What’s a typical day in a day treatment center?
Rehab day treatment centers are expected to grow rapidly in coming years, as the rehab industry looks for a way to treat patients who no longer need inpatient care but are not ready for outpatient treatment. Day treatment program managers offer this look at a typical routine:
• Day of admission: A team of nurses and the medical director looks at the patient’s therapy results and determines an individualized treatment plan, Combs says.
"Some patients come three days a week; some come five, and others come four days," says Lisa Combs, RN, case manager of outpatient services and program manager for the day rehab program at HealthSouth Northern Kentucky Rehabilita tion Hospital in Edgewood.
Discharge planning begins on the day of admission. The discharge planning team includes the disciplines of nursing, dietary, pharmacy, and therapy. The team meets weekly to discuss each patient’s progress.
• Typical day’s schedule: At Edgewood, the typical day might begin with a head-to-toe nursing assessment at 8 a.m. The nurse gives the patient any necessary medications and finds out if the patient has any complaints or concerns from the prior evening and day. Then the nurse reviews the patient’s chart and goals and discusses strategies with the patient.
The patient might begin therapy at 9 a.m., first with an hour of physical therapy. At 10 a.m., the patient receives occupational therapy. At 11 a.m., the patient meets with the nursing staff. If the patient has a wound, the nurse provides wound care.
"If the patient is a diabetic, then we’d do a blood sugar check and we’d give them any education they needed for diabetes," says Angela Portman, RN, day treatment coordinator for HealthSouth Rehab Hospital of Central Kentucky in Elizabethtown.
At noon, the Elizabethtown HealthSouth patient eats lunch and rests. If the patient is tired, he or she may lie down or relax in a comfortable chair and watch television. Sometimes a group of day treatment patients will socialize or play games. No therapy is provided between noon and 1 p.m., Portman says.
At 1 p.m., the patient might receive speech therapy, and the day could end at 2 p.m., or the patient could stay for continued education and therapeutic activities.
• Therapeutic activities between sessions: The Edgewood program strongly emphasizes therapeutic activities that occupy a patient’s time between therapy and nursing sessions. For example, a patient might have speech therapy homework assignments, and a nurse can help the patient with those. Or the patient might practice cooking or have a home exercise program that will be reviewed between therapy sessions.
"We do education and practice on diabetes, medications, and whatever their needs are," Combs says. "We do crafts and community re-entry outings with them."
Therapeutic playtime is arranged
Patients may rest, but they have to keep active. "They have to do something therapeutic while lying in a recliner," she says. For instance, a patient might play with a dough-type product, called "theraputty," which is therapeutic. "It’s squishy and stretchy and comes in different colors, and each color represents a different strength. You upgrade the theraputty as patients become stronger."
Using a rubber band with colors signifying different strengths, patients perform leg and arm exercises. Monopoly, card games, and jigsaw puzzles also may be therapeutic for cognitively impaired patients, she adds. "Jigsaw puzzles are wonderful. Will they remember to put the pieces on the outsides and corners first? Will they group colors together, knowing this is the sky and this is the grass? Will they use pincher mechanisms to connect one piece to the next?"
The program also has wind-up toys that patients can play with as a lesson in fine motor movement. "They can have toy races, so it offers competition," Combs says. Some patients, such as stroke patients, find it difficult to wind up the toys, she adds. "So it might be minor, but it’s very therapeutic for a patient."
Patients may play computer games that offer skills in problem-solving, abstract thinking, and memory. "These are games like Solitaire for patients with a profound deficit with short-term memory. Do they know how to sequence? Can they remember the ace moves to the top?" Computer games also might benefit physically impaired patients by offering some fine motor coordination activities, Combs says.
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