F-2-09-02
THE INFLUENCING FACTORS TO THE SUCCESSFUL IMPLEMENTATION OF HOME-VISIT REHABILITATION SERVICES
Kaoru Saito, Toshiyuki Ito, Maki Taguti, Tom Takaoka, Hironobu Sashika (Department of Rehabilitation Medicine, Yokohama Rehabilitation Center, Yokohama, Japan)
Yokohama Rehabilitation Center has provided disabled people with home-visit rehabilitation services since 1987. This study investigated the factors which influence the successful implementation of these services. The subjects were two groups, completed and incompleted, of the 106 clients seen in the 1995 fiscal year. The completed group consisted of 57 cases whose specific program goals (e.g. improvement of self-care or homemaking activities, reduce the demand on carers) were met and maintained at the follow- up period. The incompleted group consisted of 59 cases whose major goals were either not met or not maintained at the follow-up period. In both groups the suspected influential factors such as age, sex, cause of disability and number of caregivers were determined and compared. The results indicated that no significant differences were found regarding age, sex, type of disability or number of caregivers. However, in the incompleted group more degenerative or progressive diseases were seen as the cause of disability and the level of independence in ADL according to the Barthel Index was significantly lower than in the completed group. The results also revealed that in the completed group the client and family had more specific needs for the services and the goals set required less changes in their life style. From these results it was concluded that the success of home-visit services depends on the precise identification oft he client's and caregiver's needs and determining the long term prognosis of disability level.
F-2-09-03
CLINICAL REHABILITATION MEETING COMMUNITY CARE: EARLY EXPERIENCE OF A COMMUNITY MEDICAL REHABILITATION TEAM
Derrick K.S. Au, Hobby K.Y. Cheung, Wendy K.C. Chan, Sau-han Cheung, Nelly K.F. Ho, Winnie W.M. Yau, Raymond M.Y. Wong (Kowloon Hospital, Hong Kong)
Abstract: Community-based rehabilitation (CBR) as propounded by WHO focused on "missed opportunities for rehabilitation" in countries with less developed health care system. Application of the concept in urban setting such as Hong Kong is still exploratory. A local project called "Community Rehabilitation Network (CRN)" organized by the HK Society for Rehabilitation used self-help groups, advocacy, and programmes for empowerment with positive results. However, interface of hospital outreach teams and other community services remain fragmented. We pilot an integrative community medical rehabilitation service (CMRS) with these features: (1) link up hospital-based domiciliary OT, PT and community nursing service and medical service to provide a one-stop service open to community; (2) keyworker approach; (3) liaise with local multi- services centres for continuity of case management. RESULTS: From 1.7.96-31.12.96, 55 cases were managed by the CMRS (29 hospital-discharged; 26 community referred). Contributions are: case management for appropriate clinical services and domiciliary therapy service, caregivers education, home-safety assessment, and safety-net for deteriorating cases or decompensating caregivers. We conclude that this approach is valuable in removing services barriers and providing safety-net for high-risk disabled persons, but has limitations in home-based trainings.
