A first step towards one territorial health reform represented by intermediate structures, which perform a function halfway between home care and hospitalization (intended for acute cases), and are aimed at fragile but not serious patients, who need ongoing nursing care or simple rehabilitation treatments. Since there is no single definition of an intermediate structure at national level, the offer of this service is still very heterogeneous throughout the territory. However, with the Agreement of 26 February 2020 (on the basis of Ministerial Decree 70/2015) the Regions have identified in the so-called community hospital the solution to provide intermediate care, which can have its own headquarters or be located at converted hospitals, residential or hospital structures, but always attributable to territorial assistance.

Avoid improper hospital admissions

The goal is to avoid improper hospital admissions and respond to the social welfare needs of an increasingly old and lonely population. The community hospital is a facility with a limited number of beds (about 20), for short hospitalizations of 15-20 days, which allow the patient to ccomplete convalescence after hospitalization, facilitating his return home. The management ofassistance entrusted to the nursing staff, that clinic to the general practitioner or geriatrician. The patient can also come from home in case of a worsening of the chronic disease such as not to require complex health interventions (which is why referral to the acute care ward would be inappropriate).


The access criteria

Intermediate structures house people who need to be held under nursing observation 24 hours a day, typically after hospitalization following an acute event, and who do not have a caregiver who can care for them in their own home. Typical cases are: patients with bedsores to be medicated; those suffering from BPCO (chronic obstructive pulmonary disease) or heart failure and must continue an injection therapy with antibiotics; the subject with multiple concomitant pathologies discharged after a stroke who continues to have fever, kidney problems, low blood pressure, unable to get up and get dressed alone; who needs extensive rehabilitation after hip fracture surgery. Instead, patients come from home when they need to check and stabilize the new therapy (for diabetes, for example) or if they have a beginning of pneumonia, also from Covid. Access occurs at the request of the general practitioner, hospital wards or directly from the emergency room.

On the territory

Community hospitals they are not yet present in all regions (missing in Umbria, Basilicata, Sardinia, Sicily, Valle d’Aosta, Provinces of Trento and Bolzano, Calabria). And where they exist they can have different names. In Tuscany, intermediate care is organized within residential structures according to three levels of care intensity. The highest represented by nuclei low care, the average one from the intermediate health care residency, the lowest from the intermediate nursing care residency. In Lombardy there is talk of community hospitalizations carried out in territorial hospitals. In Piedmont of healthcare continuity beds (cavs) in hospitals or Rsa. In Liguria intermediate care is provided in special hospital wards (managed by doctors) and three experimental nursing wards. In all regions, intermediate assistance is also guaranteed with temporary hospitalizations in the RSA. While other structures similar to community hospitals are: the Nursing unit (as in Molise and Lazio) and the Territorial rehabilitation units (in Veneto).

What caregivers need to be able to do

Among the objectives of the community hospital there is also that of train caregivers in patient management, in particular regarding the correct functioning of the necessary devices (from the glucometer to the oxygen helmets) and the ability to promptly recognize any symptoms of instability. In this perspective, therefore, the caregiver is granted a easier access to the structure and greater involvement in care and hygiene procedures. Often these temporary shelters serve to give time to the family of organize the home environment to the new needs of the patient, to appoint a support administrator and find a suitable caregiver.

April 3, 2021 (change April 3, 2021 | 9:03 pm)

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