Hospitals offer rehab within wellness centers

Programs for diabetes, heart, lung patients offered

Hospital systems increasingly are opening medical-model wellness centers, creating opportunities to expand outpatient rehabilitation programs. Two new wellness centers offer a variety of rehab services for patients with chronic illnesses. Between them, the centers provide services to patients with musculoskeletal problems, diabetes, cardiac disease, and pulmonary disease.

At the same time, wellness centers provide the community with a fully equipped fitness facility staffed by health care and fitness professionals. The centers are an important addition to a hospital’s continuum of care, transitioning some sick patients to the community and providing the community with disease-prevention opportunities.

Regional Rehabilitation Center of Pitt County Memorial Hospital of University Health Systems of Eastern Carolina in Greenville, NC, planned its 52,000-square-foot wellness center, named ViQuest, for several years before its summer 2000 opening.

"We look at this center as a part of the continuum of health care," says Wanda Bennett, MS, OTR/L, administrator of outpatient rehabilitation services for the hospital. "We’ve been able to set up a program to transition patients to a wellness environment," Bennett says.

ViQuest houses some of the hospital’s outpatient rehabilitation services, including a general orthopedic program, return-to-work program, cardiopulmonary rehabilitation, and sports medicine. The center’s staff include hand therapists, physical therapists, occupational therapists, exercise physiologists, registered dietitians, recreational therapists, health educators, aquatic therapists, nurses, aerobic instructors, child care providers, and a medical director.

Centers can fit community’s needs

Wellness centers can be tailor-made to suit a particular hospital’s and community’s needs. "There really was a huge need for a wellness center," Bennett says. "We have fitness clubs in the area, but many times those clubs aren’t meeting the needs of our patients, who are less than fit."

While musculoskeletal problems were a big concern for Pitt County Memorial Hospital, other hospitals have different priorities.

For example, Cape Fear Valley Health System in Fayetteville, NC, recently opened a wellness center called HealthPlex, which features special programs on diabetes management, cardiac rehab, and pulmonary rehab.

Hospital officials wanted to move those types of services to a wellness center climate to give patients a sense that they are away from the clinical, sterile hospital environment, says Marcie Justice, MS, executive director.

The 65,000-square-foot facility also has clinical space devoted to physical therapy, sports medicine, and occupational therapy. Its staff include physical therapists, occupational therapists, a vascular health exercise physiologist, a risk reduction exercise physiologist, a psychologist, a diabetes nurse, a cardiac nurse and physiologist, and a pulmonary nurse and physiologist. There also are two contract dietitians and a fitness staff of 35.

Here are some of the wellness centers’ features:

  • Orthopedic therapy: ViQuest treats patients who have suffered musculoskeletal injuries, including hand and back injuries, whether they resulted from work, sports, car accidents, or other causes. "These include athletes who are injured and need to compete," Bennett says. "Or it could be a weekend warrior who overdid it a little bit and may need some therapy services."

  • Cardiac rehab: Cape Fear’s HealthPlex has designed a rehab program for people with heart disease, including those who have had a heart attack, bypass surgery, or angioplasty. Physicians refer patients to the program for three months of treatment using a multidisciplinary approach. The cardiac team includes a nurse, psychologist, exercise physiologist, and dietitian.

    Cardiac patients visit the wellness center three times a week to be educated and to exercise under supervision. The cardiac team sends regular progress reports to the patient’s physician. Once patients complete the 12-week program, which is covered by Medicare and other payers, they can enter a maintenance program. The maintenance program is an out-of-pocket expense, costing $45
    a month. For that fee, they may visit the facility three times a week to exercise. They can attend any of the wellness center classes on cardiac disease. Patients who need additional guidance from a cardiac specialist can receive it at the center.

  • Return-to-work program: The Pitt County rehab center’s WorkReady program includes training on how to prevent injuries, as well as job safety visits to local companies. Since part of the hospital’s outpatient rehab facility has moved to ViQuest, the wellness center has become part of the continuum of care for WorkReady clients.

    "At the wellness center, participants are working in that environment," Bennett says. "So if we have a person with a back injury, we start them at a level they can handle and train them to return to the level they need for work by having them work on our equipment and in the warm water pool."

    Once WorkReady clients complete the traditional therapy, the rehab staff continue to train them and make recommendations for how they might transition into ViQuest’s environment for a continuation of their work hardening treatment.

    The WorkReady program also features prevention education and work site visits. "We do assessments regarding ergonomic set-ups and have rehabilitation programs that are part of it," Bennett says.

  • Diabetes program: Cape Fear’s diabetes program has moved to the wellness center, where clients are taught how to manage their disease within two or three sessions, lasting about four hours. This program, recently affected by Medicare cuts, originally offered eight hours of education in two half-day sessions, Justice says.

    "Our nurses are certified in diabetes, and we have a dietitian and assistance from an exercise physiologist," she says.

    The program teaches patients about taking insulin properly, checking blood sugar levels, and following a better diet and exercise regimen. The exercise physiologist may offer patients guidance in selecting an exercise program.

  • Aquatic therapy: ViQuest has three swimming pools, including a lap pool, a warm water therapy pool, and a whirlpool. The program offers pool classes, as well as therapy programs with warm or cool water. Participants learn strengthening skills, endurance skills, and practice range of motion techniques. "Some of the specialty programs that use aquatics therapy are back rehab, chronic pain, and sports medicine," Bennett says.

    HealthPlex has a warm water pool set at 88 degrees and a lap pool at 82-84 degrees. The pools are available for recreational swimming,
    as well as aquatic therapy.

  • Pulmonary rehab: The HealthPlex program is similar to its cardiac therapy program. "Basically, it’s set up like cardiac but is designed for people who have pulmonary disease, whether it’s chronic lung disease or emphysema," Justice says. "Patients are referred by a physician; they come to the hospital for a couple of weeks, and then they come out to the HealthPlex to be integrated into the wellness center environment."

    "That’s one thing that makes us so different from other wellness centers," she explains. "Pulmonary patients are exercising on the exercise floor with the center’s healthy members."

    When patients exercise around healthy people, Justice says, their confidence gets a boost and they can become more focused on becoming well. 

Executive Summary

Subject:

Hospital-owned wellness centers give rehabs an opportunity to provide more services and a multidisciplinary continuum of care.

Essential points:

  • Wellness centers offer outpatient services for patients with musculoskeletal problems.
  • A wellness center can provide aquatics therapy.
  • Patients at wellness centers may benefit from fitness sessions held in the same facilities used by healthy members.

Need More Information?

  • Wanda Bennett, MS, OTR/L, Administrator, Outpatient Rehabilitation Services, Regional Rehabilitation Center of Pitt County Memorial Hospital, 2100 Stantonsburg Road, Greenville, NC 27835. Telephone: (252) 816-6611.
  • Marcie Justice, MS, Executive Director, Cape Fear Valley Health System, P.O. Box 2000, Fayetteville, NC 28302-2000. Telephone: (910) 609-4000.