Menu-type day program is a hit with payers

Days, hours, LOS vary with each patient

Day treatment patients at Columbia St. David’s Medical Center Austin, TX, may spend as much as five hours a day, five days a week for a full regime of therapy at the rehab center, or they may spend as little as an hour a week for treatment by just one discipline. It all depends on how much and what kind of treatment they need.

"A day program is a unique treatment modality," says Laura Hamilton, PhD, day program supervisor. "It’s less expensive than inpatient, and our focus is on the most efficient and effective treatment to return people to the highest level of functioning as quickly as possible."

Juggling staff and patient schedules to create an individual program for each day treatment patient takes a lot of time, but the concept has paid off, says case manager Shaley vonDoenhoff, LMSW.

"Some payers don’t include day treatment in their benefits package, but they’ll work to come up with ways to fund our program. They trust us because we don’t keep the patients any longer than we need to or give them therapy unless they absolutely need it," vonDoenhoff adds. (For details on how St. David’s has gained payer approval, see p. 157.)

The majority of patients are being treated for strokes and head injuries. "They come here to solidify their skills that will allow them to remain independent and to improve their level of independence in the home and the community," says Barbara Lasiter, MOT, OTR, director of the rehabilitation center.

The Columbia St. David’s program is personalized for each patient, Hamilton says. "We develop a treatment plan that depends on each patient’s areas of strength and weaknesses, based on their input, the doctor’s prescription, and the evaluation from each discipline." One patient may come five days a week from 9 a.m. to 3 p.m. and receive physical therapy, occupational therapy, speech therapy, recreation therapy, counseling, and vocational rehabilitation. Another may come just three days a week for half a day to work on cognitive issues. (For more on how staff set the schedule, see p. 156.)

Patients who need it can take advantage of other hospital programs. For example, one patient attends the day treatment program in the mornings and a cardiac rehab program in the afternoons. Others have been seen a physical therapist from the hospital pain management program.

Patients may choose to participate in recreational activities or group sessions geared to meet the needs of a variety of patient needs. (For details on recreational and group activities, see p. 156.)

As soon as patients make progress and meet their goals, they are discharged from the individual discipline. For example, a patient may start out coming five days a week and receiving treatment from five disciplines. After a period of time, treatment may taper to just one day a week for speech therapy. Some patients are in the program for six weeks; others may come to day treatment for as long as a year.

Day treatment includes the Quest program for younger people, some as young as 10, and the Bridges program for retirement-age people or older. Programs are tailored for the age groups. For example, the younger people participate in more strenuous recreational activities, and retirees don’t receive vocational rehab services.

The program has about 20 professional staff, some of whom work on a PRN basis. "The PRN staff know the patients and the program and come in to provide continuity if the census increases," Hamilton says. The patient census is usually about 30, but it can reach 37. Each discipline tracks patient improvements over time, such as how far a person could walk, how much time was needed to transfer from a wheelchair to a mat, and how much assistance was needed at the beginning of treatment vs. the end.

Each patient undergoes neuropsychological testing at the beginning and at the end of the program to measure what kind of progress they have made. Patients also are evaluated on their ability to meet a specific goal, which is set after their evaluations. A goal might be the ability to recall auditory information with 80% accuracy.

When goals are met, the staff decide if there is a next step or if the patient may be ready for discharge from that part of the program.