"Exemplary rehabilitation team - this is how it should be done !"

My mother was recently admitted to hospital as an emergency with severe pneumonia, which was complicated by a partially collapsed left lung and a very low serum sodium level, which had made her extremely confused and, eventually, unable to walk or stand. Before her admission, she had been socially active and a regular attender at local groups and family events, although deafness and slowly declining mobility sometimes made life challenging for her. 

She was admitted via Accident and Emergency into a medical assessment ward in January (probably the worst time of year to be admitted I feel, when acute services are under maximum pressure), then had several ward moves during her short admission. After a few days, she was medically fit for discharge, but remained a shadow of her former self. At discharge, she was referred to the Wishaw Rehabilitation Team under the 'Discharge to Assess' programme. 

Within two hours of discharge, she was assessed by an Occupational Therapist who gave us lots of helpful advice, always based on my mother's own wishes and needs. She then very rapidly organised personal home care services to help with washing and dressing in the morning and evening, hand rails to enable my mum to access her bedroom and bathroom upstairs, walking aids for both upstairs and downstairs, toilet adaptations, a key box, community alarm and inputs from wider team members, including a physiotherapist, the sensory care team and the local fire service.    

This story is about the excellent person centred care delivered by this team, which is an example of the type of high quality rehabilitation services that enable people who are at high risk of being readmitted to hospital to remain in their own home.