“We will provide the extra help you need to get back on your feet by supporting you to regain your confidence and strength, re-learn skills or find new ways of doing everyday activities. Our skilled, caring and friendly teams include nurses, social workers, occupational therapists, physiotherapists and care staff.”
Since Hobbs Rehabilitation started at Willow Court in September 2020 as part of the Discharge to Assess (D2A) service we have had over 350 patients come through the door! For one patient to return home requires close working partnership of 4 different providers: The Hobbs Rehabilitation team, Willow Court nursing and carers team (Hants County Council), Social Workers (Adult Services) and the medical team led by NHS Consultant Geriatrician Dr Oswell from Kingfisher ward at Andover War Memorial hospital (Hampshire Hospitals NHS Foundation Trust). If someone needs equipment for home then Equipment Stores also become involved. When you consider how many people there are in each team and how much information needs to be shared then it really is quite remarkable how patients are managed and how difficult it is to share the right information at the right time, for each team needs. D2A at Willow Court is a pivotal service for patients to recover and be assessed for either return to home, new housing or residential/ nursing care.
This service has been renamed Short Term Stay beds and the provision at Willow Court is now known as the Recovery & Assessment Suite – Short Term support in a care home setting to support you leaving hospital.
The caseload at Willow Court is mainly older persons rehab (our youngest was 52 yo) and has been varied, mainly including reduced mobility post infection, humeral/hip fractures, PD, stroke, brain tumour, predominantly on a background of dementia, as well as alcoholism, and neglect/hoarding at home. Rehabilitation of older adults involves an active process, delivered through a coordinated interdisciplinary approach, that aims to improve function and enable subjects to live their lives to the fullest potential. Frail, older adults are particularly vulnerable to functional decline as a result of illness, and rehabilitation is an essential part of medical care for this population.
Due to symptoms of delirium, brewing infections and dementia we have become highly skilled in dealing with challenging behaviour. Even Louis’s charms haven’t been enough to persuade some patients to get out of their cosy beds but the team are excellent at calming aggressive patients, particularly Rosie with her soothing voice and nurturing words. When patients develop deep sadness and anxiety, Louise works her magic with a sit down chat and tea in hand! One dear 80 yo lady Jean, was one minute living independently, managing her own finances and sweeping the leaves in the garden, then became bedbound long-term, due to infection leading to delirium and a psychotic episode. I remember being asked by her if there was a knife on her table “why?” I said “because I want to kill you!”…
On another day, sadly one day only, after the doctor reviewed her medications, she gave Louis and I the best smile and asked us many questions and seemed to have some recall of our previous visits!
Maximum length of stay is supposed to be 4 weeks but the longest stay we have had has been 6 months, as Derek who had a learning disability waited for rehousing. The majority of patients are sadly waiting in excess of 8 weeks, delays being due to Social Worker shortages, waiting for equipment and not enough carers in the community to provide home packages. However, our shortest stay was 5 days!
Rosie and Becky were the first therapists to work tirelessly in providing rehab on 2 days a week for 20 patients – there was no gradual increase to 20 patients as per contract, it was a deep dive in and do the best you can, which they did exceptionally!
Then came along the rest of the crew: Myself (Suz), Gina, Anna, Louise, Louis, Rosie, Caroline, Rachel Charles, Amy Dovey, Nadia, Hannah and Nicky Ellis with Laura Jones providing ad hoc weekend cover. We used the best fit models from Holiday Inn and Bramshott to set up an incredibly efficient therapy service, which evolved from strength to strength with each month. It probably took a good 6 months to establish a gold standard service where the IDT communicated without duplication, addressed holistic needs jointly, understood each other’s roles clearly and smiled more, even behind the masks. Dr Oswell got used to our persistent `please can you check` and `why` and questions, carers liked our magic sheets as a way to communicate patient mobility/ function, nursing team appreciated our support with pressure sore management and social workers accepted that the Hobbs Rehabilitation team are exceptionally holistic with the Occupational Therapists in the driving seat for discharge planning, and supported us with increasing our understanding about capacity and positive risk taking for discharge home as per patient choice.
Relentless – the team worked extremely hard (and continue to do so) in the first 6 months to provide a 7 day service and managed, more often than not, to provide 20 face-face contacts daily! Louise was extra busy logging all the face-face and non face-face contacts!
Scary – pre vaccine everyone was on high alert, worried for their loved ones and being extra diligent with PPE, hand hygiene and social distancing. In November 2020, myself and a night carer became COVID positive and up until December 2021 we were the only ones to have had it, so everyone has been exceptional in keeping each other safe at work! Louise and Rose became positive just before Christmas and recently carers have been off with COVID, impacting greatly on day to day cover.
Tiring – in the first 10 months, it was hard to keep going, amongst the busy caseload, worry of what was to come and anticipation of waiting for the vaccine! Lots of staff were working overtime to establish the service, cover long leave, cover long sick leave and stay late because of discharge complications or patient absconding!
Our rock from September 2020 to June 2021, without a shadow of a doubt, was Nicky Ellis. Nicky (and Rosie) worked regularly at the weekend for the first 6-8 months, so the rest of the team with young children could have quality time with their families. When we all had a wobble and I think most of us did, Nicky would call each member of staff personally and give the reassurance we so desperately needed. Her personal attention in recognising individual efforts was exceptional, and helped to maintain motivation and focus. Since Nicky’s leave, Rosie has been our rock, being ultra flexible to cover leave, switch days to suit the change in service needs and be as always, cool, calm and collected!
Challenging – reduced therapy hours from 180 hrs per week in Sept 2020 to 56 hrs in May, with an increase of beds from 20 to 30 resulted in a great deal of adjustment and sadness, as the therapy team knew the patient could often do so much more if we could see them more often….I must admit that I shed a tear or two at some of the family meetings! It has also been and remains a challenge to support the care team with the transition of caring approach to reablement/ rehab model as there is resistance to change, strong personalities to negotiate with and lack of carers to do what we ask. We have worked hard to break down challenging barriers with the Social Work team and now have a consistent approach and excellent partnership working!
Testing – following the reduced hours all the services had to make a shift in provision, and as Hobbs had to stop doing Access and Discharge visits, it then fell onto the Community Response Team to provide these essential visits. The team shrank to just myself, Louise and Gina for a while. Gina then left for Oaksey and Winchester and Rose came back from maternity leave, and with the refreshing return of Rosie, we became the Willow Court Quartet team for most of the summer period with beds increasing to 35 with only an extra 9 hours of therapy . The return of glamorous Meriel in September was a wonderful bonus!
Collaborative – we are most definitely a multi professional team working collaboratively from different organisations, towards patient centred goals. We have learnt to trust each other to get the job done, be tolerant of each other’s unique style of working and empathy towards the impact of limited resources for each service. The interdisciplinary working has been exceptional and is at the heart of all we do at Willow Court and for this reason I have taken lots of photos of the MDT, as well as therapists, to reflect the partnership working. TEAM – Together Everyone Achieves More
Social vs rehab – as therapy hours reduced so did the number of rehab patients with an increasing number of social admissions, leaving us still plenty of work but this added to team frustration by not being able to use our skills fully.
Variable – with each extension of the contract has meant a change in hours, staff mix, patient caseload and readjustment It remains one long rollercoaster!
The key ingredients which have got us through the last year are:
Cake – from Rosie`s finest brownies and Rose`s regular doughnut supply from the local petrol station, to Louise bringing in extras of her homemade soup and pizza`s and the most delicious cheese scones from the local Travelling Cupcakes, this has helped to fuel us in delivering the best we can.
Laughter – probably the most important of all to effectively manage our high stress levels! From the tale of the tumbling turd where Louise and I weren’t quick enough to catch John`s turd that dropped and gracefully scraped my shoe, to Hannah`s conversation with Lyvia`s ex-husband who was so very hard of hearing – she could be heard for miles and Gina and I laughed for hours, to Norman telling Louise “I`d rather look at a blanket than look at you” !
Colleagues – the most important of all to get through work trials and tribulations. For all of us it really has been an emotional rollercoaster due to the work challenges and personal ones. For me personally, I feel that I am only as good as the team around me and I have to say that throughout my rather long 20 plus years of working, the Hobbs team at Willow Court have truly been exceptional in rising to the challenge, professionalism and retaining a compassionate nature through such a historically challenging and difficult period.
As the Team Lead, my greatest challenge in the first 6 months was to motivate therapy staff as most of them had already been redeployed to NHS contracts 4-6 months prior to Willow Court and did not want to be working here, due to long travel time, dislike of caseload or compassionate fatigue. Rosie and Louise were the exceptional two as they have never complained once! Many of our patients have a significant degree of cognitive impairment/ challenging behaviour and weren’t able to clearly express their gratitude, so we would rely on a smile, level of comfort and calmness as a way to reflect our success.
The STS service works well and gets people home and for those that can, keeps them home for longer. We have seen more and more dependent people relying on live in carers and hoists to be transferred, to go home. The main lesson as therapists has been, key assessments, identifying and knowing when not to treat, with differential diagnosis when a patient is not well, or has no rehab potential and therefore has a new baseline. Positive communication has evolved across the teams and exceptional interdisciplinary working has been at the core of all that we do at Willow Court. We all have been proud to be able to help the NHS during such a crisis and it has been valuable to give something back to an organisation, which for most of us, has been our stepping stone into therapy. Working in partnership with the NHS and Hants County Council is no doubt a fantastic opportunity for Hobbs to expand its many valuable services.
Teamwork has been fundamental in the success of Hobbs at Willow Court with the jewels in Hobbs crown being Rose, Rosie, and Louise. They have been incredibly exceptional in providing team support to `lift us all up` when the going got tough, support personal crisis situations and continue to be so professional, compassionate and hardworking throughout! Not only is Rose the team feeder, she has provided exceptional support in her 2 days, working like a whirlwind in chairing the IDT (which can be a real challenge in terms of information sharing and personalities) and co-ordinating with Social Workers a seamless discharge home. Louise is a real diamond and works more as a Junior physio than a rehab assistant, always going the extra mile and doing the small things for the patients that make a big difference i.e. extra cup of tea, stop and chat, or taking the time to give the carers an extra helping hand! In April, Louise will have worked for 2 years at Hobbs and has been redeployed to the NHS contract throughout, being an incredible asset. Rosie is well liked by the care staff and is a priceless wonder whose deep compassion ripples amongst us all!