Rehab hospital from a consumer perspective…

My good friend wrote this up for me after his mom ended up staying in a rehab hospital in Alabama. Here was his experience:

On October 22, my mother fell breaking her left femur below the ball joint. She is a Caucasian female, 88 years old, 65 inches tall and approximately 125 pounds. She does not have osteoporosis. She lives a very active life, and lives independently. The method chosen by the orthopedic surgeon for fixing this was to do a half hip replacement. The top of the femur was cut off and replaced with the artificial ball joint. This was fitted into her natural socket on the pelvis. There was no damage in the fall to the hip itself or any other joint or bone.

Please realize that to the consumer, health care is one long continuum. Because of the fact that the health care professional is dealing with human life, it is hard for the consumer to accept a “not my job” explanation or or to accept that if a provider sees something that is wrong but not in their field to not address it. The discussion below may be taken as criticism because it is a discussion of areas that frankly fell short or could improvement would greatly benefit the professional image of OTs and PTs.

Because my mother is 88, the hospital social worker was initially recommending she go to a nursing home for rehab. To their credit, the hospital therapists stood up for her and reommended the more vigorous rehab at the local rehab hospital. However, the whole incident came across as extremely condescending. We both wondered how she would have fared had I not been present and she had been on her own, since these decisions were being made less than a day after surgery. To a lesser degree the same stereotyping occurred at the local rehab hospital. The larger offense there was their greatly underestimating the amount of therapy she was capable of doing, which to a point discouraged her. I was present for one visit to The Orthopedic Center. It was like night and day. The therapist there seemed to work harder to connect and address Mom as an individual.

The first day in her room at the local Hospital, the therapist upon leaving told the nurse, “Where’s our stuff? Everything we need is missing.” That was said in our hearing. To me, the therapist now has a responsibility to follow up past asking the nurse. So be careful what you say in front of the patient. By the way, the “stuff” never showed up, but that is another story. Suffice it to say that before we left I had the floor charge nurse and the assistant head of support services standing in front of me.

If you tell patient number one something make damn sure that you tell patient number two who has the same injury the same thing. Two days prior to her discharge from the local rehab hospital, Mom got a new room mate who also had broken her left leg in the same place. I was there when Mom came in and I was there when her new roomie checked in. They gave her a whole rundown about what her rehab would be, her limitations, what she would be expected to do and what they would do. Mom found out stuff as she went along.

When you discuss limitations on movement, please ensure you specify if they are permanent or temporary, such as during a specified recovery period. Prior to discharge at the local rehab hospital, they gave Mom a list of prohibited movements. When I arrived for the discharge interviews, I had a despondent Mom because she thought these were permanent restrictions. I pointedly asked both the OT and the PT (both of whom were “technicians” according to their name tags) about each and every restriction and we found out they were all during the recovery period. We were greatly relieved.

I am not that interested in your personal life. I am especially not interested that when you were in high school your ex-boyfriend loosened the lug nuts on your car, causing the wheel to fall off while you were driving it and your new boyfriend beat the crap out of him. The patient does not need to hear that from the therapist. Keep up on current events. If you know what is going on in the world, it gives you something to talk about with your patients and to possibly connect with them as individuals. It is also a way to avoid or redirect possibly inappropriate personal questions. Your patients come from all walks of life; you can learn from them. However, asking a patient, who has told you he is from Switzerland, where Switzerland is does not inspire patient confidence.

I have not seen so much hurry up and wait since I was a Midshipman on summer training 35 years ago. I do not understand why scheduling can’t be better accomplished. While not an OT/PT issue, I fail to see why a dressing has to be changed at 3:30 a.m. except that someone forgot to do it and the next shift caught the screw up. Also when Mom checked out of the rehab hospital, at precisely the same time as when we were supposed to be meeting with the OT and PT, the medication nurse and the team to remove the surgical staples all showed up. You could not have crammed one more person into her room. Scheduling stunk.

Personal Appearance
Please consider wearing something other than scrubs. Everybody wears scrubs. OTs, as an example, have completed a stringent, horrifically rigorous program. Differentiate yourself. At The Orthopedic Center, the therapists were in knit shirts or sweaters and khaki pants. You may be dealing primarily with an older population or, if you are with children, you want to assure the parents that their offspring is being cared for by a real professional. Like it or not, appearance makes a difference.

Also along that line, avoid visible tattoos or body jewelry. Call me old fashioned, but I have a hard time carrying on a serious conversation with someone who has a nose ring. I frankly do not care if it is part of your cultural heritage or not.

If you are dealing with patients, do not wear clogs or crocs. I watched a person pushing a cart twist and then step out of a croc (it had a heel strap which was useless) and almost fall. If that had been a patient with mobility issues, well i leave that to your imagination. Wear something that is secure to the foot.

Since You Are A Health Care Professional, Do What The Other Health Care Professional Tells You.
This conversation was overheard while I stood outside my mom’s room at the local rehab hospital during the staple removal circus.

Health Are Professional (HCP) Number One, “Hi!”

HCP2, “I knew I couldn’t get past the room without you stopping me.”

HCP1, “What’s wrong? You OK?”

HCP2, “No, I don’t feel good and I have a scratchy, sore throat.”

HCP1, “Taking anything?”

HCP2, “Yeah, I went to the doctor and got a shot and some antibiotics, but I quit taking them.”

HCP1, “You did?!”

HCP2, “Yeah, they were making me (didn’t hear the word) and I was feeling better so I quit taking them. Now I may have to go back.”

Thank you very much for bringing a now drug resistant strain into contact with the elderly. Is this how MRSA got started?

During Mom’s hospital and rehab stay she was cared for by a lot of talented people – we all realize and are thankful for that. But folks, there is room for improvement and because you are dealing with life here, you have been given a special trust and confidence.

These are my opinions and observations. If you disagree, please feel free to contact me and we can discuss. Do not beat up on the blog owner.
UPDATE: He wanted to add that it is important that the therapist clearly explain to the client what is going on. For example, his mom couldn’t understand why she had a therapist making her do an arm bike exercise when she was there for her hip.
There is a good reason, but the client needs to understand that reason.

UPDATE 2: I asked him to rate the experience on a scale of 1-10, 10 being amazing. He said it was a 6.

Nov 14, 2007 | Category: Occupational Therapy | Comments: 3

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