Rural patients benefit from community outings
Goal: Get them out of house after discharge
To make sure their mostly rural patients won’t be confined to their homes after discharge, staff of Southern Regional Rehabilitation Center in Fayetteville, NC, put a heavy emphasis on community outings.
"The reward is that our patients know they can get out and do something after they are discharged," says Laura Barrett, associate administrator of Southern Regional, which is part of the Cape Fear Valley Health System.
Barrett says the hospital has not kept records of the community outing program’s expenses, but she considers them fairly minimal, comprising only the cost of the bus and other related transportation costs such as gasoline.
"You’re using that person [a therapist] eight hours a day and paying them for those eight hours a day, so those expenses would be the same whether they were in the gym working with patients or on patient outings."
Because of the hospital’s focus on getting people out into the community, staff strongly encourage patients to go on outings before discharge. In follow-up telephone calls, Southern Regional staff ask whether patients have been active since they left the facility. "We find that the patients are getting out and doing the things they did before their injury or illness," Barrett says.
The hospital draws from 18 counties, most of which are rural. Since many patients live in areas without public transportation, sidewalks, or even paved driveways, outings to local parks are a must. There, staff help patients practice walking or manipulating their wheelchairs on sand, gravel, or pine needles.
Because many patients have low incomes and few resources in their communities, the medical center loans equipment such as portable ramps and wheelchairs to patients who need them on a short-term basis. Patients also may borrow the special sports wheelchairs and hand-cranked bicycles to try athletic activities before purchasing special equipment.
Getting out once a week
Each treatment team takes patients on outings one day a week. The outings focus on whatever activities the group has been working on during therapy and provide a good follow-up to in- hospital treatment, Barrett says.
Staff who accompany the patients are from all disciplines, including nursing, psychology, and neuropsychology. "Everyone on the staff goes. It depends who is available and the needs of the patients," she says.
Each team decides at its weekly meeting who would benefit from an outing and where to go. The staff then set goals for the outing. For instance, if the outing is to a restaurant, a goal might be for a patient with cognitive problems to be able to pay and get the correct change. For an orthopedic patient, a goal might be to get in and out of the restaurant with an assistive device.
Outings are geared toward patient interests. Younger spinal cord injury patients may go to a video arcade and learn to manipulate their wheelchairs around the games and machines. Trips to the hospital chapel or to church are popular with many patients.
"We try to get them back into the things they have done before," Barrett says.
Most of the outings are confined to patients with similar ailments, but sometimes a patient fits in with a different group. For instance, a younger patient with multiple fractures may be grouped with the spinal cord patients instead of the elderly hip replacement patients.
Patients need real-world’ situations
Barrett has found it effective to take patients into the community rather than simulating the community inside the hospital. "The distractions that go on in the real world are nothing like the controlled environment of the hospital," she explains.
The hospital is located across the street from a shopping center, which gives staff the opportunity to take patients out without using the hospital van.
The number of outings per patient depends on patient needs and lengths of stay. Orthopedic patients take one outing at the most because few are hospitalized for as long as a week. Spinal cord patients take many more outings.
"We make it our expectation from the beginning that they will go, and that is their therapy for the day," Barrett says.
One challenge staff face is combating the misconception among insurance case managers that if patients can go to a restaurant, they are ready to go home, she says. That problem can be solved by educating case managers so they understand the value of the outings.
Setting realistic goals poses another challenge, she says. For instance, patients may be able to transfer independently from a mat table, but if they go to a movie theater with non-removable armrests and low seats, they face a whole new set of challenges.
"It helps the therapists know what the patients are likely to be facing when they get out," she says.
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