promote faster recovery from illness; prevent unnecessary acute hospital admissions and premature admissions to long-term care; support timely discharge from hospital; and maximise independent living. Intermediate care services are usually delivered for no longer than 6 weeks and often for as little as 1 to 2 weeks. Four service models of intermediate care are available: bed-based intermediate care, crisis response, home-based intermediate care, and reablement. (Combination of definitions in NG74 and NG214)

Intermediate care services are provided to people, usually older people, after leaving hospital or when they are at risk of being sent to hospital. Intermediate care:
- Helps people to avoid going into hospital or residential care unnecessarily
- Helps people to be as independent as possible after a stay in hospital
- Can be provided in different places (e.g. community hospital, care home or in people�s own homes)
[Source: NHS Benchmarking (2015) in Intermediate Care � SCIE Highlights No 1 � July 2017]

Intermediate care is a set of services and interventions organised through health and social care organisations to support people proactively in their own homes, or in a community bed-based facilities, and provide structured support on discharge from hospital. It comprises short-term, multidisciplinary services that provide support to people who have been in hospital or who are at risk of hospital admission. Intermediate care helps people to recover or rehabilitate at home and is underpinned by the Home First principle that the vast majority of people recover best at home. Intermediate care helps people to be as independent as possible after a stay in hospital, or a crisis in the community, and helps people to avoid people going into hospital or residential care unnecessarily. Intermediate care services are sometimes known as �step down� or �step up� services and can be provided in different places (e.g., people�s own home, care home, community hospital).

A therapy-led approach is a signifier of the difference between intermediate care interventions and bedded or non-bedded step down interventions. Although intermediate care is free at the point of use it is very often 50/50 funded by social care, usually through the Better Care Fund, and in fact some home-based intermediate care can be fully funded by a council's ASC function. Some is fully NHS funded (more often bed-based). Intermediate care is NOT funded by a hospital. Up to 6 weeks is usual, though typical length of service is lower. Often overlooked is the utility of intermediate care to avoid an admission so intermediate care is also not only a post-acute-episode intervention. Recovery (of relative independence) or reablement is the goal of intermediate care. Most people (over 80%) leaving hospital who require an intervention on pathways 1-3 should have reablement goals achievable by either form of intermediate care - either a short term reablement-based care bed with therapeutic support, or a reablement-based domiciliary care support (often termed Home First). See https://ipc.brookes.ac.uk/files/publications/Some_key_messages_around_hospital_transfers_of_care.pdf

Intermediate tier services are those provided on a time limited basis to help people discharged from hospital, or to prevent a hospital admission. Their aim is to re-enable people to regain their independence.

A wide range of services aimed at keeping you at home rather than in hospital, or helping you to come home early from hospital after illness or injury. It is normally made up of a specific programme of care for a fixed period of time, usually up to six weeks, and is free of charge.

This guidance sets out how NHS bodies (including commissioning bodies, NHS trusts and NHS foundation trusts) and local authorities can plan and deliver hospital discharge and recovery services from acute and community hospital settings that are affordable within existing budgets available to NHS commissioners and local authorities. It applies to NHS bodies and local authorities exercising health and adult social care functions in England and should be used to inform local service planning and delivery.

This guidance applies in relation to adults being discharged from acute hospitals and community rehabilitation units in England, excluding maternity patients.

Discharges from mental health hospitals are not within the scope of this guidance. However mental health trusts are encouraged to embed some of the principles, adapted for mental health care pathways. Separate guidance will be published for those being discharged from mental health settings in due course.

This guidance is applicable from 1 April 2022.