A Realist Evaluation of a Seven Day Community Rehabilitation Unit

Abstract

Background The Community Rehabilitation Unit (CRU) at Our Lady’s Hospice & Care Services is an 18-bed inpatient facility for those aged 65+. The unit bridges the gap between acute care and community living by providing tailored rehabilitation programmes to optimise patient function. Established as a five-day service it expanded to seven days in 2020. Research on community rehabilitation inpatient services for frail older adults is limited internationally. Methods This study set out to investigate how the CRU works for patients and in what circumstances it works best and why? The objectives included developing explanatory theories, identifying perceptions of processes, resources, mechanisms and determining areas for service improvement. Phase1: a literature review, analysis of anonymised data from 200 admissions, 19 internal documents and an Expert Panel (n=7) to develop initial programme theory. Phase 2: testing and refining these theories through stakeholder focus groups/interviews (n=10) and patient interviews (n=4). Phase 3: final theory refinement and approval by the Expert Panel (n=4). Results The primary patient profile were admitted from home (94%) with mobility issues (54%) being the main reason, followed by general rehabilitation (27%). The seven-day service was positively evaluated by stakeholders and patients, although some internal feedback mentioned 'quiet weekends. The seven-day service enabled the admission of more complex patients. The CRU's location and grounds were appreciated. Resources fostered autonomy, while limited bathrooms posed challenges. Socialisation positively impacted patient motivation, as did staff. While rehabilitation focused on patient-set goals, this was not consistently documented in nursing assessments. Conclusion The CRU service was positively received and areas for improvement were identified. Reviewing PAS data to better capture admission details and reasons for admission is recommended. Formalising a philosophy of care, including a nursing-care model, to reflect person-centred, goal-oriented rehabilitation is crucial. Maintaining the seven-day service and enhancing weekend social activities are recommended to reinforce its benefits.