Day rehabilitation

Four to six hours a day, five days a week, with the same multidisciplinary team and largely the same programme content as inpatient rehabilitation — but the patient goes home or to a hotel each evening.

It suits patients who need the intensity but not the nursing: medically stable, able to travel daily, and either independent enough or supported enough at home overnight.

Practising at home each evening is not a compromise; it is where the transfer of skills actually happens. Patients in day rehabilitation solve their real bathroom, their real stairs and their real kitchen while still under supervision, which inpatients only encounter at discharge.

Patients who need nursing care overnight, who are medically unstable, who fatigue too much to travel daily, or who would be unsafe alone. Patients travelling from abroad without a companion usually need the inpatient option at least initially.

We assess this rather than defaulting to day rehabilitation, because a patient who is unsafe at night needs inpatient care.

The same goal-setting, the same standardised measures, the same weekly physician review and the same written discharge plan as an inpatient programme. The difference is where you sleep, not the standard of the programme.

For international patients we can help arrange accommodation near the centre and advise on daily transport before you commit.

Accommodation close enough that daily travel does not consume the energy the therapy needs, someone with you overnight in most cases, and enough medical stability that no nursing is required outside therapy hours.

We help arrange accommodation. If travel time or the overnight arrangement is not workable, we recommend inpatient rehabilitation instead.

Many patients begin as inpatients and step down to day rehabilitation partway through, sleeping at a hotel with a companion and coming in for a full therapy day. This is planned in advance with stated criteria rather than improvised.

It also runs the other way: if fatigue, a medical problem or a fall makes the overnight arrangement unsafe, we move back. The level serves the patient rather than the booking.

Evidence comes mainly from two related models of care. A Cochrane review of 16 trials with 3,689 older people found that medical day hospitals led to fewer deaths or poor outcomes than no comprehensive care, and showed no clear difference from comprehensive care given in other settings; the evidence was of low quality 1.

After stroke, a Cochrane review of 17 trials with 2,422 participants examined leaving hospital earlier, with rehabilitation continued in the community 2. Hospital stays were about six days shorter, there were five fewer people dead or dependent per 100, and readmissions were similar 2. The benefit was clearest when a co-ordinated multidisciplinary team delivered the service, and in people with mild to moderate disability 2.