Intermediate care in nursing-led units – a comprehensive overview of the evidence base

Abstract

The development of intermediate care services, aimed predominantly at older people, formed a significant part of the UK Department of Health's National Service Framework (NSF) designed to guide the development of services for older people at the beginning of the 21st Century. The stated intention was to provide a more appropriate environment of care for some of the large number of elderly patients who occupied acute beds ‘inappropriately’. The goal was to prevent unnecessarily extended stay in acute care, to improve the outcome of the transition between acute and community care and prevent ‘excess’ dependence, including unnecessary hospitalization and iatrogenic dependence. Despite such positive statements of intent, the plan to create 5000 intermediate care beds in the UK by 2004 led some to voice concern that this heralded a return to ‘workhouse’ wards. Fears were expressed that patients would experience inadequate rehabilitation and diagnostic failure due to lack of proper assessment.