Start at the T: Why Time-Limited Rehab Plans Work Better

When people talk about SMART goals in rehab, they usually start with the “S” — specific. But I think we need to flip that. If you ask me, we should start at the “T” — time-bound. Because without a timeframe, rehab isn’t really rehab at all. It’s just care.

And while we know that care has its place, rehabilitation is about progress. This means having a structure, an endpoint, and a way to measure whether someone is actually moving forward.

Why “T” comes first

Over the years, I’ve seen rehab programmes where people have been receiving 24-hour care for over a year, but with no clear goals, no defined outcomes, and no end in sight. When I ask why, there’s often no clear answer. Sometimes, even the person receiving the care wonders why the support is still in place.

That’s where SMART goals should come in — to make sure support is tailored, time-bound and focused on helping the individual regain as much independence as possible.

Because if we don’t know when we expect something to happen, how can we know if progress is being made?

The human element still matters

Of course, it shouldn’t just be checklists and timelines.

At the start of any rehabilitation journey, there needs to be time to build a therapeutic relationship; this is especially important in cases involving brain injury or complex trauma. It’s a stage that shouldn’t be rushed and, from a nursing perspective, it’s one of the most important foundations you can lay.

But once that trust is there, we have to move forward. We owe it to the individual to start setting clear goals and working towards them. That’s where the structure of SMART comes in — and where starting with “T” can help the rest of the process fall into place.

Structure doesn’t mean inflexibility

Timeframes aren’t about rushing towards a goal. They’re about direction.

Setting time-bound goals gives everyone — the individual, the rehab team, the legal team — a shared understanding of what we’re working towards. And it makes it much easier to reassess when things aren’t progressing.

Sometimes those goals will need adjusting, and that’s fine. But I’d always rather see a structured plan that needs adapting than no plan at all.

What good rehab looks like

Rehab that’s person-centred, goal-focused and time-limited is rehab that works. That might look like:

• ›A clear outline of what independence could look like for the individual
• ›Regular reviews to check progress against the agreed goals
• ›A phased plan to reduce support over time
• ›The flexibility to adapt when needed

In short: it’s about giving people a fair chance to move forward, rather than leaving them unsure about what’s next.

Good rehab gives people the tools and confidence to rebuild their lives. But without time-bound goals, even the best-intentioned support can start to slip into maintenance rather than progression.

So next time you're reading a rehab plan, commissioning support, or writing a report — start at the end. Start with the “T.”

It’s the best way I know to make sure we’re not just caring, we’re helping people make progress.