The 5 people you need to know in Acute Rehab

Being admitted to the hospital is incredibly scary. There is a transition in an acute facility from independence to (potentially complete) dependence. When you've been medically stabilized but are not quite back to your starting point the next step is usually admission to an acute rehab facility. Here they have medical and nursing coverage 24/7 as well as three hours of therapy 5-7 days of the week. You may have entered the hospital for an elective procedure and this is a planned step, or something traumatic happened and this is another part of your journey back home. The people listed below are the heavy hitters in the acute rehab realm, ones that you will definitely have contact with and will play an integral role in helping you get back to your baseline (ie. back to your old self). 

1. Case manager- Think of this person as the travel agent for your life. They are the access point for services when you leave the hospital and play an integral part during your stay. All information from physicians, nurses, and therapists are compiled by your case manager. When a recommendation or decision is made about your discharge destination, this is the person that will make it all happen. If you go home, they will set up home services (OT, PT, speech, nursing) or if you are going on to another facility they will help you and your family find the right one for you. Case managers usually have a social work background, so they can help connect with other services in the community- meals on wheels, adult day programs, respite care for caregivers, oxygen and medical equipment delivery. They are also the people to talk to about power of attorney requests, medical proxies, short term disability and worker's comp. Case managers do varying levels of this, for every single patient, at the same time. Oh, and they also interact with your insurance company. When you've been extended 5 days so you can get home instead of going to a skilled facility- thank these guys. 

2. Therapy team- As an OT I'd love to put my discipline in its own category but that's not the reality of how rehab works. Physical, Occupational, and Speech therapy all work closely and in somewhat overlapping fashion at times to improve safety, strength, and function as quickly as possible after an injury. These are the individuals that can break down problems you may encounter when returning home after rehab. I'll break down the different disciplines and how we impact patient care in an upcoming blog.

3. Nurse- Your (or your family member's) nurse is an invaluable resource in the continuum of care. They typically work in 8 or 12 hour shifts and hand off information to one another at shift change. This is the person that will talk with you about pain management, dressing changes, discharge instructions. They also have a wealth of knowledge for family members about how the patient has been sleeping, eating, etc. Nurses are a special breed. My mom is a nurse. Their greatest skill is that element of calmness they bring to a stressful situation. The dynamic between nursing and therapy is important for patients to learn to push themselves and to take care of themselves. Also helpful to know, every shift has a nursing supervisor, so should you feel like there's an issue not being addressed- that's your person.

4. Doctor- DO, MD, (put PAs in the mix too), typically from internal medicine and physiatry (rehabilitation medicine). If everything is going well in rehab you won't see your doctor a lot- It's a good sign. They typically come in early in the morning for rounds and to see new patients on their first "official" day in rehab. I explain the difference between internal medicine and physiatry as- internal medicine keeps everything going, physiatry helps you get back to where you were.

5. Patient services/patient experience/ombudsman- Ideally a rehab stay goes according to the following schedule- patient admitted, patient evaluated, rehab program with gains over length of stay, patient discharged to disposition of choice with follow-up services and transition to outpatient. So what happens if things aren't going well? If there is an issue at any point during your stay, someone needs to know about it. Healthcare professionals are entrusted with patients safety and dignity while they work to improve their level of function. If there is an issue a Patient Services representative should be notified right away. Contrary to popular belief, it's best to do this while you are still in the facility. Once you've left it's harder to track people down, especially if you are in a rehab with a high turnover rate. 

Going through this is difficult for patients and families. At the end of many stays we, as therapists, used to have the opportunity to conduct home assessments for patients we were unsure about discharging home. These visits are becoming less and less frequent with healthcare reimbursement changes and increasing demands on therapists. The need for these home assessments haven't decreased. Pictures and measurements of your "problem areas" at home are a good start, but it is not possible to conduct a thorough assessment without walking through the home. 

If you or a loved one are currently in this acute care-rehab transition period and would like to have additional resources to inform your decisions, give me a call. I would love the opportunity to help put a person or their family member's mind at ease about the next step.