An integrated community and hospital service for adults with physical disability: two years experience

This article describes a service for adults, below the age for geriatric services, who have severe physical disability. This service combines a well developed community service with two specially adapted hospital units, totalling 33 beds, used for assessment, rehabilitation, intermittent care, and, for a few patients, residential placement. Over two years, 167 mean and 129 women (median age 42 years) were referred for registration; 82% were accepted. Ninety-three percent suffered from neurological disease, with the most common diagnosis being multiple sclerosis. Registration requests were most commonly for rehabilitation or community support; only 5% were for continuing inpatient care. In spite of physical decline for patients with progressive disorders (26%), most patients were perceived to have maintained or improved their social and psychological status after being registered with the service (92% and 89% respectively); whilst 51% of those admitted for rehabilitation improved. Although there are many recommendations for a close integration of hospital and community services for people with physical disability, this report is one of the few to describe the day-to-day working of such a service.