TRAIL rehab system offers patients an outside experience from inside hospital

Program developed by multidisciplinary team

It’s sometimes not practical to arrange for transportation to take rehab patients to community settings where they can work on re-entry issues, so a Michigan rehab facility has found a solution that brings the outside world into the patient’s rehab arena.

Called Therapeutic Rehabilitation Approach to Independent Living (TRAIL), the system was developed by a multidisciplinary committee that included representatives from most disciplines, including case management, social work, therapy, and administration, says Stacie Bommersbach, RN, MBA, program director for neurosciences and rehab at Genesys Regional Medical Center in Grand Blanc, MI.

"The team was looking at developing a community re-entry program and was exploring transportation such as bringing patients into the community of a mall," Bommersbach says.

"One thing we found out was that it’s very complicated to get transportation these days within the rehab continuum," she says.

There are strict criteria regarding drivers and transporting patients, and the costs would affect the rehab facility’s budget, Bommersbach says.

"Now that we’re going into a new reimbursement system under the prospective payment system [PPS], we don’t know what our financial picture looks like yet," she adds. "And we found that we’d be driving patients to a setting similar to what we already have here on the campus."

The team also began to realize that the hospital system already had facilities that are easy for families to coordinate and that include community-type amenities, such as three nature trails that lead through wooded areas, a Rite-Aid pharmacy, a gift shop, and three cafeteria-style restaurants.

"We have a medical equipment store in the atrium area, and we have a credit union with an ATM machine, and of course we have a hospital information booth, so the patient can practice asking for directions," Bommersbach says. "There’s also a chapel."

Within the rehab unit there is an outside gardening and porch area near where the trails are located. Rehab patients also have access to an on-site beauty salon.

"Patients plant all of the flowers in the garden trough, and they do the watering and weeding," Bommersbach says. "It’s a beautiful porch area with some chairs."

Add these features to the rehab’s use of a fully furnished, transitional-living apartment where patients and families can spend a night or weekend prior to the patient’s discharge, and there are a variety of community re-entry experiences available without rehab staff having to take patients off the hospital system’s campus, Bommersbach adds.

Therapists can even assist patients in automobile transfers by using the rehab facility’s four-door Cadillac car.

"We use it for both wheelchair and joint camp patients, but we don’t use it for driving," she says. "If they have weight-bearing restrictions, we make sure that they are following those and that they are able to maneuver in and out of the car safely."

The stationary auto also is used to teach the family and patients safe transfer skills.

Once it became clear to the TRAIL committee that the hospital campus already had a plethora of community re-entry experiences, it was only a matter of adding a few extra items to the list. 

For example, the rehab facility created a house door entry, including a few steps to walk up so patients can practice getting out of the car, walking to the steps and door, and entering the house.

"It’s an actual door where you walk up two steps like you would be entering your house," Bommersbach says. "It has a door handle and lock that patients have to maneuver to get into the house, and it has a doorbell."

On the other side of the door are a few feet of floor space, walls, and windows. The backside of the door has a ramp that wheelchair-bound patients can use.

In all, the rehab facility’s patients have been very satisfied with the community re-entry program, Bommersbach notes.

"We do patient/family satisfaction surveys, and 99% of our patients say they would recommend our rehab unit to other patients. We thought that was a pretty good statistic," she says.