As a 19-year-old college student, Justin Hutchens began work as a resident assistant at an intermediate care facility in Greeley, Colorado.

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Guidelines recommend intermediate care should be used for a maximum of six weeks, but between 10% and 20% of patients were under the care of the services for 90 days or longer.

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After ten days in the pediatric intensive care unit at Johns HopkinsChildren's Center in Baltimore, her burns were healing so fast that doctors moved her to an intermediate care ward with hopes of releasing her soon.

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Debbie Lindon-Taylor, nurse consultant for intermediate needs care, said the whole philosophy of the unit had changed.

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The report blames delays in transferring elderly patients from ward beds to intermediate or home care and a lack of resources for helping people in the community which could prevent them being admitted to hospital in the first place.

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