Background
When the Italian MS Society’s in-home rehabilitation service was established in 1976 in Genoa, there were no services provided by the National Healthcare System (NHS) that met the needs of severely impaired people with MS who had difficulty leaving their homes and who were thus not receiving services from which they could benefit. In addition, the NHS gave priority for rehabilitation to people in acute situations rather than those with a chronic illness. Also, the public facilities offering rehabilitation through the NHS had, and continue to have, limited hours that preclude many employed people with MS from accessing services.
The MS Society assumed all costs for the service until 1982, when the NHS officially recognised the importance of in-home rehabilitation for many people with MS, in order to avoid lengthy hospital stays and to reduce costs related to frequently transporting severely disabled individuals to a rehabilitation facility.
Aims:
• To offer rehabilitation services to people who otherwise would not access these services due to the seriousness of their condition, architectural barriers of the home or transportation difficulties.
• To provide a more flexible possibility for receiving rehabilitation services for people with MS who are employed.
Marketing the service
The MS Society has information stands in the major MS diagnostic and treatment centres where information about the in-home rehabilitation service is provided.
Public health-related service providers often let people with MS know of the rehabilitation service and direct them to phone for further information. This serves to avoid a lengthy waiting period for receiving rehabilitation through an NHS facility.
Regular information about the rehabilitation service appears in the MS Society’s magazine.
Word-of-mouth has proven to be an efficient marketing tool for the service as well.
Organisation of the service
A social worker receives an inquiry from an interested individual, explains all services available, attempts to understand the needs and interests of the person and determines if access to the rehabilitation service is appropriate.
The team, consisting of a rehabilitation physician, nurse, occupational therapist, physical therapist, social worker and psychologist, meets with the individual at the out-patient rehabilitation centre for a comprehensive evaluation. The initial evaluation may also be performed in the person’s home by the entire team if it is impossible for the individual to reach the rehabilitation centre.
The team determines whether the person is appropriate for rehabilitation, if rehabilitation can be provided within the home (i.e. is the home the most appropriate environment) and develops the rehabilitation plan.
Services available through the in-home rehabilitation service include the following:
• Physical therapy
• Psychological support
• Speech and swallowing therapy
• Advice on technical aids and home modifications
• Evaluation and training for the individual and family by the nurse
Results
The region of Italy covered by the in-home rehabilitation service has an estimated 1,500 people with MS. The service currently follows 651 individuals in their homes. Rehabilitation, support and consultancy are carried out by 13 rehabilitation physicians, 75 physiotherapists, two occupational therapists, six psychologists, one nurse, one social worker and one administrator.
Expenses
• Hourly fee for rehabilitation staff
• Reimbursement for home visits that require excessive travel time
• Continuing education for staff
• Administrative costs
Disadvantages of the service
• May be difficult for rehabilitation professionals to reach some areas of the region served
• Can be a barrier to socialisation
• Provides a “non-neutral” environment that potentially can place the rehabilitation professional at a disadvantage
• Creates difficulties for use of special equipment
Advantages of the service
• Creates better opportunities for involving family members in the rehabilitation plan
• Training is performed in the person’s real-life situation and not in an artificial healthcare setting
• Allows significantly disabled individuals to receive rehabilitation
• Allows employed people with MS more flexible access according to their individual needs, without the necessity of taking time off of work
• Eliminates worsening of fatigue experienced by many people with MS due to travelling, heat, waiting, and other negative aspects associated with attending an out-patient clinic
• Provides the ideal setting for testing of and training in the use of assistive devices In-home rehabilitation, provided by professionals who receive specialised continuing education, can be an important service for many people with MS. While there are some disadvantages, the service has proven that hospitalisation for rehabilitation is not necessary in all cases, and so also serves to contain costs.
For more information contact Dr Maria Laura Lopes De Carvalho, Italian MS Society Rehabilitation Centre at segreteriaaism@iol.it.
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