START

START (Supported Transfer and Accelerated Rehabilitation Team) is part of the Waikato DHB's Older Persons and Rehabilitation service. It provides intensive rehabilitation for up to six weeks in patients’ homes following a stay in hospital or presentations at Emergency Department.
 

STARTRegistered nurses (both hospital and community nurses), allied health and health care assistants work together with the patient to develop specific goals, and build a home-based rehabilitation programme around those. The health care assistants also provide home based support services with a rehabilitation focus to help the patient become more capable and confident, and oversee rehabilitation exercises in the home.

For example, an 86-year-old lady wanted to get back to going to her club five days a week for lunch. This was important to her as it provided her nutrition, socialisation, motivation, confidence and exercise. The START team developed all the steps that it would take to achieve this goal. For the first week, the programme was exercising daily with the health care assistant until she was confident. To go to the club she needed to get showered and dressed. The health care assistants coached her to do these things daily until she was doing them independently. Over the next four weeks, the patient achieved all the goal ladder steps to enable her to get back to the club for lunch.

Description

START is a 7-day-a-week service between 7am and 9pm.

The aim of START is to:

  • provide and promote rehabilitation of patients in their home environment in collaboration with community therapy services and specialist geriatric medical care
  • provide and coordinate continuing clinical assessment to recognise deterioration and need for change in nursing or medical treatment or hospital admission
  • work collaboratively with long term care providers
  • provide and improve education to patients, carers and family
  • undertake a collaborative and individualised programme of health promotion for each client. Particular emphasis is placed on the role of fitness and prevention of deconditioning

A second component of START is the admission avoidance process where a START registered nurse works with emergency departments to avoid unnecessary admissions and ensures a person is transferred back into their homes with intensive support.

Key personnel

Graham Guy
Manager

Raewyn Dean
Charge Nurse Manager - START 

Location

The START service began operating in Hamilton in October 2011 as a pilot, and was so successful it now operates right across the Waikato DHB's district.

Contact information

 Ph: (07) 8398669

If you or a family member is on the START programme, contact details will be given to you.

Referral information

Inclusion criteria

  • the client is over 65 years and is domiciled in Waikato DHB
  • the client either presents to Waikato Hospital or Thames Hospital emergency departments, or is being discharged from any of the Waikato DHB hospitals following an acute illness and has a borderline level of function with an associated reduction in personal (PADL) and / or extended (EADL) activities of daily living
  • following assessment, the client is considered to have potential for partial or complete recovery with suitable home rehabilitation within six weeks
  • the client is able to stand and transfer with one person (with or without the help of a resident carer)
  • the client consents to being treated at home by the team, is aware of and is in agreement with the objectives set by the referring inter-disciplinary team
  • the client’s home is judged to be safe for the client in addition to the visiting staff
  • the client’s home provides an appropriate and safe environment for rehabilitation interventions

Exclusion criteria

  • clients who have been discharged from acute hospital care for more than 48 hours
  • clients without clinical need, only social need e.g. clients needing support during usual caregiver’s admission to hospital
  • where the home environment is not conducive to achieving the rehabilitation outcomes for the client
  • where the client’s primary rehabilitation intervention is provided in an outpatient setting
  • clients with progressive or deteriorating conditions where partial or full recovery cannot be reasonably expected within six weeks (e.g. palliative care);
  • the client is eligible for assessment, treatment and rehabilitation funded under the Injury Prevention, Rehabilitation, and Compensation Act (2001)
  • the client’s service needs are covered under another service specification or funding stream.


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