Table 3.

Themes involving organizational aspects.

Main Theme	Brief Description	Sub-Theme	Description
Environmental aspects	The environment on a rehabilitation ward is safe and invites rehabilitants to practice as much as possible.	Building aspects	The environment on a rehabilitation ward should resemble the domestic situation as much as possible so that rehabilitants feel stimulated, free, and able to practice meaningful, functional tasks. There should be therapy rooms on the ward for interdisciplinary team dynamics and the participation of informal caregivers. It is advisable to have the possibility to screen off part of the room for privacy. Walking distances to the bedrooms should be considerable, and there should be handrails, chairs, and exercise facilities in the corridors and a possibility to go outside. For different levels of stimulus processing, there must be variation in rooms with more and less stimulus. Opinions differ as regards the desire for single or multi-bedrooms. Single bedrooms offer privacy and a quiet environment, whereas multi-bedrooms offer contact with other rehabilitants. A sliding wall can offer a solution. The bedroom should be furnished in a way that the rehabilitant is stimulated to get out of bed.
		Ambiance	The ambiance should enthuse rehabilitants and make them feel safe enough to work on their recovery. Most participants think a cozy, homely ambiance is important to stimulate rehabilitants to practice, have contact with fellow rehabilitants, and encourage each other to practice. Relaxing activities should be scheduled in addition to therapy moments.
Staff aspects	All team members work in an interdisciplinary way and stimulate rehabilitants to practice throughout the day.	Team mix	The team should be sufficiently ‘mixed’ in terms of rehabilitation skills and experience. Recommended professionals in the rehabilitation team are: nurses, physical therapists, occupational therapists, psychologists, social workers, case managers, dieticians, speech and language therapists, physicians (elderly care or rehabilitation), and volunteers. Some participants think the nurse needs a name that better reflects the role of a therapeutic rather than caring nurse, for example, “rehabilitation coach”. Regardless of the name, the nurse must be seen as a therapeutic team member.
		Team dynamics	In an interdisciplinary team, each discipline has expertise in a particular area, but team members can look beyond the boundaries of their own field. All disciplines are equal, and there is no (in)formal hierarchy. Working in smaller teams, taking courses together, and therapists working directly on the ward are ways to improve interdisciplinary dynamics. The rehabilitant and their informal caregiver must also be part of the team. Multidisciplinary consultation in the presence of the rehabilitant is preferred and is often used to coordinate rehabilitation goals.
		Attitude of staff	All employees should have an empathetic, motivating attitude in order to involve informal caregivers and stimulate rehabilitants to practice throughout the day. They, therefore, need to be able to see training opportunities in daily activities. The approach of the team is coordinated, so rehabilitants always know what to expect. Staff members ideally choose to work in the field of rehabilitation, are flexible, can set priorities, have an interdisciplinary mindset, and are stress resistant.
		Training requirements	Medical guidelines are not always suitable for geriatric rehabilitants. Staff must be able to deal with this by using evidence-based practice principles, building sufficient experience and having additional training in geriatrics.
Organizational aspects	Implementing a CRE requires a shared vision on rehabilitation, and a project group to supervise the process. Even though internationally the organizational aspects differ, the concept of CRE is suitable to get the most out of rehabilitation.	Vision	It is important that all professionals (including management) have a shared vision on geriatric rehabilitation and make informed decisions.
		Administration	Participants experience that too much time is spent on administrative tasks, partly due to incompatible systems and regulations—time that could be spent on the rehabilitants and their rehabilitation.
		Regulations and funding	Participants feel that the rehabilitation system is driven by the way it is funded, which differs internationally. Optimal rehabilitation cannot always be offered due to insufficient reimbursement. Unfavorable decisions are sometimes unavoidable within the therapies. Participants experience a negative effect of regulations regarding privacy and liability in the rehabilitation process.
		Safety	Participants think rehabilitants and informal caregivers need to be safe to practice. The approach of the professionals and the design of the building may affect this safety positively or negatively. Despite some international differences, participants agree that pushing the boundaries, taking calculated fall risk, and using technical innovations to prevent risks will improve rehabilitation.
		Different settings	There are international differences in the setting in which rehabilitation for older persons is offered, and whether it is separate from rehabilitation for younger adults. However, these differences are secondary: the concept of a rehabilitation environment must start at the hospital ward and should continue after discharge in a slightly modified form.
		Naming	Sometimes, the word rehabilitation “hotel” is used for a rehabilitation ward, which may create expectations of being pampered instead of there being hard rehabilitation work perform. Using the word “patient” emphasizes being ill. Using the word “person” or “rehabilitant” stimulates looking at a person’s abilities.
		Implementation	Implementing a CRE requires a balanced team, and all team members must agree on the need for the implementation of a CRE. A project group or initiator should supervise the implementation of themes within CRE, work on time management and keep everyone enthusiastic. It takes a lot of time for a new method to become fully embedded in the daily routine.
Factors outside the ward	The discharge process must be well prepared and supervised. Home visits allow rehabilitants to practice meaningful tasks in their own environment and be prepared for discharge.	Outpatient rehabilitation	It is important to visit the home environment during inpatient rehabilitation because the situation at home can be different from the rehabilitation ward. It is best for rehabilitants to practice meaningful tasks in their own environment. However, some participants think rehabilitating in a good CRE can have added value.
		Discharge process	It can be beneficial to guide the transition home by continuing the rehabilitation process by the same professionals in outpatient rehabilitation. Rehabilitants and informal caregivers sometimes think they are not ready to be discharged, while professionals think they can manage at home. It is important to keep communicating about the discharge process. Additionally, longer rehabilitation can sometimes be beneficial to increase a rehabilitants’ independence, which subsequently leads to lower healthcare costs in the long term.