Hospital therapists follow joint patients home
Program ensures continuity of treatment
The staff at MossRehab have found a new way to reduce the lag time between therapy in the acute care hospital, therapy in the rehab hospital, and therapy in the home for joint replacement patients.
Therapists on the staff at the Philadelphia facility visit patients in their homes prior to surgery, see them in the acute care and rehab hospitals, and then continue providing therapy after they have gone home.
Through contractual arrangement with a local home health agency, the hospital therapists make between four and seven home visits to the joint replacement patients they treated at MossRehab.
Therapists work on ambulation, balance, and mobility issues and help the patients adjust to conditions at their homes.
"There is a huge benefit in terms of the continuity for patients. They know the therapist who is going to work with them at home. And they don't lose any therapy time between discharge and when the first home health agency visit can be scheduled," says Julie Hyland, MSN, chief operating officer of MossRehab and associate vice president of Albert Einstein Healthcare Network.
Patients typically stay two to three days at Einstein Medical Center following surgery, then are transferred to MossRehab for a four- to seven-day stay. In the past, patients often lost a day of therapy when they were transferred from the acute care hospital to rehab because the therapist had to conduct an assessment. Often, it took as long as three days after discharge for a home health therapist to be scheduled, Hyland explains.
No more lost ground
During that time, patients were unsupervised at home, and they often lost some of the ground they gained in the hospital.
"Most of our patients are in their mid-60s or older, and the loss of a day of rehab can set them back significantly. With today's shorter length of stay, patients can't afford to lose a day of treatment," Hyland adds.
The program give patients' continuity in treatment because, whenever possible, the same therapists treat them in the acute hospital, in the rehab facility, and at home.
The program starts four to six weeks before surgery, when therapists make a one-time visit to the patients' homes, perform a home assessment, and teach them a home exercise regime to prepare for surgery, says Gary Crandall, MS, PT, director of campus therapy Albert Einstein Healthcare Network.
"The home exercise program gets the patients in stronger physical condition. At the time of the visit, the therapists can assess the home for safety and find out what needs the patients may have on return," Crandall adds.
Avoiding home care licensure
State laws required MossRehab to have a home care license in order to send its therapists into patients' homes. To avoid going through licensure, MossRehab entered into an arrangement with a local home care agency that subcontracts with the Moss therapists to provide home care for joint replacement patients.
Therapists are scheduled for home visits during time that would not interfere with their treating patients in acute rehab. Most home visits are scheduled for early morning or late afternoon. If there is an available time slot in their hospital schedule, therapists might visit the patients during the day.
Therapists volunteered to work in the program and looked at it as a chance to earn extra income. Under the subcontracting arrangement, the home care agency is responsible for billing payers.
If the therapists make the visits on their own time, they are paid directly by the agency. If their caseload makes it possible for them to make the visits during their regular working hours, MossRehab bills the home care agency for the time.
Since care in the home is so different from care in the hospital, the home care agency provided educational training the therapy staff would need to function in the home. The home care agency ran the educational program in the early evening and attracted a group of nine therapists to the first classes. The training included maintenance of a safe environment in the home, adaptive equipment in the home setting, documentation, and paperwork.
"In the hospital we have wide-open spaces, free of carpet, and the floors aren't slippery. Therapists in the home have to deal with throw rugs and other obstacles and help patients adapt to them," Hyland says.
Although hard data are not yet available, Hyland has received positive feedback about the program from patients, therapists, and the home health agency. "It has been hugely successful in terms of patient satisfaction. The therapists say it has made a big difference in how quickly the patients regain their independence."
[For more details, call Julie Hyland at (215) 456-9012.]
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