Critique of a Rehabilitation Unit

Introduction

At the end of 1996, I moved one rehabilitation unit in the UK to another prior to returning home after a lengthy stay in hospital.

I wrote the original version of this document as I felt appalled that a service like that it described could still operate in the late 1990's. To misquote a popular saying:

"Nice building, shame about the service!"

General Impression

From the first moment I arrived, when nobody greeted me or explained anything about the service, I formed the impression that:

The unit was dominated by the nursing staff, some of whom seemed to feel that they could do just about anything to make their lives easier.
Amongst the nursing staff, there was an atmosphere of "just coping" and no sense of professionals doing a job they enjoy. Only a few of the staff appeared to have been trained. There are times when the unit seemed understaffed and others when staff seemed to have little to do and were visibly bored.
The unit was run following out-of-date and inflexible principles. It reminded me of horror stories of hospital wards in the 1950's. There were rigidly enforced visiting hours and a complete ban on visitors during mealtimes.
Few, if any, of the users were happy.
There was no empowerment of the users. There seemed to be an on-going power struggle between staff and users.

Rehabilitation

Rehabilitation could mean several different things, but the service had no clear policy on what they were trying to achieve.

This meant:

There seemed to be no structure to the withdrawal of support - I was continually having to remind some nurses that I could walk with a frame. Not once did anyone suggest that I tried something new. I was moved back from a single room (where I was just about ready to sleep with the door closed - I had been in hospital an awfully long time) to a ward just before going home.
Apart from physiotherapy, no effort was ever made to increase my functional ability. Occupational Therapy input was limited to ordering equipment.
I received no input to help me in my daily life. Indeed, few people expressed any interest in what I want or need to do during a typical day. We had to ask for training on using the aids that I being issued with - even through some, such as the seat raisers, are dangerous if used incorrectly.
No-one explained what I might hope to achieve or offered any counselling.

Were The Service Users Ill?

There was a perception amongst staff at the service that the users were all 'ill' and therefore the emphasis throughout the service is that nursing and medical intervention are paramount.

I suggested:

That the auxiliary nurses be renamed "enablers" and wear normal day clothes.
That they be retrained with the best of practise in community care so that users can get familiar with the sort of care they will be receiving in the community.
That these enablers take the views of the users into account. It should be mandatory to do as the user requests unless there is a good reason not to.

Nothing too radical there, you might think!

Respecting the Users

I saw others subjected to, and experienced myself, some appalling breaches of reasonable behaviour towards users.

For example:

People being ignored after having made reasonable requests.
People being given medication by wholly inappropriate means. I saw that one user's pills were mixed with their food without their consent.
People being made to wait in the corridor in sheets because there is no shower available. This happened nearly every day and is the thing that sticks in my mind most vividly. Remember, this was 1996 - not 1896.

Re-integrating the Users

The service was quite well placed, next to a shopping street in a major English city, to allow users to prepare to move back into the community - to do things like shopping and enjoy a quiet pint in the pub.

But:

There was no attempt to use the local facilities. It would have been quite possible for a user to return to the community having just had a single home visit - quite unprepared and running the risk of a very low of quality of life.
The equipment was all standard hospital issue rather than being of the type that would used at home.

I suggested:

That visitors should be encouraged to take users out and that the service provide the necessary assistance.
That one or two rooms should have furniture and equipment like that found at home and that a normal-sized bath should be installed.

Conclusion

I concluded that I had not enjoyed my time at the service. A typically British understatement!

To get some action, I sent the report to the Chief Executive of the body responsible for the service. Do you know what happened then? Yes - a nice letter blaming a change of staff and then NOTHING… No action, no changes, zilch!

For other articles click here.

Any Comments?

I'm really keen to hear what you think of this. Please email any comments to: andy@tof.co.uk