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Addressing Rehab Outcome Killers

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When a resident leaves a skilled nursing facility after a successful rehabilitation, it’s a clear signal to the community the facility is doing its job. In fact, satisfied residents often become the facility’s best salespeople by sharing positive reviews with family and friends. On the other hand, when a resident fails in rehab, they may spread a very different message in the community — that the facility failed and is not a good choice for others who need rehab services.

Hospital systems and insurance companies are continually making the same evaluation, asking which facilities they should trust with their patients who need rehab. In contrast to long-term care units, where a constellation of factors collectively known as “quality of life” are the most critical elements, rehab outcomes are cold, hard facts referral sources can see: What percentage of the patients return home? How long does it take? How many need to go back to the hospital?

The bottom line is that facilities that want to survive the changes in the structure and financing of health care need to deliver top-notch rehab outcomes.

In my experience, it’s not the size of the gym or the brand of equipment that distinguish the best rehab units. These factors, while important, are external to the patient. What really matters is what happens when patients are confronted by the enormous emotional challenges of rehab. How the facility helps its patients respond to common psychological demands and distress is what separates a successful discharge from an unsuccessful rehabilitation outcome.

All subacute patients experience psychological distress. By definition, they have recently endured some traumatic event — a stroke, a broken hip, a car accident, etc. They spent a few disorienting days in a hospital where their diet, routine, medication regimen and other anchoring elements of their life were disrupted. They often had significant pain and fatigue. And after all that, when they get to the subacute facility, they’re told, “Let’s get to the gym!” So it’s not surprising that many subacute rehab patients, at exactly the moment they need to put forth a Herculean effort, fail to do so because of significant levels of anxiety, depression, poor motivation and other psychological factors.

In fact, the vast majority of subacute rehab patients who receive a solid biopsychosocial evaluation will present with several of these “rehab outcome killers”:

  • Depressed, withdrawn, tearful, passive, pessimistic
  • Combative, irritable, frustrated, non-compliant, angry
  • Unrealistic expectations or recognition of disability
  • Cognitive impairments
  • Maladaptive personality issues
  • Chaotic or intrusive family dynamics
  • Low frustration tolerance
  • Poor tolerance of pain
  • Hopelessness, low motivation

It is unrealistic to expect residents to overcome the physical challenges they are facing without aggressive attention to these behavioral health issues. The most successful facilities get psychiatric and psychological services involved at the first indication of an emotional issue that might impede a successful rehabilitation outcome.

For the full text of this article by Richard Juman, PsyD, click here to visit McKnight’s Long-Term Care News.