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Description of the program:

  • Located in the Charlotte and Lewis Steinberg Family Rehabilitation Wing, Baycrest rehab services provide goal-directed inpatient rehabilitative therapy after an acute event or illness, musculoskeletal injury, surgery or hospitalization, which is key to ensuring that patients can return to community living.
  • Our rehabilitation services offer a comprehensive array of specialized interventions focused on the unique needs of frail seniors with complex needs, including multiple health conditions, physical impairments, recent functional decline and cognitive change. We provide supports as required, while respecting the wishes and goals of the patient to remain as independent as possible.

Goals of the program:

  • The desired goal of rehabilitative care includes the maintenance or sustaining of functionality, the restoration of functionality and/or the development of adaptive capacity.
  • Goals and discharge plans are developed from the patient's perspective, with caregivers recognized as key to enabling patient/client function.
  • Patients and caregivers are involved throughout the rehabilitative care process to support the attainment of goals and the patient’s return to community living.
  • Inclusion
    • Adults age 55 and older
    • Patient is medically stable to participate in and benefit from rehabilitative care to meet the needs of his/her specific mobility and functional goals in the home environment
    • If patient smokes, is able to do so safely and make own arrangements
    • Patient has identified goals that are specific, measurable, realistic and timely
    • Patient has restorative potential and may attain a maximal level of functioning given his/her medical condition
    • Patient has the mental, physical and cognitive endurance to participate at the minimum level
    • Patient will sometimes be assigned to the Low Tolerance Long Duration (LTLD) or High Tolerance Short Duration (HTSD) program upon assessment by the Registered Nurse Utilization coordinator (RNUC), who collaborates closely with the referring partner. Assignment to a particular program is based on updated medical and functional update, goals and discharge plans to the community, with supports as recommended by the clinical team
    • Patient has the ability and willingness to meaningfully participate in therapy
    • Patient has sitting tolerance and able to sit up-right for a minimum of one hour
    • Patient has established realistic and appropriate discharge plans to facilitate return to community living
    • Expectation that discharge planning and discharge destination are determined prior to admission
  • Exclusion
    • Dialysis
    • Mechanical ventilation
    • Bi-level Positive Airway Pressure (BiPAP)
    • Tracheostomy Tube & Nasogastric (NG) Tube
    • Needs greater than 50% Oxygen
    • Total parenteral nutrition (TPN)
    • Bariatric equipment needs (300lbs +). This would be evaluated on a case-by-case basis.
    • Elective surgeries for hip and knee replacement (No Bundle care approach)
    • Weight bearing status <50% for both upper and lower extremities
    • Recent stroke or acquired brain injury
    • Treatment for other co-morbid illnesses/conditions that interfere with the patient’s ability to participate in rehab (e.g. dialysis or active cancer treatment)
    • Unmanaged responsive behaviours limiting the patient’s ability to participate at the minimum level required by the rehab program
    • Vacuum-Assisted Closure (VAC) Therapy. This would be evaluated on a case-by-case basis.
    • Specialized Amputee rehab

Expected Length of Stay:

  • Length of stay will vary by individual needs, as determined by the health care team.

Application Process:

  • An application can be sent by the patient’s health care team in acute care through the Resource Matching and Referral (RMR) system or via fax: 416-785-2471. For fax referrals, please use the GTA rehab referral form: GTA Rehab Network Rehabilitative Care & CCC Referral Form
  • All applications are reviewed to confirm that our services are appropriate to meet the patient’s care needs.

For referrals to the service: Please speak to your acute care service provider or hospital discharge planner.

Click to print or download the brochure for the In-Patient Rehabilitation Program.

If you are interested in applying to our rehab program or wish to discuss eligibility criteria, please speak to a member of your care team in acute care, such as a physiotherapist, social worker or discharge planner.