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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 • 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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