When the condition is less serious and the patient is well enough to go to and from outpatient appointments, the choice may be obvious. You simply look for a facility that has the expertise on staff, is well equipped and has a track recording for achieving good outcomes.
However, when the patient’s condition is more challenging, especially when it’s layered with other health issues, when more intensive rehab is required for optimal recovery, or when travelling to an outpatient facility is difficult, the physician’s task in matching rehab approach to patient becomes more complex.
In such cases, there are essentially three options. If the primary concern is that the patient can’t come to rehab, visiting therapists can bring rehab to the patient. The limitations in this approach are time and technology for patients who might recover faster and more fully with more hours of targeted therapy or the benefits of new technologies that aren’t necessarily portable. However, when financial limitations or coverage benefits are a concern, or when patients are being cared for at home by family and other caregivers, visiting therapists can bring the advantages of professional rehabilitation services, instruction and encouragement to the patient at home.
The other two choices are either an inpatient rehabilitation hospital where the primary focus is recovery or a skilled nursing facility that offers rehabilitation services as part of its care. Considerations in choosing between these approaches include 1) the optimal outcome desired, 2) the patient’s overall condition and prognosis, and 3) medical issues that might require closer physician monitoring.
For Michael Rosemore, DO, Medical Director at HealthSouth Lakeshore Hospital, physician monitoring is a particularly important component.
“Many rehabilitation patients are dealing with multiple health issues that may need to be closely monitored by a physician. They aren’t likely to be able to go to their doctor’s office every day. However, we have a minimum of two physicians assigned to each case. We not only assess each patient promptly on admission—we make daily rounds. Based on how patients are doing, we can make adjustments in their therapy and consult with their physicians if an issue arises,” Rosemore said.
Physician monitoring in a skilled nursing facility may vary, but it typically reflects Medicare rules and reimbursement restrictions. It may be a matter of several days after admission before patients are seen by a physician, and physician visits may be limited to once a month and can require a change in the patient’s status for reimbursement to be approved.
The second consideration in deciding which approach to rehab is likely to be the best choice—the patient’s overall condition and prognosis—also factors into the first and perhaps most important consideration—the optimal outcome desired.
If a patient is in decline, nearing the end of life or is likely to need more and more supportive care for a condition with a poor long-term prognosis, rehabilitation services available at a skilled nursing facility may help to improve quality of life.
However, if the outcome desired is returning patients to the fullest possible function as quickly as possible, in-patient rehabilitation hospitals have a great deal to offer.
“The entire focus is on recovery and helping patients achieve the best possible outcome. Our goal is to help them regain function and return to their lives as soon as possible,” Vickie Demers, CEO of HealthSouth Lakeshore, said. With 107 facilities across the country, Birmingham-based HealthSouth is the largest provider of in-patient rehabilitation hospital services in the United States.
“One of the key differences in how we help patients regain maximum function so quickly is intensity. Instead of an hour a few times a week at home, or perhaps less in a facility where rehabilitation isn’t the primary purpose, our patients receive at least three hours of therapy a day, at least five days a week,” Demers said.
Medical director Rosemore also points out that the targeted focus on rehabilitation also adds the collaborative advantages of having a multidisciplinary team highly trained in the specialized aspects of rehabilitation.
“We have leading edge rehabilitation expertise in exceptionally well trained physical therapists, rehabilitation nurses, speech therapists, respiratory therapists and occupational therapists who help patients regain independence in the everyday functions of daily living so they can live safely and well, even if they live alone,” Rosemore said.
“We may also call in our nutrition and dietary team to address specific issues. For example, in our initial assessment when patients come through the door, we sometimes find difficulty in swallowing, particularly in patients with neurological problems. Our dietary team can help them work around the problem to get adequate nutrition to regain their strength and avoid complications from reflux and aspiration.”
HealthSouth Lakeshore provides rehabilitation services for patients with a wide range of conditions ranging from stroke, post-op neurosurgery and other neurological conditions to recovery from cardiac events and surgery, multiple trauma and joint replacement.
Two other advantages rehabilitation hospitals are well positioned to offer are new technologies and new therapies. Among the technologies used in rehabilitation at HealthSouth Lakeshore are the Autoambulator™, which robotically assists patients in walking and adjusts the amount of weight bearing as the patient progresses, and LiteGait™, which assists weight bearing and balance. Bioness™ is used to improve hand movement and grasping. There are also technologies to help with arm and shoulder movement, to improve swallowing, and help wheelchair patients improve strength and flexibility.
The SmartStep™ is an insole that collects information on how a patient is walking and provides visual and auditory feedback. Wii ™makes the repetitive movements of therapy a game so it is more engaging and fun. The X-Sensor™ detects how much pressure patients are putting on which areas of their bodies to help prevent complications from pressure points.
“One of our newest therapies is also one of the simplest,” Demers said. “Our music therapy gets our patients singing. They enjoy it, and it’s great for helping them with respiratory therapy and speech therapy, too.”