Helping you stay home and avoid hospital

Short-term reablement, otherwise known as intermediate care, is short term support to help you remain independent and meet your goals. It becoming increasingly important in Wales as health and care services work more closely together to deliver the best outcomes possible for people.This could be, for example, if you’ve been in hospital for a period of time and are returning home, or if you’re at home and you have important care need that arises. At present, short-term reablement services are provided by both the NHS and local councils in three different ways:  

  • First, home-based short-term reablement provides a range of services to you at home, including therapeutic (treatment aimed at healing a condition) support from occupational therapists and physiotherapists. This is designed to support you to stay at home and live as independently as possible, including whether you’ve recently been discharged from hospital or you’re potentially going to require hospital treatment in the future. This service is currently provided by the Community Resource Team in Cardiff and the Vale Community Resource Service in the Vale of Glamorgan. 
  • Second, there is a focused service providing additional support if you require a higher level of intervention initially to support you to live independently, before this is tapered down over time. Here, teams including therapists, district nursing, and domiciliary care may work closely together to provide the right level of support. 
  • Finally, if you don’t require the full range of services that a hospital provides but aren’t quite ready to live home independently following a hospital stay, there is a bed-based service where temporary care is provided either in a community hospital or residential home until you are ready to return home to live independently. 

In the future, the @Home programme will lead to the introduction of a fourth type of short-term reablement which will provide a crisis response service to residents across the region. This will be a service if you need admission to hospital. A clinical team will be able to rapidly visit you and assess your needs before recommending the right care for you, whether in hospital, in the community, or at home.  

The aim of the @Home programme is for all of these four types of short-term reablement to be brought together in a single team of doctors, nurses, occupational therapists, physiotherapists, social care professionals, home care providers and more. This will mean that services are able to maintain the right size of workforce to meet the demand for services in the local population and ensure that people get the right care at the right time.  

Our Priorities

DECHRAU’N DDA
STARTING WELL

We want every child in Cardiff and Vale to have the opportunity to thrive. Our work focuses on children in vulnerable situations and the services that support them.

HENEIDDIO’N DDA
AGEING WELL

We know how hard it can be to find help when people need it the most. We want to make sure there is community support to help people stay as healthy as possible so they can carry on doing the things that matter most to them.

BYW’N DDA
LIVING WELL

As a Partnership we have worked together with people with a learning disability, their families, carers and the third and independent sector to produce a clear direction for the planning and delivery of adult learning disability services across the region over the next five years.

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