Looking for new settings for rehabilitation?
Looking for new settings for rehabilitation?
Just look at the creative options coming your way
Inpatient stays are getting shorter. That’s not news. What is newsworthy are some alternatives to traditional rehabilitation settings launched recently by innovative rehab providers.
"The population and its health care expectations are changing. People [and payers] are looking for different venues to receive their rehab services," says Steve Baldwin, SLP/CCC, senior vice president of rehabilitation services for Continucare in Miami. "Of course, outpatient rehabilitation centers are blooming of late, but what we’re banking on is that active seniors are looking for their recovery to take place in an even more nontraditional setting."
With more and more older Americans getting involved in wellness activities, Continucare launched a partnership with Bally Fitness Centers, a national health club chain, to manage certified outpatient rehabilitation facilities (CORFs) inside Bally Fitness Centers. Plans are to start with several Florida locations before expanding nationwide. At press time, Continucare had one Florida facility open and two more under construction. "We have a self-contained, clinical area with all the appropriate equipment staffed by Continucare therapists right inside the Bally centers," Baldwin says.
Stepping down and out
Continucare manages the rehab facilities and receives designated reimbursement as a CORF. "What’s nice about this option is the nonclinical setting and the step-down program. If a client gets treatment at one of the Bally rehab clinics and is at the point of discharge, the therapist can take the patient into the main fitness area and guide and coach them through the routines they can use as they continue their recovery."
The step down program will grow in importance as Medicare continues to cut back on covered services, placing caps in the future on rehab reimbursement, Baldwin adds. "The step-down allows us to more easily reintegrate patients back into the community."
Of course, he admits that the Bally clinics are not appropriate for every rehab client. "We’re thinking more of the businessman. He’s a golfer who needs a total hip replacement. He thinks of himself as active. What type of place will this person select for his rehab? I think this option will appeal to many."
Homeward bound
Bryn Mawr Rehabilitation Hospital in Malvern, PA, has taken rehab even farther from the traditional setting, right into the patient’s home. Bryn Mawr Rehab at Home provides comprehensive, hospital-level rehab with all the comforts of home.
"We approached our insurance advisory council with the idea, and our payer case managers gave us some good suggestions for making an at-home program work," says Dana Trainor, RN, CRRN, CCM, program manager for Rehab at Home. "For example, sometimes in the acute setting the payer case manager is notified after the fact that a client needs acute rehab and he’s decided to come to Bryn Mawr. They told us they’d like to be told earlier on about rehab needs so that they can help the client determine the best setting and level of care."
At press time, Rehab at Home had successfully seen two patients through to discharge. The first was a woman with orthopedic injuries and internal injuries to her midsection Trainor met in the acute care facility. "She was slated for discharge to a skilled nursing facility [SNF] to spend six weeks flat on her back and then possibly to enter rehab. She was feeling hopeless and depressed at the thought of six more weeks of hospitalization."
Eventually, Trainor helped work out a special arrangement that kept the patient for four weeks as an inpatient at Bryn Mawr and then moved her into the Rehab at Home program instead of into the SNF. "At four weeks, she went home in a wheelchair," Trainor says. "She started doing some weight bearing and using assistive devices right away."
Trainor says Rehab at Home provides roughly the same level of care as someone going into an acute rehab program. "We include up to three hours of therapy a day plus six nursing visits and three physician visits a week. Patients have to be able to work hard. They have to be able to manage at least an hour and a half to three hours of therapy a day. They can have medical problems, but if they have the potential for needing immediate assistance, this option might not be for them," she cautions, adding that the Rehab at Home program can get a physician or nurse to the patient within an hour through the use of a telephone or call light.
The program staggers its services over the course of each day and charges a per diem rate, similar to an inpatient facility. "Patients might have an occupational therapist come in the morning to help them get up. A little later, the physical therapist comes, and still later, the nurse, to make sure that all is well," Trainor says. "Patients don’t have to have family available to them to enter the program, but it was designed to work with caregivers who could be trained to work with the patients."
Safety issues to consider
Of course, some homes might not provide a safe environment for a home rehabilitation program. Rehab at Home uses an assessment tool to evaluate safety issues that could impact the success of the rehab program. Some issues covered on the assessment include:
• Does the neighborhood present a safety risk to the patient or staff?
• Is there a potential for drug use or physical abuse in the home?
• Are there smoke detectors in the home?
• Are there adequate electrical outlets?
• Are the stairs and doorways wide enough for wheelchairs or walkers?
• Is the bathroom big enough for assistive devices?
Perhaps the biggest advantage of the Rehab at Home program is that it eliminates the need to transfer skills from the hospital to the home environment, Trainor says. "I anticipate that we may be able to actually shorten their rehab time. There aren’t any rails in the hallways at home to hold on to. It’s the real world. We’re eliminating the middle ground.
"Sometimes, we go so far in our assistive technology and adaptive equipment in the acute rehab setting that the environment is so user-friendly it bears little or no resemblance to the patient’s reality when they are discharged home," she says. "Many patients have a rude awakening when they get home. Nothing is as easy as they thought it would be. The Rehab at Home approach is proactive. The patient deals immediately with their own reality. And we help them set up their own environment to maximize their ability to handle their own needs."
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