NSW Rehabilitation Model of Care


To implement a consistent model of care for rehabilitation services which supports equity of access, appropriateness of care, and the provision of care in the least restrictive setting available.


Through the provision of early, intensive rehabilitation, patients will benefit from:

  • Shorter lengths of stay in hospital due to more intensive therapy services; 
  • Greater choice and flexibility in how and where they receive their rehabilitation services; 
  • A quicker return to their previous level of functioning; 
  • More active involvement in deciding their rehabilitation goals; 
  • Care closer to home.

By targeting specific patient cohorts, it will also be possible to prevent the rising incidence of physical deconditioning by reducing patient wait times for a place in dedicated rehabilitation wards.


The rehabilitation model of care is a framework for rehabilitation services to use to ensure the care they provide meets the recommended standard.

It describes the range of settings in which rehabilitation occurs and identifies key principles that should be in evidence across each of the care settings.


The Rehabilitation Model of Care supports:

  • Early, intensive rehabilitation starting in the acute setting through appropriate and early identification of relevant patients
  • Collaboration with acute services and education about the role of rehabilitation services
  • Access to a variety of care settings including intensive ambulatory settings for those patients who do not require inpatient care
  • Reduced length of stay by offering rehabilitation services in the least restrictive setting depending on patient need
  • Coordinated and integrated care across the rehabilitation continuum
  • Patient-centred and evidence-based care. 


The Rehabilitation Model of Care was developed in consultation with the experts from the rehabilitation and aged care sectors including rehabilitation physicians, geriatricians, directors of allied health, and rehabilitation nursing. Consultation included site visits to 10 rehabilitation sites in NSW  and consultation with interstate and international jurisdictions.

Key Dates

2010Development of Rehabilitation Model of Care
2011Endorsement by Director General NSW Health of the NSW Rehabilitation Model of Care
2011Gap analysis undertaken by all LHDs across NSW comparing ‘as is’ service with the new model
2012Establishment of ACI Rehabilitation Network
2013Development of Implementation Toolkit and Evaluation and Monitoring Tool
17 July 2013Rehabilitation Implementation Workshop held

Pilot Sites

Northern Sydney Local Health DistrictNorthern Sydney Local Health District
South Eastern Sydney Local Health DistrictSouth Eastern Sydney Local Health District
Prince of Wales Hospital
St Vincent's Health NetworkSt Vincent's Health Network

Implementation Sites

ACI is currently partnering with 5 LHDs to implement the Model of Care in their chosen care setting.

Hunter New England Local Health DistrictJohn Hunter Hospital
Tamworth Rural Referral Hospital
Murrumbidgee Local Health DistrictWagga Wagga Base Hospital
Nepean Blue Mountains Local Health DistrictNepean Hospital
Northern NSW Local Health DistrictBallina District Hospital


A Rehabilitation Toolkit has been developed. It includes a Performance Monitoring and Evaluation Tool that provides guidance for key performance indicators; to evaluate the implementation of the model of care.

Further Details

Further information is available on the ACI Rehabilitation webpage:


Or the ARCHI website:




Claire O’Connor
Rehabilitation Network Manager
02 9464 4639

Chris Shipway
Director, Primary Care and Chronic Services
02 9464 4603

Page Top | Added: 5 November 2013 | Last modified: 20 January 2014

Claire O’Connor
Rehabilitation Network Manager
02 9464 4639