Effect of size on the function of three day hospitals: the case for the small unit.

The work load of three day hospitals attached to active departments of Geriatric Medicine was studied over a one-year period. A significant difference in the functional efficiency of the three units was noted. The smaller 12-place and 15-place units provided effective short-term rehabilitation, whereas the 28-place unit did not. Size seemed to be the major factor in the success or failure of a given unit. This study throws serious doubts upon the wisdom of a policy of building large day hospitals with all their accompanying problems of staffing and transport. An effective unit for out-patient rehabilitation can be provided with 10 to 15 places per day if the staff members are chiefly remedial therapists. In the districts studied, a provision of 0.5 place per 1,000 of the population aged 65 or older would have been sufficient to meet the perceived need for rehabilitation. However, this would not have been sufficient to satisfy the requirement for out-patient investigation and medical treatment on a day basis.