Posted by Albert Holt, MD on February 9, 2011 under Rehabilitation | 
After any significant and catastrophic injury, it is important to choose the path that will get you the best recovery. A large part in that decision is picking the correct rehabilitation center for your injury. This is the second half of our top ten list intended to help you get the best rehabilitation and recovery. To see the first part of the list, see last week’s post.
6. Research
Many nationally recognized centers conduct clinical studies in collaboration with leading experts at other hospitals, research centers, medical schools and universities around the world. The best clinical centers will work to develop, refine and evaluate new treatments, including drugs, surgical techniques, diagnostic tools, and various therapy interventions that will improve the outcomes of patients.
7. Patient Satisfaction
Many centers will actively promote their patient and family satisfaction scores. You should ask if you can speak to some of those patients and families who were polled and would be willing to discuss their experiences.
8. Accreditation
Rehabilitation centers may be certified by the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities. These accreditation authorities ensure local rehabilitation facilities meet basic standards for their services. Some facilities are included in the Model Systems of Care by the National Institutes of Disability and Rehabilitation Research (NIDRR) (part of the U.S. Department of Education). Model systems must conduct research of interest to NIDRR and collect data on the specific injury type (spinal cord, burn, etc.). In order to gain and maintain expertise, these designated systems provide care to a significant volume of people with the specific type of injury.
9. Family Support
If you will have a prolonged stay at a rehabilitation facility, you will likely appreciate the convenience of having your family and support nearby. In addition, they will likely want to learn more about your condition, rehabilitation and your eventual return home. You will want to see the facilities where family can stay (if available) and the resources for education and training that is available. You will also want to know the level that family is involved with and engaged in the process, not only at the beginning, but also throughout the stay and after the discharge to home.
Some things that are helpful for families include:
- Basic needs such as housing, meals and parking
- Coordination of medical resources from public and private insurers
- Support and education for families
If you will require a personal care attendant to help with your activities of daily living, it will be important for your family to understand how to find and hire personal care attendants when you are home. You will also have to think about how to balance the needs that you have with any family that will support you in addition to the attendant.
10. Discharge Planning and Coordination
Choosing the rehabilitation facility is a first and critically important step on the road to recovery. It needs to be part of an overall plan for the rest of your recovery and lifelong adjustment. Some rehab centers will have discharge planners who will help you along the way. Discharge planners will:
- work with others, including your case manager, to coordinate ongoing medical and therapy care needs, including providers such as local independent living centers;
- incorporate referrals into their discharge planning;
- establish follow up care (with the center that you have chosen for your acute rehabilitation or another local center if you have traveled);
- make arrangements for someone locally to evaluate the home for modifications;
- provide referral to an appropriate physician(s) and other medical specialists in the community;
- ensure scheduled equipment evaluations for appropriate fit and function when home;
- establish thorough vocational evaluation and referrals;
- make referrals to other services and resources in the community.
In Summary, choose a center that has:
- Experience and expertise in your type of injury
- A continuum of services available and partners for acute care services
- Facilities and expertise in tailoring equipment and assistive technologies for your needs
- Family support, services and housing as needed
- Collaboration with other providers in referring patients to and from facilities
If you are able, TAKE A TOUR and GET A FEEL FOR YOURSELF!
Remember, the relatively short stay at a specialized rehab facility (including those far from home) can make a world of difference in your near and long term course of recovery.
Posted by Albert Holt, MD on February 2, 2011 under Rehabilitation |
After any significant and catastrophic injury, it is important to choose the path that will get you the best recovery. A large part in that decision is picking the correct rehabilitation center for your injury. The following are the first five of ten tips to help you get the best rehabilitation and recovery. Come back next week for the rest of the list.
1. Specialty Care
Depending upon the rehabilitation needs, you may consider centers that specialize in the treatment of spinal cord injuries, brain injuries, multiple trauma, etc. It is important to understand the experience and expertise of the team that will be setting your rehabilitation plan.
Physiatrists (a.k.a. physical medicine and rehabilitation physicians) usually manage the overall care for rehabilitation patients. They should be part of an interdisciplinary team of professionals, and be board certified in PM&R. The physiatrist should facilitate the coordination of different medical specialties in your care. There should be physician coverage seven days a week, 24 hours a day.
Specialized rehabilitation nurses should be managing your daily care.
Experienced physical, occupational and speech therapists tailor a comprehensive treatment plan to your specific needs and provide therapy for a minimum of three hours a day, five or six days a week. The program should include recreational and other activities on the weekends and evenings.
Psychology and neuropsychology services should be available to help you cope with the many challenges you may face, including individual and group psychotherapy, couples, vocational and substance abuse counseling.
2. Associated Facilities
It is important that the rehabilitation facility have a direct connection to or direct affiliation with a medical center that is capable of more acute care services if the need arises. This usually lends itself to having consultations from those same subspecialists when needed. These services should include neurosurgery, neurology, urology, orthopedics, plastic surgery, neuropsychology, internal medicine, gynecology, speech pathology, pulmonary medicine, critical care medicine, general surgery and psychiatry.
Some facilities even have physical connections that will allow them on-site access to emergency services in case of serious illness or major complications.
For spinal cord injured patients who are on ventilators it is important to note that some facilities will manage this condition and others won’t. One must gain a full understanding of the resources and expertise in managing patients on mechanical ventilation, and the success in getting patients weaned from these devices.
3. Specialized equipment
Part of the rehabilitation program usually includes getting the correct equipment. Assistive technology should be fitted correctly with the patient taught to use it while in rehab. You will want to have everything working properly by the time that you get home. It is important to establish whether your facility has the capability to provide, fit and modify any specialty devices such as manual wheelchairs, functional electronic stimulation bikes, as well as prosthetics and orthotics. While some centers have the latest and greatest equipment with all of the “bells and whistles” that you could imagine and more, the truly experienced facilities and staff understand that the best equipment for you is the one that you will use most proficiently in your daily life.
Some of the specialty equipment and training may need to include driver education, in addition to cooking and meal preparation in a modified setting.
4. Peer support
Peer support and contact with others who have similar injuries can be a critical part of the rehabilitation process. It can help you to adjust to your injury by learning from others who are going through and have gone through the same rehabilitation process. Some specialty centers have programs that bring alumni back to the centers to help in this process. This peer support is most helpful and accepted when people share similar problems and issues. You should ask about the age and gender mix of your injury for the peers at the facility may help you to identify places that have a peer group for you. This is an especially important consideration when choosing programs for women. For example, it is often difficult for women recovering from spinal cord injuries to find peer support because the incident rate among women is much lower than it is for men.
Some facilities offer specialized rehabilitation programs tailored to adolescents, patients on ventilators, low-level brain injuries, dual diagnoses (brain and spinal cord) and neuromuscular diseases, as well as advanced rehabilitation programs for patients who are several months or years post-injury or illness.
You will want to ensure that there are appropriate services if you or your families do not speak English.
5. National Ranking
You will want to understand how the facility compares to its peers on national and local levels.
Next week I’ll continue the list with tips 6-10, covering areas like accreditation, family support and more.
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