Our Patient Journey
This section of our website aims to provide patients and their families with the necessary information required when planning their rehabilitation journey at our facilities.
Referral & Admission
A referral for admission to our facility will usually be done by the patient’s specialist doctor. The specialist’s office will complete a Patient Referral Form (PRF) which is sent to our admissions department. (PRF – available for download here)
When the specialist doctor refers the patient for admission and depending on bed availability, our case manager will discuss options and the process with the patient and family, request authorisation from the patient’s medical aid and coordinate the transfer of the patient to our facility.
Items to Remember
Whether attending Spescare as an outpatient or as an inpatient,
we want your stay with us to be as comfortable as possible.
Please ensure you bring the following items:
- Identity Document
- Medical Aid Membership Card
- Current medications (Any pre-existing prescribe medication supplied on discharge)
- Physical aids e.g. hearing aids, walking frame etc.
- X-rays and doctor’s letters
- Sleepwear, dressing gown and slippers
- Comfortable clothing and shoes for
- Books and magazines
*Please note that space is limited for the storage of clothing and personal belongings and even though we take precautions to keep your belongings safe we cannot take responsibility for personal items.
Assessment & Care Plan
Once admission is finalised the patient will be assessed by each member of the multidisciplinary team. The team members will conduct an in-depth medical and functional assessment measuring all function areas relevant to the patient’s daily life. The team members will discuss their findings and agree upon a set of medical, physical, cognitive and psychosocial treatment goals, which are then also discussed with the patient and the patient’s family in a formal family meeting. An indication will be given of the required length of stay during this meeting.
Therapy & Update
Patients will receive daily therapy based on the selected care plan seeing the different members of the multidisciplinary team and will also received daily nursing care. The multidiciplinary team will monitor the patient’s daily progress and formally scores the progress once a week.
Multidisciplinary team meetings are held weekly, discussing each patient and their respective progress. During the meeting any adjustments to the care plan is made according to the progress
shown by the patient, this is to ensure an optimal recovery process. Regular updates will be provided to the patient, the patient’s family and medical funder. Our care coordinators will send updates to the medical funders and provide feedback on the extension of the authorised length of stay.
Patient functional progress is measured based on the Beta Scale Tools developed by the South African Database for Functional Medicine.
Discharge & Return Home
The discharge planning process begins early, patient home needs are assessed and recommendations are made by the multidisciplinary team. The recommendation will include advice on the appropriate equipment needs, modifications required at home and if dedicated care workers are needed after discharged. If required a social worker will do a home visit.
The team will facilitate all the requirements for making arrangements with suppliers for equipment and arranging with home-based nursing agencies for caregivers. Once a patient is ready for discharge a final update will be sent to the patient’s primary physician, family and medical funder and follow-up appointments are arranged with the multidisciplinary team if needed.