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Tuesday, April 8, 2014

Acute Rehab Hospital

Back in February, we went to see Bob's neurologist. The purpose of this visit was discuss another Botox injection for Bob's neck and also to get some physical therapy on board, as home health care therapy bowed out in January....

At that time, the doctor decided Botox wasn't working and nixed the idea of continued injections. The doctor also wanted Bob to receive some sort of "specialized" and "intensive" therapy, to get him back on track and to help with his dystonia symptoms. He didn't think home health therapy was "intensive" enough and didn't feel the outpatient rehab at the charity hospital was "specialized" enough. The doctor and his PA said they would research some alternatives for an intensive and specialized therapy and get back to me. At that time, I did mention cost would be factor as Bob's insurance requires a $45/session copay for PT and we certainly cannot afford to pay for 2-3 sessions a week for many weeks. And, I explained, that's the reason we always went to the charity hospital, because it was free. The PA promised she'd look into programs that might qualify for grants, etc.

OK. I must admit I was a bit excited about this! I was imagining a fancy specialized outpatient facility with the latest highest tech equipment and latest therapy protocols! You know, a place Bob could go to 2-3 times a week and use cool robotic walking devices, etc., or maybe even aqua therapy for Bob's dystonia!

So imagine my surprise when, in March, I receive a call from an acute rehab hospital telling me that they have received a referral from Bob's neurologist to admit Bob, as an inpatient, to their facility.

This was not at all what I expected... I expected something totally outpatient. And Bob had been in an acute rehab hospital in 2010, and that experience was far from pleasant.. And I knew, it would take a lot of convincing on my part to get Bob to agree to staying inpatient in a facility.

My main concern was also that overnight stay. For different reasons. Would Bob be well cared for? Would they have enough nurses? Could Bob, with his aphasia, even manage the "nurse call" button? Would they understand what he needed when he can't articulate very well? And would he end up with infection after infection, and pneumonia, as he did the last time he was in acute rehab hospital?

But I told myself to keep an open mind, as the woman who called from the facility bragged about how great they were, told me that they had "all the new high technology" therapy equipment.  So the hospital sent three therapists to our house (PT/ST/OT) plus a nurse to do a pre-admission evaluation. That was in March.

Meanwhile, I decided to do some online research on this hospital, and found a couple of pretty bad reviews that validated my worse fears. The first one commenting on the poor nurse to patient ratio and slow response time when nursing assistance was needed. The second review commenting that the facility was terribly understaffed and there was not even enough therapists for the patient population and patients had to wait their turn, while the therapists ran between patients, trying to juggle 3-4 patients at time. Hmmmm?  Then I found a 2008 State Attorney's investigation on "Battery on the Elderly" at the facility.  Jeepers.

Then the Admission office from the hospital called and told me the co-pay for Bob's stay would be $1675.00.

So that whole idea was pretty much dead in the water, and I must admit, I was almost relieved. But when I contacted the PA at the neurologist's office to tell her the deal was off, she told me that she would make some calls and see if she could come up with some funding. And when I told her that I wasn't quite so sure if this was the place for Bob because of what I learned online, she told me to call the facility and schedule a tour, and maybe that would change my mind...

Last Friday, we did just that. Bob and I went to the rehab hospital for a tour.

Now this a small place, 70 beds, and located out of town. The transport took 45 minutes to get there. (I wondered if The Green Machine survive this trip! Daily. For a few weeks!) The facility was nice enough looking, for a hospital, but was very small.  We were met at the lobby by a nurse and one of the "supervisors" for our tour.

Armed with my internet research, I asked a lot of questions. Including the nurse-to-patient ratio, which was sadly 8-1, much lower than the recommended standard of 5-1 for a rehab facility. When I asked what the CNA to patient ratio was, the supervisor couldn't even tell me. She said, "Oh, we have enough."

If those responses were not enough red flags, the next BIG red flag that went up my flagpole was the "therapy room".

I tell you, we walked in there and I thought, at first, a large, noisy meeting was taking place. There were at least 20-30 patients with wheelchairs or walkers, seated around the perimeter of this small room and at a table. These patients appeared to be doing nothing but sitting there, talking amongst themselves. That's when the tour guide told us this was "the afternoon therapy session". Huh? I didn't see anyone doing any therapy! Then I looked a little closer, and noticed that one of the five patients at the table was actually stacking colored cones on top of other colored cones, so I guess that's an OT session right there. Then I noticed one Nu-Step in the corner, though no one was using it. And also a exercise bicycle thing, also not being used. We walked through the room and, wow, I saw an actual therapist helping someone work with therapy bands. Then another therapist helping someone work with some pulleys connected to the wall, but that was it. So what were all these other patients doing? Waiting their turn, evidently, just like that one review stated.

And I also saw, one fellow in a wheelchair, sort of pushed into the corner, all alone. He looked about 30 years old, paralyzed from the neck down--from what I could tell, and he looked so sad. My heart went out to him. So sad and alone and no one minding him or giving him any attention... No one even talking to him. I don't think I'll ever forget the very sad, haunting way he looked at me when we walked by on that tour.

Then I stood there, listening to the tour guide, rambling on about how great it was that their patients get an hour and half therapy session in the morning, and another hour and half therapy session in the afternoon, five days a week (they take weekends off), and I asked her, "So this is it?" (meaning one Nu-Step, one bicycle thing and some pulleys on the wall? and 3 or 4 therapists? for all these people?) and she told me they had two other therapy rooms, beside this one.


Then I asked, "Are all the sessions group sessions?"

She said, "No, we do give individualized therapy, if needed."

Then I asked what type of "specialized, intensive" therapy they would have for Bob, as his neurologist seemed to think this facility was equipped for "specialized, intensive therapy" especially for stroke and dystonia. She couldn't tell me, but said she'd get one of the therapists to talk to me.

So a woman comes over, and she is introduced as the supervisor in charge of therapy, and I ask her what type of therapy they could offer my husband, and she basically told me that the only thing they could do for Bob's dystonia was some neck stretching exercises and maybe a neck brace. And other than that, you know, the usual parallel bars type walking therapy.

So I asked if they offered Art Therapy.


I asked if they offered Music Therapy.


I asked if they had Aqua Therapy.


I asked if they had any special aphasia therapy.

And she said that they had speech therapy. (Well, whoopee, been there, done that, and not the same thing...)

I then asked the tour guide to show us the other therapy rooms. Both of which were unoccupied. One did have one set of parallel bars, not being used. And they both had some exercise mats. And, oh yeah, one pretty cool looking machine which was a combination of a standing machine and a treadmill, so basically the patient in a seating position would be pulled to standing, then feet clamped on peddles, the machine would actually move the legs in a walking simulation -- so yeah, that was pretty cool, but again, no one was using it. 

Before we left, we saw a speech therapy session, which was, once again, a group session.

And, as we left, I asked Bob what he thought of the place.

He said, "NO WAY!"

That makes two of us.

I called the PA and said thanks but no thanks -- and told her that I thought Bob would get more 1-on-1 therapy at the charity hospital's outpatient facility. And she's going to send a script. And I'll have to contact the financial aid office and hopefully, Bob will be approved once again.


oc1dean said...

Maybe the botox wasn't working because the doctor who injected Bob did not hit the correct location. They should be using an electronic signal to know when they are at the right location for the shot.
The acute rehab hospital sounds like a complete waste.

Barb Polan said...

It must be such a disappointment to have something you had high hopes for fall so far short. That's why my husband tries to dampen my enthusiasm when something new and glittery in the rehab world catches my eye. My disappointment is never pretty.

How nice though that you and Bob had identical reactions.

Mike Furr said...

Your a patient advocate by default and an amazing one! Armed but maybe not so dangerous this time. All the right questions and observations. Sounds like the trip was worth the effort even though the facility didn't meet it's description. The good news is that the Doctors want to get him needed therapy and they are trying to assist you to see that happens. I'm sure good things will come of it!!

Anonymous said...

It's so good you researched the facility early and questioned the doctor about it. Clearly, he is ignorant of what the facility provides/doesn't provide. The tour was definitely an eye opener and I'm sure wasn't too difficult to walk away from it. I would have been curious enough to ask the wheelchair patient sitting in the corner alone how long he had been sitting there.

I wonder if the 90 min. therapy session twice a day for each patient includes the sitting around watching?

You and Bob made a good decision. Now the next step is keeping pressure on the doctor for other therapy options & assistance.

Hugs, Dan

Diane said...

Dan, it appears that 90 minute therapy session includes sitting around watching, as they have two separate sessions in the morning and two in the afternoon, and patients are given a "schedule" as to which session to attend... jeepers

Dean, the doctor did use some electronic machine to sense muscle contractions while he was doing the injections... did he do it right? who knows!

Jenn said...

Interesting "field trip". Yikers. Glad you're firm about what should and shouldn't be done! Stay powerful!

I was wondering the same thing as Dean re:location of Botox injection. How to find out? Good question. Second opinion is all I can come up with (oy).