Improving functional status with rehab

Two leaders at the Rehab Unit in the Carson Tahoe Regional Medical Center are Debbie Christeson, outreach coordinator, and Char Foerschler, nurse manager. The two women are enthusiastic and positive about their work and their unit.

The unit gives post-acute rehab care to patients who have been in the hospital for surgery, stroke and other illnesses, in which they cannot function as well as they did previously. The patient may be referred by a doctor or a hospital. The outreach department will see the patient and determine if the person wants to come to rehab and meets other criteria for need.

"Medicare does pay for the treatment after certain criteria are met such as progress diagnosis and cooperation of the patient," Christeson said. "There are three hours of intense therapy a day, split up into intervals and it is essential the patient can tolerate it and be willing to cooperate.

"A patient can remain in therapy up to a certain point so long as he or she continues to progress. A team conference is held each week to assess the progress of the patient, then Medicare determines the amount of time the patient may stay. He or she must need and progress in two out of the three services, occupational (OT), physical (PT) and speech therapy."

"There are 37 employees - nurses, therapists and certified nurse assistants in the unit: three full-time therapists in the PT department, two in the OT and one in the speech along with assistants and CNAs," Foerschler explained.

"The PT gym contains mats, bikes and other types of equipment to assist patients in developing motions they will need to do at home to improve functional status and get on with the quality of life.

"The OT includes self-care such as bathing, grooming, toileting and dressing. This therapy is usually done in the patient's room or in the kitchen where they practice cooking normally done at home. Safety issues are stressed.

"Speech therapy includes help with cognitive skills, actual speech and swallowing. After a stroke or in Alzheimer's disease, some patients forget how to swallow and there are exercises and ways to help with this activity.

"To qualify, the OT, PT and speech therapists need a minimum of a bachelor's degree, but many have master's degrees," Foerschler said. "The aides or 'techs,' need a high school diploma and on-the-job training. I have worked in the Carson-Tahoe Rehab Center since 2006 and have a registered nurse degree as well as an MA. My background has added to what I bring to our unit. I'm glad I still have some patient contact.

"From 2001 to 2005 I worked at the rehab unit in the old Carson-Tahoe Center as a nurse-practitioner, then I went into family practice for a while and came back to this unit."

"I worked in the hospital in the late '70s, then in home health and hospice and now here," said Christeson. "I also have an RN degree.

"We have about 83 percent success for patients who go home and have home nursing; nine percent go to a nursing home."

"We stress safety in our discharge plan with the patient's family and the rehab team and use our outpatient rehab and Home Health if necessary," Foerschler said. "Medicare will pay for Home Health and provide nurses for some nursing care. If the patient needs 24-hour care, private pay takes over."

Each woman stated that their goal is to get people back home, and to return people as close as they can to their prior level of functioning.