This year the HSE’s Winter Plan has been developed within the context of delivering essential healthcare in a COVID-19 environment. A range of initiatives is being undertaken to support this work, which aims to enhance community capacity and decrease acute hospital demand.

The plan primarily aims to support additional intermediate care beds, proposals for acute hospital egress.

Comprehensive re-ablement and therapeutic care service in short stay beds in residential facilities.

Under this scheme Mowlam Healthcare have 95 fully funded HSE beds in eight of our locations. These dedicated beds will be available to short stay patients/clients that have been clinically assessed as requiring short term step-down/step up care. Access to these beds will be available to both the Acute Hospitals and Community Services.

Criteria

Access to these beds will be allocated to the following patients/clients:

1. Patients/clients who require an agreed programme of re-ablement/or assisted therapy services to return home following a hospital admissions or as a hospital avoidance measure
2. Patients currently in an Acute Hospital requiring a Home Support Package (HSP) applied and approved by Community Services and are awaiting a service provider so that a suitable HSP can be put in place within an agreed timeframe of admission to the short stay bed (maximum 8 weeks);
3. Patients/clients in the community who have been approved for a Home Support Package (HSP) and are awaiting service and who are deemed a significant risk as a result of the delay in the HSP being provided (HSP will need to be available within 8 weeks);
4. Patients/clients awaiting the delivery or installation of aids and/or appliances that cannot discharge home/remain at home and where there is an agreed/approved timeline for provision of same; (within 8 weeks)
5. Patients awaiting minor home adaptations preventing them to be in their home that will be completed within a specified time period agreed prior to admission to the short stay bed;
6. Patients in need of a period of recovery prior to returning home with assisted therapies or who are at home and require a period of therapies in a residential setting which will benefit their recovery and who have an agreed Care Plan for a set timeframe of up to (8 weeks);

Community services only

1. Patients in the community who have applied for NHSS and have been medically approved and are at a significant risk while waiting for NHSS funding and placement;
2. Patients/clients in the community who require a period of respite who will benefit from additional therapy supports in a residential setting for a set period of time;
3. Patients/clients who have been identified by their GP/Community Services as requiring a period of residential care to prevent a hospital admission.

Clients not eligible under the criteria

1. Patients in Acute Hospitals with standard convalescence or long-term stay requirements which are currently supported under National Transitional Care arrangements;
2. Patients in acute hospital whose rehabilitation requirements have been deemed to require input of specialist geriatric or rehabilitation team(s)
3. Ward of Court applicants or patients/clients with legal complexities in relation to their NHSS application. (there is already provision under Standard Transitional Care Funding for these clients who are patients in the Acute Hospital)
4. Patients/Clients in Private Hospitals and covered under medical Insurance.
5. Patients/clients showing responsive behaviour (formerly known as challenging behaviour) whose care needs cannot be met within the environmental infrastructure of the residential centre.
6. Patients/clients who require 1:1 care.
7. Persons requiring detoxification from alcohol or drugs.
8. Patients with mental health care requirements.
9. Patient/clients who do not to have an agreed care plan with a defined timeframe and exit strategy for discharge from the short stay bed.
10. Day care service.

Referrals will be accepted from:

1. Hospital (discharge coordinator, Bed manager, CNM’s, MDT teams)
2. Community 9 Primary Care Teams, Public Health, GP’s, Community Rapid Response, MDT teams. Integrated Care Teams, Social Workers, CIT teams and Psychiatric services for later life)

Our Egress beds are located in the following nursing homes:

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