Once upon a time, a very long time ago, in a country called England, elderly patients recovering from serious operations or strokes were not sent packing from NHS hospitals and asked to cope at home on their own. Nor did remaining in hospital condemn other patients to sleeping on trolleys. And, in these happy circumstances, the recovery process could be continued further in convalescent homes. At least it could until these started disappearing in the 1970s.
Now, however, the desire to empty hospital beds as quickly as possible can create a crisis of its own.
Olwen Finlay, chairman of Agile, an association of chartered physiotherapists working with older people, says: “There is a danger that those who are not given time to rehabilitate may have to enter nursing homes when they might have otherwise only needed sheltered accommodation.
“Many peoples’ perception of the ageing process is that it is characterised by a lack of activity and responsiveness, but this is a misconception because short-term disabilities can soon become permanent if early intervention doesn’t take place.
“It’s important that the issue of older people isn’t just brushed under the mat, because in the longer term, it can cost the NHS more in readmission to hospital and long term care (LTC). We need collaboration between all the professions and more multi-disciplinary teams.”
Rehabilitation uses physiotherapists, occupational therapists, social workers, doctors, nurses, and speech and language specialists to help people learn new skills and adapt old ones, and minimise the effects of disability and handicap. The focus is on optimising an individual’s normal functional abilities and improving their quality of life experience rather than on diagnosis.
Some provision is made in NHS hospitals, but this has declined during the past 10 years. And the potential of other settings, such as nursing homes, is underused.
Professor Graham Mulley, professor of medicine for the elderly at St James’s University Hospital in Leeds, refers to research that shows that less than 10 per cent of elderly people in care homes have any rehabilitation in the home. Furthermore, those that do often have to pay for it – in addition to what they are already paying for nursing home costs.
For the time being, most LTC insurance policies do not cover rehabilitation. PPP lifetime care is unusual in doing so, but only pays out after the standard initial three-month waiting period at the claims stage – and the first three months can be crucial to the success of rehabilitation.
Some other insurers will consider offering rehabilitation but do not specifically state this in their policy wordings. It seems only a matter of time, however, before immediate rehabilitation treatment becomes a standard feature in LTC policies.
Frances Mace, a freelance occupational therapist based in Amersham in Buckinghamshire, is involved in assessing whether or not LTC policyholders have a valid claim.
She says: “In my experience about half the people I am asked to assess would have a reduced need for LTC if they received suitable rehabilitation treatment.
“It could make the difference between being able to cope at home on limited care and equipment and having to enter a nursing home fulltime.”
Treatment could also result in some LTC policyholders in nursing homes being able to return home or to a sheltered environment and receive more limited care at a reduced cost to their insurer. Estimates of the proportion vary from between 10 and 20 per cent.
Geoff Brown, managing director of BUPA Health Assurance, the health protection subsidiary of BUPA, says: “I would be surprised if we don’t end up offering rehabilitation, but it’s early days. What we are looking at is similar to what happens with income protection policies where insurers pay for occupational therapy if they feel it’s in their claims management interests. My gut feeling is that it will reduce the cost of LTC cover-but we have no statistics to prove it.”
Margaret Borwick, director of Cassidy Courts Donald & Partners, a specialist intermediary based in Petersfield in Hampshire, is exploring ways she can improve her clients’ underwriting chances by demonstrating that rehabilitation has reduced their need for care in the future.
She says: “Many insurers are looking at how they can incorporate rehabilitation within their benefit structures and it could reduce the cost of LTC cover and provide a model the NHS can follow. It’s in everyone’s interest.
“The NHS already offers acute therapy, but not chronic therapy, and this is what the private sector is thinking of offering. Even those in their 40s and 50s who cannot currently afford LTC will benefit in due course because these therapies should be available on the NHS by the time they need them.”
Elaine McGinlay, director of nursing care at Barrington Lodge, a Croydon-based nursing home chain that provides rehabilitation facilities, feels that the widespread availability of rehabilitation will revolutionise the way LTC is offered rather than reduce insurance costs. These are expected to continue to climb as a result of rises in the cost of nursing care and equipment and in property values.
She says: “Except for the very ill and very frail at the end of their lives, there won’t be any LTC because of these developments. People will remain at home, come in for therapy in blocks of around two weeks, and be maintained in as good a level of physical condition as possible. It will take up to five years to arrive at this situation but the trend is already starting.”
Sheila Scott, chief executive of the National Care Homes Association, does not feel that the impact will be anything like as dramatic, but acknowledges that, on average, people may enter care homes a couple of years later than before.
She says: “Rehabilitation is a developing area and it seems to us to be an appropriate resource to have. But it is not the answer to everything because high success rates reflect the fact that those being sent for treatment are the ones most likely to benefit.
“Nevertheless if insurers are prepared to foot the initial costs, the long term savings could be huge.”