Early rehabilitation in geriatrics

Geriatrics is the medical specialist domain concerned with the diseases and care of the elderly. The objective of geriatric care is to sustain or to restore to maximum autonomy for the patient and to prevent the need of long-term nursing care. To achieve this aim, simultaneous acute-medical and rehabilitative treatment of the patient is necessary. Therefore (early) rehabilitation plays a prominent role in geriatrics. It is an integral part of the acute medical care of geriatric patients. With the Sozialgesetzbuch IX (SGB IX) which came into effect in the year 2001, early rehabilitation in hospital obtained a new legal basis. In 39 section 1 SGB V, now early rehabilitation is for the first time explicitly described as part of hospital treatment. It is therefore necessary to organise early rehabilitation in a way that as many patients as possible with the medical need for rehabilitation are registered and optimally cared for. Resources already existing in geriatrics, neurology (phase B) or in general early rehabilitation must be taken into consideration when planning the implementation of the new law. This article describes the development, structures and processes of early rehabilitation in geriatrics. An inquiry from the ministries of the regions of the Federal Republic of Germany (FRG) in summer 2001 shows that there are now 314 inpatient geriatric institutions with a total of 16297 beds. More than half of these beds are situated in small- or medium-sized acute hospitals (< 400 beds), a fourth is situated in rehabilitation hospitals. The portion of big hospitals (greater than or equal to 400 beds) with geriatric departments is much different in the regions of the FRG. Totally there are less than 20% of the big hospitals provided with geriatric departments. In Germany the situation in geriatrics is in so that special as there is a distinction between acute ( 108/109 SGB V) and rehabilitative geriatric settings ( 111 SGB V). This situation is embodied in social law but not explained by medical reasons. In this case the regions of the FRG assign different priorities. While some (e.g. Hamburg) regard geriatrics exclusively associated with acute hospital settings according to 108/109 SGB V, others (e.g. Rheinland-Pfalz) prefer geriatric rehabilitation according to 111 SGB V. Overall you find predominantly acute geriatric settings in the FRG. Therefore the legally required early rehabilitation can partly be based on the existing structures of the early rehabilitation in geriatrics. In the future it will be essential to allocate patients to the most suitable department, in terms of geriatric departments as well as other indication specific or general early rehabilitative institutions. If necessary, existing structures have to be supplemented according to the actual requirements. In this context a combination of general and indication specific early rehabilitative institutions can be taken into consideration as well.