Intermediate Care Services

The Intermediate Care Services is a multi-disciplinary service providing short term restorative care and rehabilitation for adults over the age of 18, who have experienced a recent decline in their abilities for various reasons. The service is designed to rehabilitate people to help them accommodate illness or disability by learning or relearning the skills necessary for daily living. The service supports people by assessing and agreeing goals with the person, for them to work towards. The aim is to enable the person to get back to their original baseline ability, or to a new baseline, giving them as much independence as is right for them. The rehabilitation is provided within the person's own home and community or a bed based facility if necessary, for a short term period. There is no charge to Service Users.

Aims

The aims of the Intermediate Care Service are, through timely and focused intensive interventions:

  • To maximise long-term independence, choice and quality of life
  • To avoid unnecessary hospital admissions, by providing appropriate restorative support
  • To support effective and timely discharge of hospital patients who are medically optimised
  • To minimise the requirement for longer term support

Examples of those, for whom a referral to the Intermediate Care Service may be appropriate

  • If you are recovering from recent illness or injury which has temporally affected skills necessary for daily living such as surgery, heart attacks, strokes etc. and require support to recover independent living functions

  • If you are medically stable but require a short stay in a bed based facility for intensive restorative care

  • If you need support to settle at home and re-establish a routine following a stay in hospital, bed based Intermediate Care or respite facility

  • If you were previously independent but are at risk of losing functional ability or increasing your dependency on support services due to a temporary incapacity or loss of confidence

  • If you have sustained an acquired brain injury where acute intervention has ceased and there is potential for you to regain independent living skills

This list of examples is not exhaustive. We are happy to discuss your potential referral with the referrer, to determine whether we would be the right service to support you.

Anyone who is referred to Intermediate Care must be deemed to have an understanding of the intentions of the service provision and be willing to engage with the service. If you decide to decline at the time of the initial assessment or before, the duty of care will be returned to the referring party.

Initial Referral

Referrals can be made to the Intermediate Care Service by the following professionals, if they identify that you are eligible for the service and that you would benefit from short term restorative care and a support:

  • Social Worker
  • All Therapists
  • All Specialist Nurses
  • Transfer of Care Co-ordinator
  • Long Term Conditions Co-ordinator
  • Doctors and General Practitioners (GPs)
  • Wellbeing Partnerships
  • Senior Community Nurses
  • Ambulance / Paramedic Services  

Before one of these professionals can refer you, they must discuss the service with you, and you must be in agreement for them to refer you. As part of the referral, they will let us know your personal contact information, some information about your health and needs, and why they feel that our support is required. This information will help us to determine how best to support you.

The Intermediate Care Team

  • Advanced Clinical Practitioners who will receive and triage your referral, providing a rapid crisis response where necessary, complex decision making and enabling innovative solutions
        
  • Referral and Assessment Officers who will explain the service to you, assess your support needs, discuss and agree goals with you, for your rehabilitation and arrange the support required

  • Occupational Therapists who will, if you need it, help you to work out how to manage everyday activities more easily and independently

  • Physiotherapists who will, if you need it, help you to improve your movement and physical activity

  • A Social Worker who will complete Mental Capacity Assessments and chair Best Interests meetings if you need it, provide advice and information and work with you if you have complex social needs

  • Support Workers who will support you directly with your restorative goals for a short term period of a few weeks. They will do this through demonstration, guidance, encouragement, verbal prompting, creative problem solving, repetition, practice, and increasing difficulty and/or duration of an activity. They adapt each session to meet your needs on that day, as you gain independence

The staff employed by the Intermediate Care Team are carefully screened. They are Disclosure and Baring Service (DBS) checked and are required to undertake a period of induction and training during their probationary period. This training is updated at regular intervals throughout their employment and they have regular meetings and formal supervision and observation. They wear a uniform and carry identity cards. Like all employees within Manx Care, they are required to abide by the General Data Protection Regulations (GDPR), and all other Manx Care Policies and Procedures.

Office Contactable Hours

Monday to Friday: 9am to 4:30pm

Telephone: +44 1624 686186 - answer machine also available

Please note calls made out of hours or over the Weekend / Bank Holidays will be dealt with on the next working day.

Assessment once a referral has been received

Depending on your situation and your needs, the Intermediate Care Service will respond to your referral in different ways, which are most appropriate for you. For example:

  • If you are living at home and have suffered a loss of ability to maintain your activities of daily living (meal preparation, washing, dressing, etc.) for some reason, and do not have sufficient support already available to you, but you do not require a hospital stay based on your medical health

  • It may be appropriate for our Advanced Clinical Practitioners to respond rapidly to you in a crisis situation. They will assess your needs, and aim to create a wraparound package of support which will either enable you to remain at your home safely whilst supporting you to regain your independence over a short term period with some restorative goals to work towards, or provide a bed based facility to begin work on your restorative goals

  • If you are an inpatient in hospital, and are medically optimised, however you need some additional support to strengthen and or regain confidence with your activities of daily living once you go home

  • It may be appropriate for one of our Advanced Clinical Practitioners or one of our Referral and Assessment Officers to meet with you, discuss the service, work with the Ward staff to plan your discharge, then come to your home to assess and discuss your needs, and agree some restorative goals. If you need it, the Referral and Assessment Officer will request the input of different professionals within the team, to best meet your needs

  • If you are living at home and have suffered some falls lately, you may have lost some confidence and/or some strength, but you are managing your activities of daily living

  • It may be appropriate for a Referral and Assessment Officer to contact you and arrange to come in the next few days to assess your needs, and discuss and agree some restorative goals with the aim of reducing your risk of further falls, and building your confidence back up

Individual Goal Plan in the Community

When it has been established how much support is required and what goals will be undertaken by the Intermediate Care Service, your goal plan will be drawn up and allocated to appropriate members of the team. The tasks to be worked on, in order to meet the goals, are clearly shown on the goal plan which will be kept in a folder. Your Support Workers will work in accordance with the agreed goal plan in your folder. Support Workers will make notes within your file at every visit. Please feel free to read these.

Review of Service and Goal Plan

Reviews are ongoing throughout our input; Support Workers, Occupational Therapists and Physiotherapists will monitor your progress and change goals as required. Review records are completed after each session, on a computer system which is shared with other professionals who are involving in supporting you. If it becomes apparent that you will need longer term support, we will discuss this with you and support you to access appropriate professionals and/or services.

A satisfaction survey will be left with you as the service finishes to allow you to give us feedback on your experience with us. When we receive these surveys and feedback, we share the feedback with the relevant team members. If there is criticism, we approach this positively, by reflecting, discussing and learning from it. All feedback is welcomed.

Additional Information

  • The Intermediate Care Service cannot provide nursing care, nor is it possible to organise a service in an environment that is considered to be unsafe for the staff members

  • The service will provide any basic Occupational Therapy or Physiotherapy equipment as identified during assessments. This is free of charge. For equipment beyond the scope of the service provision, we will provide information about aids which you may choose to purchase privately to enable additional tasks to be carried out

  • It is not possible to guarantee that you will have the same Support Worker for every session. Changes sometimes have to be made to maintain the efficiency of the service, and to manage holidays, sickness and days off

  • If you wish to cancel your service, or plan to go away for a while, it is important to inform a member of the team as soon as possible. Please remember to let us know when you are returning so that the service can resume. Please telephone +44 1624 686186

  • Insurance Cover - Manx Care carries Employee and Public Liability Insurance fully covering the Intermediate Care Service. Please be aware that your personal possessions are not covered by this insurance. Every care will be taken when carrying out our duties, however if any accidental damages to your possessions occur as a result of Intermediate Care support, Manx Care will not be able to repair or replace

  • The Intermediate Care Eligibility Criteria document are available from us on request. Please contact us on +44 1624 686186 if you would like a copy

Who you can contact for more help

If you have any questions about the Intermediate Care Service, which have not been answered here, we welcome you to contact us on +44 1624 686186.

If you wish to comment or complain about any aspect of your care, this may be done verbally, or in writing, using the form which you will find in your support folder, or we can send one to you.

If you have any concerns you would like to discuss about the Service, please contact the Service Manager:

Mrs Clare-Jane Kennaugh

Email: Clare-Jane.Kennaugh@gov.im

Telephone: +44 1624 686186

Address: 

Intermediate Care Services,
Palatine House,
Murrays Road,
Douglas,
Isle of Man,
IM2 3TA

Alternatively, you can contact:

Manx Care Advice and Liaison Service also known as MCALS

Email: MCALS@gov.im

Telephone: +44 1624 642642

Website: www.manxcare.im

If you feel that a problem has not been dealt with satisfactorily, you may wish to contact a senior Manager:

Mrs Michelle Breed - Head of Intermediate Care, Manx Care

Email: Michelle.Breed@gov.im

Other useful numbers

  • Medical Emergency: 999
  • Manx Emergency Doctor's Service (MEDS): +44 1624 650355
  • Nobles Switchboard and ask for the on call Duty Social Worker: +44 1624 650000
  • Mental Health Crisis Team: +44 1624 642860
  • Adult Protection Team (Safeguarding): +44 1624 685969