Serving rural patients after discharge
Creative approaches ensure follow-up care
Faced with shrinking lengths of stay and a patient population scattered throughout a large rural area, rehab staff at St. Charles Medical Center in Bend, OR, use a variety of approaches to ensure patients get the care and follow-up services they need. Some of the department's patients live as far as 160 miles from the hospital. "With 50% of our patient load coming from outside the immediate area, there's a real problem with isolation and lack of community resources," says Dan Streck, MA, MPH, leader/manager of rehabilitation services.
St. Charles, a 181-bed medical center with 12 rehab beds, is a Level 2 trauma center and the largest hospital east of Oregon's Cascade Moun-tains. The most severely injured patients often are transferred to a larger rehab center with more of the high-tech equipment they need, says JoAnne Bernt, LPT, physical therapist in the rehab section. "We have the skills to care for these patients, but we don't have the vendors in the area to provide them the equipment they need."
However, the St. Charles unit does treat spinal cord patients with a C-6 or lower injury and brain injury patients with higher levels of functioning.
Rehab staff work closely with insurance case managers to extend the stays of patients in rural areas until they can function independently at home if inpatient and home health services aren't available in their area, says Alan Burke, LSCW, team leader for outpatient rehab and social work.
Some insurers will increase the stay if staff can show it's more costly to provide home health services in rural areas than to continue inpatient rehab, he says. For example, one patient's stay was extended five days because there were no home health services in his community.
Rehab staff often recommend splitting the stay of spinal cord patients who live too far away to come to the hospital for outpatient rehab and can't get those services in their communities.
During the first admission, patients learn basic skills such as transferring and home exercise and are discharged home until enough healing occurs for them to participate in a full rehab schedule. "We divide up their rehab stay, so we want use up their benefits while they are healing," Bernt says.
Because so many patients are discharged to rural areas, rehab staff have a discharge plan in effect and start teaching patients and families the first day, says staff nurse Kim Chilson, RN, RNC.
Early discharge planning is a routine part of every rehab admission, but staff make sure family teaching is scheduled early for patients from remote areas, adds Paula Glesne, MA, inpatient rehab center administrative coordinator.
If a patient lives within 50 miles of the hospital, a staff member goes to the home before discharge to solve problems such as architectural barriers. Families of patients who live farther away may borrow a video camera from the hospital and tape their home to help in discharge planning. Staff teach what patients will encounter at home. For instance, video and measurements of bathroom facilities allow patients to practice bathroom transfers just as they will do them at home.
Patients are encouraged to call the rehab unit 24 hours a day if they have problems or questions after discharge. They often call about medication, skin care, feeding, or types of dressing supplies. "Our services don't just stop on discharge. We've got people on the staff who can help them solve the problem," Chilson says.
"We often provide emotional support, helping people through difficult periods of time when there isn't community support," Glesne says.
Here are some other ways rehab staff help meet the needs of patients from rural areas:
· Custom-made videos. Patients who live outside Bend take home a custom-made video showing caregiving procedures and their exercise program. The tapes help the family and also come in handy for visiting nurses or therapists, Chilson says. Each discipline films what it needs to teach. For instance, occupational therapy may tape a therapist showing the patient how to dress or do home exercises. A speech therapist may tape a session working on language issues.
· Family housing. Rural families may move into an on-campus apartment with patients for several days before discharge so they can practice caring for them in a residential setting. Having hospital staff close by helps families gain confidence. The hospital also helps families find low-cost or free short-term housing.
· RV park. The hospital has set up an area in the parking lot where families may park recreational vehicles for free and live while the patient is hospitalized or receiving outpatient care.
[For details, call Dan Streck at (541) 382-4321.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content