Service : Intensive Community Rehabilitation Service

Service overview

We provide full rehabilitation support in your home for up to two weeks following your discharge from hospital.

Our aim is to support your recovery by helping you learn practical and social skills which will make you more independent and confident and improve your overall quality of life. We will work with you to set and achieve goals.

Your goals can be based on a range of areas in everyday life, such as:

household tasks
personal care
community activities
exercise and balance
nutrition and hydration
using mobility equipment

We can also support your carers and family members by offering advice and guidance on a range of topics, such as safe ways to assist with mobility and transfers, encouraging independence, and where to go for ongoing help and emotional support.

Once your two-week rehabilitation period ends, we will ensure you are referred to the appropriate community teams or services for any further support you might need. This may include occupational therapy, exercise classes, or social services.

Accessing our service

Our service is available to adults aged 18 and over who are registered with a GP in Slough, Windsor, or Maidenhead.

Referrals to our service can only be made by a healthcare professional, such as a GP. We are unable to accept self referrals.

We may ask your referrer to send a recent occupational therapy or physiotherapy report so that when we come to reviewing your referral we can make sure you will receive the right support.

Preparing for an assessment

Our initial assessment will usually take place in your own home. We believe that this allows us to get the best understanding of your needs and how we can support you most effectively.

During the first visit, you will be assessed by a nurse and/or physiotherapist, who will check:

your vital signs, such as blood pressure, heart rate, temperature, and oxygen levels
your blood sugar (glucose)
any areas that might be at risk of skin breakdown (pressure areas)
your mobility, balance, and strength

The full assessment usually takes about 60 to 90 minutes, depending on your needs, and the results will tell us what support or equipment you may need.

Managing your health

The following are self-help materials that help to manage health at home. These resources support safety and wellbeing in daily life.

Falls Prevention Checklists:

Checklists can help identify tripping hazards and suggest ways to make the home safer.

Exercise

Gentle yoga, tai chi, or chair-based routines can improve flexibility, balance, and strength.

Watch the video to learn

View NHS Physical activity guidelines

Hydration and Nutrition, Healthy Eating Booklets

Easy-to-follow guides with recipes and portion tips can support healthy eating and weight management.

Medication Organisers and Charts

Pillboxes and printed medication logs can help track doses and prevent missed or double doses.

Visit NHS to learn more about medication tips

Relaxation and Breathing

Mindfulness or deep-breathing exercises can help reduce stress and anxiety.

Visit NHS for breathing exercises for stress

Sleep Improvement Guides

Simple bedtime routine and environment tips help improve sleep quality and rest.

Visit NHS for sleep tips

Social and Cognitive Activity Books

Puzzle books, hobby journals, or brain-training apps support mental activity.

Common Musculoskeletal condition

Low Back Pain - physiotherapy guide

Download

File size: 174KB

pdf

Osteoarthritis Of The Hip - Physiotherapy leaflet

Download

File size: 410KB

pdf

Osteoarthritis Of The Knee - Physiotherapy leaflet

Download

File size: 362KB

pdf

Shoulder Pain Relief - Physiotherapy leaflet

Download

File size: 210KB

pdf

Frailty

With some forward thinking, many of the challenges that frailty brings can be managed, or even avoided. You can help to keep your health, mind and social life in order by taking just a few simple actions. Watch the video to find out more.

Maintaining strength as we age

Watch the video to learn how to maintain your strength, as you get older.

How to prevent falls:

Watch the video to learn how to prevent falls.

How to get up from a fall

Watch the video to learn How to get up from the floor after fall.

Your e-Health Passport

Your e-Health Passport lets us know what's important to you - from your preferred name and pronouns to how you'd like us to support you and communicate with you.

Learn more

Contact us and FAQs

Intensive Community Rehabilitation Service

Contact number: 07827 984 287 (available 8am - 4pm)

Email: ICRService@berkshire.nhs.uk

Frequently asked questions

Can I receive support after the two week period?

Support is not available from our service after the two-week period, but we will refer you to the appropriate services for continued support.

Will I be given any equipment to help me at home?

As part of your assessment, we will look at how you manage at home. If we feel you would equipment would help you move safely and independently, we will provide you with equipment, such as walking sticks, Zimmer frames, toileting aids, or other aids.

Will I receive help with personal care, like washing, dressing, and meal preparation?

Our Multi Therapy Assistants (MTAs) will support you to do personal care tasks yourself, but they will not do them for you. Their role is to help you become as independent as possible in your home.

For example, we can help you heat up a pre-made meal, but we do not prepare meals from scratch, as our focus is on helping you learn or regain the skills to manage tasks like meal preparation yourself.

Will your team help with housework or other domestic tasks?

No, our service does not include support with household chores or domestic cleaning tasks. This means we are unable to assist with vacuuming, laundry, washing dishes, general tidying, and other housework.

Can you help with my nursing or medical needs?

Yes, if you have short-term nursing needs, such as dressing changes or pressure area monitoring, our team can support you during the time we are involved. After the two-week service period, we will ensure you are referred to the relevant community nursing or healthcare teams for any ongoing clinical support.

How long does each assessment session last?

The duration of each session can vary depending on your needs, abilities, progress, and overall health on the day.

The first assessment usually takes around 60 to 90 minutes, as we take the time to understand your current situation and goals, while follow-up sessions for support and exercise are generally 30 to 45 minutes long.

Will I be given a specific time for my visits each day?

While we do our best to make sure you have a regular routine for visits, we can’t guarantee a specific time each day. Our schedule can be affected by delays, such as traffic, emergencies, or the needs of other patients earlier in the day.

We always aim to visit within a reasonable time window and will keep you informed if there are any significant delays.

We can also help you with

Is there any information for friends, family and carers?

If you’re a family member, carer, or you look after someone, there’s practical, financial, and emotional support available from a range of local communities and national organisations.

How do I request an interpreter?

We can provide language translation and interpretation support.

Tell our staff which language you prefer to use, and we will make sure the right communication support is in place for your assessment and treatment. Please let us know as early as possible so we can ensure the appropriate translation or interpreting support is available.

We offer a range of professional services to ensure everyone can understand and be understood:

Telephone interpreting
Video remote interpreting (VRI)
Face‑to‑face interpreting
Written translation
British Sign Language (BSL) interpreting

How can I get information in an accessible format?

Anyone with a disability, impairment, or sensory loss has the right to receive information in a format that meets their needs.

Under the Accessible Information Standard (AIS) – a legal requirement for all health and adult social care providers – we must ensure that people who use our services, including carers and families, can understand the information we provide and communicate effectively with us.

We can offer information in a range of accessible formats, including:

British Sign Language (BSL)
Large print
Braille
Audio
Easy read
Email
Text message
Face‑to‑face support with a carer or advocate present

If you need information in any of these formats, please tell a member of our team and we will make sure your communication needs are met.

Are service dogs allowed to my appointment?

Yes, you are welcome to bring your registered service animal, such as a guide dog, hearing dog, medical alert dog, or other trained assistance dog to your appointment.

These animals are recognised as essential support and are permitted in most areas of our services.

To help us prepare, please let the team know before your appointment if you will be attending with a service animal. This allows us to make sure the environment is safe and comfortable for you, your animal, and other patients.

Please note that service animals may not be able to enter certain restricted clinical areas for safety or infection‑control reasons, but we will always work with you to find an appropriate alternative.

What does it mean to treat our team with respect?

Respect is important.

We will be polite and kind and we expect that you treat our staff in the same way.

Abuse, hate and discrimination against our staff is unacceptable.

We will take strong action against anyone who is verbally, racially, physically, or sexually abusive to them.

This may include contacting the police to prosecute, and stopping future access to our healthcare services.

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External support

EMED Group - Non Emergency Patient Transport Service (NEPTS)

EMED Group can provide their service if you have a medical condition that means you cannot use other forms of transport. Check their website for the full eligibility criteria.