NHRMC Rehabilitation Services celebrates 25 years of providing care for patients this year.
About 250 staff members provide services at the NHRMC Rehabilitation Hospital, New Hanover Regional Medical Center, NHRMC Orthopedic Hospital, and Pender Memorial Hospital. Outpatient rehabilitation care is offered at Oleander Rehabilitation, Independence Rehabilitation, Rocky Point, and the Nir Family YMCA.
About 95 percent of the patients who come to the Rehab Hospital have already been seen by physical, occupational, and/or speech therapy staff. Rehab therapists provide services in all areas of the hospital, including the emergency department, the intensive care units, and in other inpatient areas. The therapy staff work closely with medical staff, nurses, and other disciplines to promote safe mobility, functional movement, and other activities to work toward regaining as much independence as possible. It is vital for patients to begin therapy while still being stabilized in their medical care.
Depending on patients’ needs, therapies and services provided at the Rehab Hospital include rehabilitation nursing, occupational therapy, physical therapy, speech therapy, case management, recreation therapy, nutrition services and respiratory therapy. The rehab program is overseen by physicians with a specialty in physical medicine and rehabilitation.
The hospital serves nearly 800 people a year with an average age of about 64. Most stay about 16 days.
“The patients that we get at rehab hospital are highly weighted toward neurological diagnoses,” said Tammy Bartley, clinical director of the rehabilitation hospital. “Stroke is our largest population, followed by what we call medically complex such as amputation or trauma, followed by brain injury and spinal cord injury.”
Patients at the Rehab Hospital receive an average of 3.35 hours of combined physical, occupational and/or speech therapy a day, depending on need, said Leslie Kesler, administrator of rehabilitation services.
Typically, patients receive therapy for five days in the first week and six days in subsequent weeks, taking Saturdays or Sundays off. Therapy in the hospital is 99 percent individual rather than in a group setting, about 9 percent more than the national average.
Medicare, Medicaid and other insurance usually pay for rehab.
Here’s a look at some therapies and services provided by the NHRMC Rehabilitation Hospital:
“The unique part about rehab nursing is we’re carrying on the things they learn during therapy as an inpatient during the day and expanding those interventions during a 24-hour period,” said Freddy Simpson, manager of rehabilitation nursing at the hospital. One example is getting patients out of bed to use the bathroom instead of relying on bed pans or other aids, Simpson said.
Kesler said education is a big part of rehabilitation nursing.
“Most of our patients that come to the Rehab Hospital are severely injured or severely ill,” Kesler said. “Our nurses do a great job of educating our patients and families about their medical conditions and what they need to know to be able to manage their conditions after discharge”
Nurses work with patients on the medications and activities they need to maintain their health, she said.
“For a patient who has had a stroke, the likelihood of having a second stroke becomes even greater than somebody having their first stroke,” Kesler said. “So that education on being as healthy and active, for me, is a key part of rehab nursing.”
The hospital has 23 certified rehabilitation registered nurses, she said.
Bartley said even though occupational therapy sounds like the hospital is getting patients ready to go back to work, it is focused on getting them ready to function independently at home.
“The occupational therapist is looking at a patient’s ability to dress themselves, bathe themselves, being able to toilet, brush their teeth, feed themselves – all basic skills they need to be able to function independently at home,” she said.
Some occupational therapists specialize in working with stroke patients. They teach skills such as sitting and standing, both still and when reaching for something. They also help patients cope with visual field neglect, such as not seeing something on one side of the body.
“Working with the patient to compensate for those deficits or teaching them how to relearn how to do things so they can manage,” Bartley said. “If you can’t see things on the right side of your body, you’ve got to learn to turn and look and find those things or do a different set up in your home.”
Occupational therapists specializing in patients with spinal cord injuries work with those patients and their families on how to manage self-care at home.
“Once they get those basic skills under their belts, they’re working on some higher-level skills such as the ability to work safely in the kitchen to cook a meal, to problem solve, to work through their barriers at home,” Bartley said.
Growth in the proportion of neurological patients at rehabilitation reflects growth of NHRMC’s expanding neurosciences program.
“We’re seeing more patients survive things that even five years ago you might not have survived, or your quality of life would have been so poor,” she said. “Our therapists in the NHRMC tower are involved with those patients within hours of them being medically stabilized.”
Kesler said when the rehabilitation hospital opened in 1994, about 40 percent of patients were orthopedic patients. That has declined to about 4 percent in 25 years.
“Our neurological patients with strokes, spinal cord injuries, brain injuries and other disorders like Guillain-Barré and such, combined, that’s probably 70 percent of our population now,” Kesler said.
Outpatient OT staff specialize in working with people with hand and arm injuries, pediatric therapy, and neurological rehab.
Physical Therapy encompasses specialized comprehensive evaluation and treatment of individuals with movement disorders. PT not only helps patients build strength and endurance but also facilitates improved coordination, balance, and functional movements, such as re-learning how to walk again after amputation, stroke, or trauma. For babies born with developmental delays or adults with neurological conditions, managing muscle tone and promoting purposeful functional movements are key skills that physical therapy staff help address.
NHRMC Rehab Services has physical therapists with advanced training and national board certifications in areas of neurology, geriatrics, and orthopedics. The acute care therapists often see patients the same day as surgery for joint replacement or other orthopedic conditions and then the patient often continues post-operative rehab as an outpatient.
Speech Language Pathology
“Part of the inpatient rehab program includes speech therapy,” Bartley said. “Those, again, are more with those patients with those neurological deficits. So those patients, following stroke or brain injury, typically have a combination of several issues.”
Those include the ability to eat their food and swallow it without it aspirating into their lungs.
“Often those patients have cognitive deficits along with the ability to communicate,” Bartley said. “They may fully understand what someone is saying to them, but they can’t speak to it because of the location in the brain that was damaged.”
Speech language pathologists specialize in working with patients that have problems swallowing, communicating, thinking, and problem solving, and patients with memory issues.
“Our case managers also are certified rehab nurses and they are the coordinators of care for the patients,” said Kim Moore, manager of compliance/outcomes at the hospital. “They act as liaisons between the patients, the families and the staff, helping to arrange family training, helping them with resources when they are approaching discharge and helping to educate the patients about their options for discharge.”
She said case managers see the big picture and help to coordinate patients’ care while in the rehabilitation hospital.
“The case managers are the primary persons who talk to the patients and their family,” Kesler said. “The case manager tries to balance out all the information from the physicians, the various therapists, the various nurses. They act as a translator to help keep it all together. They’ll identify any barriers that will keep a patient from going home and work together to resolve those barriers.”
She said about 84 percent of patients who come to NHRMC Rehab Hospital can return home, about 10 percent more than the national average for inpatient rehab facilities. Many of the patients need ongoing therapies after inpatient discharge, some having home care therapy or going to outpatient rehab.
Also, on the case management team are social workers and a rehabilitation counselor who help patient with adjustment issues.
“When a patient can’t go home, the social workers will find a place for them to go until they can go home, such as a short-term skilled nursing facility placement,” Moore said. “They also help them with any resources they would need.”
Sometimes patients have a bond with a staff member and might be more forthcoming about an issue, she said.
“While that might not be their specialty area, that staff member can establish a relationship with the patient and help them work through that and work with the team as a liaison,” Kesler said.
The hospital also has support groups for stroke, amputee and brain injury patients that are open to members of the public.
Licensed recreation therapists use recreation and community-based therapy to improve level of functioning and independence and to promote health and wellness. Recreation therapists work with patients to identify individual goals to enhance recovery and improve the ability to participate in previous or new adapted recreation and leisure activities.
They also focus on improving the patients’ ability to identify and use community resources to successfully return to an active lifestyle.
Swimming, gardening, cooking, creative arts, stress management, sports/fitness, electronic games, shopping, dining out and using public transportation are examples of activity-based interventions to address the assessed needs of patients. The activities help the patient adjust to physical injury or disability and enhance quality of life.