Rehabilitation and long confining to bed represent in Italy an important objective in the health plans, both regional and national ones,
in relation to the new epidemiologic and demographic table. The disability new vision promoted by the OMS has to mark planning interventions
by starting from the health necessities of the services insufficient offer. The nineties have been characterized by a growing interest concerning
rehabilitation and long confining to bed activities.
A new situation it has had with the demographical changes produced by:
middle life extension
health concept alteration, now understood as complete physical, psychic and social well being
expectations increase, from the population, as regards the medical cures
chronic nature situations increase and acute conditions reduction
need to organize welfare courses that guarantee the service continuity and not only the only assistance in the acute phases.
From the normative point of view two events, among the other ones, can be considered notable:
- the hospital bed-places planning again, with the destined places increase, for the chronic nature and those destined to the acute conditions decrease, culminated with the State-Regions Conference's measure, dated 08.08.2001, that fixed the bed places number for acute cases in 4/1000 inhabitants and the rehabilitation and long confining to bed bed-places in 1/1000 inhabitants;
- Guide-lines for the rehabilitation activities? promulgation, always by the State-Regions Conference, dated 07.05.98, that established the rehabilitative intervention phases, the cures intensity level, service's net features and reciprocal relations, the social health integrated way structure.
What is rehabilitation?
It's a problems education and solution process, in which the person with disability is led to reach the best possible life level on physical, functional, emotional, social, rational plane, with the least possible restriction of her operative choices.
Rehabilitation health activities, necessarily require the person with disability global burden, an individual rehabilitative plan predisposition and its achievement
through one or more rehabilitative programmes. It can easily be understood how the rehabilitative intervention is different from the clinical one in classical sense.
To the data referred at 2000, the bed-places/1000inhabitants are hardly 0,17 therefore so far from the 0,50/1000 inhabitants standard, of which we must be equipped
to answer to the chronic nature situations emerging in all the country. Therefore it emerges that it isn't absolutely thinkable to reconvert the hospitals for acute
cases into rehabilitation and long confining to bed hospitals through a simple label change.
Such re-conversion must happen through a real discontinuity compared with the past. It becomes necessary the acquisition of new technical-professional competences, of
a different way work method, of a particular attention to the hotel services quality, by considering the confining to bed protracted duration and of a planning that
knows keep suggestions by a modern and global vision of the rehabilitative way. The ?open? hospital concept, extremely contemporary, appears particularly appropriate
especially in the case of rehabilitation and long confining to bed hospitals, that should have to be planned in a functional manner to have the burden not only of the
physical disabilities, but also of the psychological problems of people in need that wait for the re-entry in their familiar and social surroundings.
Many illnesses chronic nature, that were mortal in the past, is undoubtedly a modern medicine important result, but it will take with it, in short times, deep transformations
to the health system and on the services that have to be supplied.
The chronic illnesses, in the long run, give birth to the joint presence of different pathologies, that require an efficient, capillary and good articulated assistance
that the present territorial health service can't guarantee and so , at least till this service's strengthening, long permanence of this ills typology in the hospital
structures is expected. So, it'll have to be prepared some structures capable to receive these patients and their families and the humanized spaces have to be a central
part in them, as it's logical.
Though this attention towards ?more human? spaces is valid in every hospital structure, it can't deny that there are particular realities, in which humanization from
added value becomes a primary need. Asignificant example is formed by the Hospices and by the Palliative Cures Unities . They are structures destined to receive the
terminal ills and their families, to assist them in their illness last phase. Finally they are spreading in our country, thanks to the 28 December 1998 Legislative
Decree n. 450, converted, with modifications, into the n.39 law of 26 February 1999, with which Health Ministry has provided for a national programme, to achieve in
every single region and autonomous province, one or more than one of this kind of structures, by providing the necessary economical resources with the following 28
What are the Hospices and the Palliative Cures Unities?
They are health structures in which is offered to the terminal ill and to his family a divided and structured welfare programme, in order to improve the residual
life quality of the ill, incurable through the physical symptoms and the sorrow check in its quadruple valence (physical, psychological, social and spiritual one)
and to guarantee to the patient Human dignity till the end, by taking care of him and by providing a valid support to his family.
Essential feature of these structures is that they present themselves as some man measure hospital ones. It first of all means that it will have be planned in order
to guarantee all the necessary requirements, so that the service to which it's destined can done efficiently, functionally and efficaciously, not only in quality
terms for users, but also in terms of management economy in the whole supposed life cycle. Humanization will regard planning aimed choices (of functional, forma aesthetic
nature), in order to transform the health structure in a place in which users can be at their ease, by opposing to their common and general perception on the hospital
and health surroundings (as cold, aseptic and impersonal places). The necessity to go into the ?humanization? process, arises by the presupposition that every
surroundings ?can deeply influence the behaviours, the states of mind and the people relationships procedure, as well as the activities development?.
These conditionings are much more important in a Hospice , because they regard people that are already burdened by a tension condition, of psychological and emotional
stress that, on a side, reduce their adaptation and orientation skill in ?foreign? surroundings, on the other side, promote the detachment process from reality;
such processes can influence not only the patients, but also the operators (doctors, nurses, male nurses and so on), for their delicate and highly tiring tasks that
they have to carry out.
the practice, to humanize means:
To satisfy all those needs that permit to product comfortable and dignified surroundings;
To recreate surroundings very similar to a ?home? that, though it's provided with medical equipments, is capable to sadden (in the patients, their family and the operators) belonging and well-being sensations;
To contrast the psychological malaise because of the feeling in ?foreign? surroundings, so different from the usual daily life places.