Intermediate Care Facility patients benefiting from holistic healthcare model

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Cleaners prepare the Intermediate Care Facility at University of Limerick. Photo: Cian Reinhardt

PATIENTS in the UL Hospitals Group (ULHG) Intermediate Care Facility (ICF) at the University of Limerick (UL) are benefiting from a holistic, multidisciplinary approach to their ongoing rehabilitation when they are transferred to the facility from the group’s acute hospitals.

The ICF was opened on June 8th in the reconfigured main hall of the UL Sport Arena, a fully equipped temporary hospital setting for non Covid-19 or post Covid-19 patients who no longer require acute medical attention, but who can benefit from ongoing rehabilitation and support before final discharge.

Seventy-five-year-old Tom Noonan from the western County Limerick village of Dromcollogher was one of the first patients to be transferred to the ICF when he arrived on Friday June 12, just four days after the facility opened. Tom admits he was initially puzzled at the novel healthcare setting.

“When I arrived, I noticed the basketballs and sports equipment, and then I saw all the nurses and staff, and I thought to myself, ‘Where am I at now?’ I didn’t know what to expect when I was coming here, but I’ll tell you this, I couldn’t have come to a better place,” Tom said.

Tom who suffers from a number of conditions, including chronic obstructive pulmonary disease (COPD) had 10 days earlier been admitted to UHL with a gangrenous toe. He was concerned when it was decided he could not be operated on, but has been delighted with the decision to transfer him to the ICF.

“Everything I need is right here, and everyone has been so kind. I’m being well looked after by wonderful doctors, Dr Con Cronin and Dr Eithne Mulloy, the nursing staff are minding my medication, and the physiotherapists have been bringing me for walks and to the gym.

“I’ve been through loads in the past few weeks, but I always try to stay positive. Only for the staff here, I wouldn’t be able to get around at all, and with all the physio and exercise they do with me, I’m getting around fairly well now,” Tom explained.

Tom also praised the work of the PALS team, including Conor Mehigan and Aileen Culhane, who have helped him to keep in touch with the outside world through video calls with his two brothers and three sisters.

“They’re so good for helping me with that. It’s typical of the care you get in the place. Honest to God now, I’ve never in my life had care the like of what I’ve received here.”

In the ICF, as Tom’s testimony makes clear, rehabilitation is the primary focus, based on a rounded, holistic vision of healthcare and wellbeing.

Medical and healthcare expertise is directed toward supporting the patient’s readiness for discharge, not just physically building their strength and communication skills, but also preparing them mentally and helping to ensure their home or residential care setting is optimised before their discharge.

The 68-bed ICF, which has capacity to scale up to 84 beds, grew out of the collaborative relationship between UL Hospitals Group and the University of Limerick, and was developed as a contingency solution to the patient flow and crowding challenges experienced in the region’s hospitals during the pandemic.

It is expected to be in place until at least September with an option to extend until November. The ICF is laid out in partitioned wards and fitted with ward support accommodation such as clean and dirty utilities, pharmacy, pantry, staff change, clinical treatment areas, two recreation areas, and four enclosed rooms.

Numbers of patients at the ICF have increased steadily, and staffing has grown in line with this increase. As of this week, a total of 50 patients have benefited from rehabilitation at the ICF to date, and there are currently 31 patients being cared for in the facility.

Rostered 24/7 cover is provided by a workforce of approximately 70 personnel, including two consultant physicians, Dr Eithne Mulloy and Dr Con Cronin, and encompassing Non-Consultant Hospital Doctors (NCHDs), an Assistant Director of Nursing, Nursing staff, Clinical Nurse Managers, Health Care Assistants (HCAs), a Ward Clerk, support from the Patient Advocacy Liaison Service (PALS), a receptionist, catering, security personnel and porterage for day and night, and hygiene staff.

The Allied Health team at the ICF includes Clinical Nutrition & Dietetics, Medical Social Work, Occupational Therapy, Physiotherapy and Speech & Language Therapy, and they have been supported by students of Clinical Nutrition & Dietetics, Physiotherapy and Speech & Language Therapy from UL.

Fiona Steed, UL Hospital Group’s Allied Health lead, explained that the number and range of Health & Social Care Professionals (HSCPs) has enabled a complete and fully rounded approach to patient needs.

“Patients at the ICF are benefiting from a complete, multi-disciplinary approach to their ongoing needs, from a range of disciplines. And because of our partnership with UL, we’ve also benefited from having practice tutors in Physiotherapy, Speech & Language Therapy, and Clinical Nutrition & Dietetics, and students in those disciplines.

“All of this is hugely beneficial, not just for the patients, whose healthcare experience is enhanced, but also the students, whose learning needs are being supported.” she said.

Senior Physiotherapist Mary Flahive, who has worked at UHL for the past 12 years, said: “When you say rehab, most people think, physio, some occupational health, maybe a bit of speech and language therapy, and that’s it.

“In the ICF, we have a whole-team multi-disciplinary approach, and that entire team, a full range of disciplines, is right here, focused only on the patients in this facility. It’s very patient-centred.

“As well as physio and occupational therapy, we are also providing dietitian input and medical social work. It’s not just about physically preparing them for home, but also ensuring their home situation is optimised. It’s about optimising people for discharge in the fullest sense of the word ‘holistic’.” she added.

Senior Speech & Language Therapist, Joanne Mannion, who is also a practice tutor at UL, said that the ICF space has conferred remarkable opportunities for professional collaboration, and increased the quality of the learning and training received by the current cohort of physiotherapy, speech & language therapy and dietetic students.

She explained: “The space here is so conducive to team work – where you have Physios, OTs, Dietitians and Social Workers sharing a workspace, with close access to Nursing, Medics, Catering.

“There are so many opportunities for collaboration, and that really improves the quality of care for the patients. I can think of one patient we have been working with collaboratively for one hour a day, every day.

“That intensity of input would be unheard of in other settings. Similarly, it’s been lovely to give the students the opportunity to provide therapy in line with evidence-based practice.

“This will really benefit them when they start their careers, perhaps in a busier acute environment, to have had the chance to develop and cement their skills at this stage in their development.

“One of the most successful initiatives here is the social communication group, where we pick a conversation theme, and encourage patients to interact and communicate in a group.

“This group is possible because of the engagement and initiative of the speech & language therapy students. We work with the OT to incorporate meaningful activities for patients.

“We had a music theme one week, where we focused on music from the 50s, 60s and 70s, and printed pictures of musicians from those eras that patients were able to cut out and make collages of to place by their bedside,” Joanne said.

She added: “The therapy here is holistic and patient centred. Another social communication group theme was about travel, and where people had travelled in their lives, whether in Ireland or abroad.

“One patient said she had forgotten how much she had done in her life. This is really rewarding and meaningful therapy that effects change in so many more ways than reducing risk to the patient. It’s about the patient’s sense of wellbeing.”

Josephine O’Shea, a resident of Oola, between Limerick and Tipperary, found herself marking her 91st birthday in the ICF after she suffered a fall at home on her kitchen floor, sustaining painful bruising on her side and back.

It was her third fall in the past seven years, and came as a significant blow to her self-confidence. She was transferred to the ICF after spending a night at UHL, where it was decided she would benefit from some rehabilitation in the new facility.

Ahead of her discharge from the ICF after two weeks of care, Josephine was effusive in her praise of the multidisciplinary team.

“I’ve been amazed, because when we were driving in here, I was thinking, ‘Where on earth are we coming to?’ but I’m so pleased they did transfer me.

“The physiotherapists, Scott Murphy and Emer McGettrick and others, were great—they helped me to get on my feet and walk around, and many of the staff would also make time to have a chat with me. With all the rest and exercise I’ve had, I feel so much stronger now.”

“I have a much more positive attitude now as well. Dr Cronin and Dr Mulloy and all the staff are wonderful. They’re so kind, and very reassuring, and they’ve given me the confidence I need to go home,” said Josephine, reflecting fondly on how the staff presented her with a cake on her 91st birthday and sang ‘Happy Birthday’ to her. “I’m not giving up now,” Josephine says. “I’m going to go for the Hundred!”

Yvonne Young, Assistant Director of Nursing at the ICF, said that redeployment to the ICF has pushed everyone out of their comfort zones.

She said she has been inspired daily by patients, and by the manner in which Clinical Nurse Managers, Staff Nurses and Healthcare Assistants have embraced the challenge as a unique and exciting opportunity.

“The phenomenal national response to the COVID-19 crisis was reflected in everyone’s approach to working in the ICF, and we really must acknowledge the phenomenal input of people behind the scenes who have worked tirelessly to make this facility a reality,” Yvonne added.

Describing the kindness that underpins the nursing ethos in the ICF, Yvonne explained: “We must never forget that during a patient’s healthcare experience, they are vulnerable. It has been a frightening and anxious time for them.

Some have been hospitalised for long periods, without any contact with friends and loved ones. So while high standards of safe, effective and individualised patient care are important, it is just as important that care is delivered with kindness and compassion.”

“Working in the ICF has been a pleasure. I believe we have something really special here that works, and it’s a model that can be replicated anywhere,” Yvonne concluded.

Professor Paul Burke, Chief Academic Officer of UL Hospitals Group and Vice Dean of Health Sciences at UL, was the executive lead on the ICF project that he describes as “a wonderful link” between the clinicians of UHL and the teaching staff and students from the school of Allied Health Sciences in UL.

“It has been great to see the patients benefit from this tremendous collaboration and receiving state of the art rehabilitation care from our physiotherapists, occupational therapists and speech and language therapists.

The input from dietetics and support from social work has also been outstanding. This facility truly shows what can be achieved when we have this unique opportunity to fully resource a rehab facility, thanks to the additional support of the University, that helps people recover quickly after a prolonged stay in hospital,” Prof Burke said.

“To see all these staff working alongside our nursing and medical staff has been a very rewarding experience, and I hope we can continue to keep this model of care functioning when the ICF goes back to the University. I would like to thank all those involved who have made this project possible.” Prof Burke concluded.