Patients visit community without leaving hospital

On-site merchants provide real-life experiences

Rehab patients at Genesys Regional Medical Center no longer have to brave rain, ice, or snow to practice their activities of daily living in the community. Without leaving the medical center, patients can make daily visits to the pharmacy, gift shop, bank, beauty shop, or restaurants located in the Grand Blanc, MI, medical center’s Health Park facility, which opened in February 1997.

Soon they’ll be able to practice getting in and out of a car, walking up stairs, manipulating a wheelchair ramp, and opening the screen door and front door to a house — all within a few minutes of their rooms.

It’s all part of the Genesys Therapeutic Rehabilitation Approach to Independent Living program (T.R.A.I.L.), which incorporates real-life experiences into patients’ daily activities whenever possible.

Instead of trying to create a simulated community environment where patients could practice shopping, banking, or driving a car, Daniel Swank, MPA/CRRN, director of rehabilitation, says the staff decided patients could benefit from the real thing, using space and businesses in the new facility.

"We have tried to capture as many real-life experiences as possible right here on the campus," Swank says.

The T.R.A.I.L. system was developed by a multidisciplinary committee that included representatives from case management, social work, and physical, occupational, recreation, and speech therapy.

"We started by looking at what we have available here and how we can use it to create ways that we can help patients prepare for life after discharge," says Eileen Gibbs, RN, BSN, MA, case manager and chair of the T.R.A.I.L. committee.

T.R.A.I.L. makes use of physician offices, a gift shop, a pharmacy, a bank, a medical equipment store, and three restaurants on the main floor of the facility. Construction crews are building the facade of a house on the rehab unit ground floor. The house will have a front porch with a side ramp on one side and steps on the other. Patients will be able to practice going into the house by opening the screen door and the entry door. A series of raised planters surrounding the porch will be used for recreational therapy.

General Motors Corp. donated a 1996 Cadillac Seville for the hospital to use in its simulated environment. The engine has been removed and the front end removed up to the fire wall. Swank worked with the fire marshal to meet regulations for bringing the donated car into the building. "We give patients as many opportunities as possible to try their skills and to feel better about what they can accomplish in the real world," Gibbs says.

Before rehab services moved into the new facility, the rehab staff took patients on community outings and tried to simulate community-type activities in the hospital. "Community outings take a lot of planning and involve a lot of staff time. With shorter lengths of stay, often patients were able to go into the community only once during their stay. Now we can work on it on a daily basis," Swank says.

Having community activities available on campus is easier on the patients, who often get tired when they go on outings, Gibbs adds. Using the real-life environment of a shop or a bank works better to help patients make the adjustment to their communities than setting up a simulated environment, Swank says.

"One of the problems we’ve encountered is that we train patients here in a simulated environment, but it’s stressful for them when they go home and have to stand in line and make decisions," he says.

Now patients can go to the automated teller machine (ATM) at the bank, withdraw a small amount of money from a special account, and go to a restaurant.

"There are so many factors involved in the real community as opposed to practicing on a pretend basis on a mock-up of an activity," Gibbs says. For instance, when brain-injured patients use the ATM or cash a check, staff can observe if they can calculate how much money they’ll need, if they can write the check, if they can manipulate the ATM or manage at the teller, and how they manage their money.

Patients also experience "real-life" situations such as having a stranger waiting in line behind them, something they can’t experience in a mock-up, she adds. Trips to the bank, store, restaurants, and beauty shop are scheduled as part of patient therapy as well. How often a patient participates and in which activity depend on their goals and treatment plan.

Whenever possible, family members work with the patients and rehab team on the activities, Gibbs says.

Getting merchants involved

Swank has arranged with the merchants in the Healthpark facility to accommodate the patients. He’s creating a campaign to let the public know the establishments are working with the hospital to provide rehab patients with real-life experiences. The rehab staff plan to hold informal training sessions for staff at the commercial establishments to teach them what to expect and how best to deal with people with disabilities, Gibbs explains.

When the donated car is set up in a room in the hospital, patients will be able to practice using the power windows and seats, opening the trunk and putting a wheelchair in, and getting in and out of the car on various surfaces, such as concrete and gravel.

"In Michigan, we have such severe winters that it becomes very difficult to practice outside. In the past, patients have been able to practice car transfers only a few times. Now we have the ability to work with the family and patient throughout the whole stay," he says.

Future plans call for setting up part of the patient dining area as a restaurant. Currently, there’s a cafeteria and patient dining room with tables and chairs. Swank would like to install booths with hanging lights so patients can practice maneuvering into the booths.

"The medical center was built to be patient-focused. What we were trying to do is to bring part of the world into it. It has worked out very well for rehab patients," he says.

[For more information on T.R.A.I.L., call Dan Swank at (810) 606-6511 or Eileen Gibbs at (810) 606-6544.]