Here are steps for starting a day treatment center

Programs can use outpatient facilities, staff

Rehab facilities interested in starting a day treatment program should tailor services to their expected client population, but there are some general guidelines to follow, according to rehab managers in charge of day treatment programs.

Angela Portman, RN, day treatment coordinator for HealthSouth Rehab Hospital of Central Kentucky in Elizabethtown, and Lisa Combs, RN, case manager of outpatient services and program manager for day rehab at HealthSouth Northern Kentucky Rehabilitation Hospital in Edgewood, offer these suggestions:

Use the infrastructure of your existing facility. At Elizabethtown, the program was housed in the inpatient facility, but administrators decided to switch the program to the outpatient setting because it would allow more flexibility in staffing, Portman says. "When the inpatient census was high, the inpatient therapists had limited hours they could devote to the day treatment patients."

The day programs use the same staff as the outpatient programs, with the addition of nursing positions. This staffing arrangement means the programs have access to the full range of therapy, including physical therapy, occupational therapy, speech therapy, psychology, and nursing care. "If a day treatment patient needs two therapies, then we schedule them over three or four hours," Portman says. "If they need three or more therapies, we schedule them over five to six hours."

Between therapies, patients might rest or receive medical care. A day treatment program needs designated space, such as a room in which patients can relax between therapy sessions.

The Elizabethtown program has its own gym where staff can provide wound care and privacy for other procedures. The gym offers a home-type environment with a sofa, Portman says.

The Edgewood program has a living room, kitchen, dinette area, office, and bedroom. It’s decorated with wallpaper and plants, and it has recliners that vibrate. Patients use the room to practice their homework, play games, play on a computer, receive medical care, or rest. (See story on a typical day treatment schedule, p. 51.)

Develop specific admission criteria. The Edgewood program was developed for patients with any type of neurological, orthopedic, respiratory, or general medical disability, Combs says. Some typical diagnoses admitted to the program include stroke, spinal cord injury, brain injury, asthma, chronic obstructive pulmonary disease, multiple sclerosis, Guillain-Barre Syndrome, traumatic brain injury, cancer, arthritis, and Parkin son’s disease. Program criteria are:

— Patients must have identifiable rehab goals, with a purpose for coming to the program.

— Patients must be able to participate in the program without significant limitations of medical condition, decreased motivation, or lack of progress.

— Families should be willing to participate in the program and assist with discharge planning.

— Patients must be 14 years or older.

— Patients must require a minimum of two disciplines.

— Patients must have some type of medical management or endurance issue that necessitates the need for nursing or medical care. That issue can be anything from poor endurance and an inability to withstand three hours of therapy at one time, to the patient’s need for a blood draw, wound dressing change, or intravenous infusion or catheterization.

Establish hours, transportation, meals, and other details. The program is open from 8 a.m. to 4 p.m. Patients who come in the morning receive breakfast, and those present at noon receive lunch. The program also provides transportation to patients living within a 30-mile radius who have no other means of attending. "One of the biggest benefits is the family can continue to do the things they need to do, and the injured person still gets what he needs," Portman says.

Along with meals, the program provides nutritional education by a staff dietitian as needed. "We also assist with activities of daily living if they need that help," Portman says. "We work in conjunction with an occupational therapist to provide transfers, baths, and that sort of thing while they’re here."

Focus on marketing, reimbursement, and referrals. When the Edgewood program began in July 1998, most of the referrals came from the inpatient program. Now the referrals are about 50% from the inpatient unit and 50% from outside the hospital. "We market it to the public through different events, such as a big block party that we held here last September," Combs says. "We had a disk jockey, dancing, a big cookout, and we invited the neighborhood to come." Discharge planners, patients, and staff hosted the party.

Other marketing events include open houses and speaking/educational engagements provided through a public outreach service.

Day treatment patients can be referred by family members, physicians, assisted-living facilities, home health agencies, skilled nursing facilities, and insurance companies, Combs adds. Medicare provides reimbursement for the program at a per therapy, outpatient rate. HealthSouth sometimes negotiates with insurers for a per diem rate. "We have contracts with several insurance companies," she says.

Need More Information?

Lisa Combs, RN, Case Manager of Outpatient Services and Program Manager of Day Rehab, HealthSouth Northern Kentucky Rehabilitation Hospital, 201 Medical Village Drive, Edgewood, KY 41017. Telephone: (800) 860-6004 or (606) 344-4231. Fax: (606) 344-4235. Web: www.

Angela Portman, RN, Day Treatment Coordi nator, HealthSouth Rehab Hospital of Central Kentucky, 124 Heartland Drive, Elizabethtown, KY 42701. Telephone: (270) 769-3100, ext. 371. Fax: (270) 769-6870. Web: