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Rehab Realistic recovery Rehab providers struggle with their clients’ desire to go home and also the reality that progress takes time and does not always result in a return ticket By Julie E. Williamson When it comes to rehabilitative care, skilled nursing providers must perform a delicate balancing act. Not only do they have to keep rehab patients optimistic about their progress, they also must stay focused on setting realistic goals and committing to prudent, not rushed, discharge planning. Simultaneously meeting those goals has become increasingly challenging for skilled nursing operators. They are caring for higher acuity patients today, which can delay rehab progress–and, in some cases, lead to premature dis- charge based on the assumption that a patient isn’t responding well to therapy. Providers are also fac- ing reduced reimbursement and budget cuts. In some cases, this is Photo: Daleview Care Center making it increasingly difficult to employ and retain quality thera- pists, and embrace new rehab technology and modalities. “The discharge to home or to a lower level of care is still too low early as possible to set realistic Therapy specialists push residents to overcome limitations at the newly in some skilled nursing facilities therapy goals and develop a dis- expanded rehab therapy center at Daleview Care Center in Farmingdale, NY. and markets,” notes Robert Levin, charge strategy. Any plan should CEO and president of Covenant take into consideration a wide charge environment will be and “The facility’s ability to com- Care LLC, a skilled nursing and range of factors, including the what the patient will be required municate a more realistic time assisted living provider based in patient’s overall condition and the to do in that environment (such frame to the resident and family as Aliso Viejo, CA. “The key chal- therapy interventions available. as home activities, meal prep, and soon as possible upon admission lenges in getting residents to “First we need to stabilize, so on). “This process is critical is extremely important,” explains their highest functional level and then rehab,” stresses Levin. “We in getting everyone’s interests in Rick Starke, vice president of cli- safely discharged to a lower level meet with the patient and their alignment,” he emphasizes. ent services for Accelerated Care of care or home are setting mutu- family within the first 72 hours, Preliminary meetings also Plus, a provider of specialized ally agreed upon goals early, and after nursing, therapy and social provide an effective forum for rehabilitation programs for long- having the staff and the equipment services have done a complete discussing unrealistic discharge term care operators and rehab to get the job done.” assessment and care plan. At this expectations that may have been service providers. meeting, we discuss our plan and set by physicians. Often, physicians Establish goals early answer questions.” indicate to families that the patient Step by step Among the first steps toward He says it’s critical to establish will need to be in a nursing home Providers also are finding suc- successful rehabilitation, sources goals, time lines and objectives for several weeks when, in reality, cess by focusing on smaller, more say, is working directly with the at this meeting, and also have an that time frame is far too brief, tangible goals, as opposed to focus- patient and family members as understanding about what the dis- explains one rehab specialist. ing strictly on the discharge itself. 34 www.mcknights.com • June 2009 [ ] Virginia Mennonite Retirement aggressive therapy sooner. Community in Harrisburg, VA, “Hospitals are discharging considers smaller goals, such as “When you discover their patients as quickly as they can,” a patient’s ability to walk a short
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