Neuro day treatment helps avoid long-term care
Program results in payer, patient satisfaction
A neurology day treatment program has worked so well for patients who otherwise might go to long-term care that payers have been willing to keep patients in it for up to a year and have gone out of contract to provide the service.
The program at HealthSouth Rehabilitation Hospital of Charleston, SC, is primarily for severely impaired stroke and traumatic brain injury patients with cognitive defects. The goal is to help patients learn what they need to return to social activities and the work force.
The program is so popular with referral sources that the number of patients per day has grown from four or fewer when it started three years ago to an average of 12 today. Payers are willing to fund the program because its intensive therapy enables disabled patients to be discharged from the acute care hospital a few days sooner, depending on the severity of the injury, and to go home instead of to a transitional living center or skilled nursing facility. Most patients spend five hours a day at the hospital for individual and group therapy and lunch.
Having patients come to the hospital for five hours a day of therapy makes it easier for the family to manage at home, Ray adds. Family members and staff communicate frequently about adjustment issues, and often staff can help the family with problems that occur after discharge, he says.
Most patients in the program are severely impaired, both physically and cognitively, while a few are on a high functional level but need some assistance with cognitive issues, says Thad Ray, MA, psychology technician. The HealthSouth neurology day program is set up to provide services five days a week, but attendance depends on patients’ needs, particularly at the beginning of treatment and as they prepare for discharge.
Patients who are unable to tolerate five days of treatment immediately after discharge from the rehab hospital may be limited to three days a week until they build stamina. After they reach the five-day level and begin to improve, they may cut back to three days a week again. Generally, each patient sees each therapy discipline for about an hour, for a total of four to five hours of a day. As they improve in an area, their therapy is decreased.
Most therapy is individual, but groups meet to explore topics such as psychological adjustment and cognitive issues. Patients take weekly outings into the community to practice activities of daily living they are working on in therapy. The group outings are designed to assess patients’ functional levels and to provide socialization activities.
Proper placement
When patients are referred to the program, Ruth Hays, MD, a physiatrist and medical director of the hospital, conducts an assessment and sends appropriate patients for assessment by each therapy discipline. Neuropsychologist Brian West, PhD, assesses patients who have severe cognitive deficits to determine if they have the cognitive skills needed to benefit from an intensive program.
Staff set long- and short-term goals and made the information available to payers. "Payers like to have an estimate of time. They like to see that a patient makes progress," says Michele Skripps, RN, case management coordinator. If there is any question about whether patients are appropriate for the program, the treatment team recommends a two-week trial to determine if they can make progress. "What distinguishes our program from others is that we do take tough patients and give them a try. We take them for a two-week trial with the understanding that if they don’t show improvement, we don’t keep them," Ray says.
Taking patient on a two-week trial basis has helped HealthSouth build relationships with payers, Ray says. "An integral part of our success is that the payers understand we’re not going to warehouse people. We won’t keep them if we don’t think they can benefit."
The treatment team meets twice a week: once with West to review clinical issues, and once with Hays to discuss program goals and progress. The weekly team conference summaries for each therapy are faxed to payers so they can see what patients are doing and which treatments are recommended.
Some patients have been in the program for as long as a year; others have been discharged much sooner because they stopped making progress. "If a patients shows signs of improvement that would enable them to return to a less supervised living situation, we keep them until they plateau," Ray says.
If a patient reaches a plateau, the hospital alerts the insurance carrier that additional gains are not expected and works with the insurer and family to come up with other options, Skripps says.
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