Restorative care program to give patients better option for rehabilitation

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The cornerstone of quality health care is making good choices. For many post-treatment patients in acute care, those choices can seem a maze of challenging alternatives to waiting in hospital. Restorative Care, a new program based at the Garden Street Site of Brockville General Hospital (BGH), is offering many local patients a better option.

“We introduced the Restorative Care program in January of 2010, under the name of Slow Stream Rehab,” says Sherry Anderson, BGH Director of Complex Continuing Care, Rehabilitation and Palliative Care. “We have since changed the name to Restorative Care for a number of reasons. The program is not general rehab. As well, the South East Local Health Integration Network (SE LHIN) has identified Restorative Care as one of the priority areas in its new Clinical Services Roadmap, so this brings our program in line with that.”

The premise of Restorative Care is to target frail or elderly acute patients in hospital whose recovery takes more time. These clients may stay longer in acute care beds not designed for the care they require post-treatment. The first step in the new process is having the rehab charge nurse complete rounds in acute care, working with the inter-professional team to identify those who would qualify for Restorative Care. Once a patient is identified as a possible candidate, the discharge planner meets with family and patient to identify barriers to discharge. Patients are admitted to Restorative Care based on a certain criteria. Average length of stay is four weeks, and the staff follows up with a post-discharge telephone survey one month later. The Community Care Access Centre (CCAC) can also provide at-home services for additional support required after discharge.

“This is an inter-professional approach: Charge nurse, physiotherapist, occupational therapist, nurses, PSWs, and recreational therapist,” explains Anderson. This is not intense rehab. The therapist sets the rehab program and the nurses help carry it out, ensuring that all care in the program is followed through.”

Most important, the patient gets the right care, instead of becoming one of too many Alternative Level of Care (ALC) patients in the Ontario hospital system.

Patients in acute hospital beds are there because they need acute care services. This means they need short-term, intensive medical treatment for an illness, injury or recovery from surgery. Once patients complete this “acute care” phase of treatment, they often require an alternate level of care (ALC). ALC patients are individuals in hospital beds who would be better cared for in an alternate setting—long-term care, complex continuing care, convalescent care or rehabilitation. Not only does the ALC patient not get the right care he or she needs, the acute care bed remains unavailable for someone else needing acute care services.

Restorative Care was one of the initiatives undertaken at BGH in recent months to respond to the increased numbers of ALC patients. Home First, a province-wide program to help hospital patients wait for alternate care options in the comfort of their own homes with enhanced at-home service, led the way. One of the options researched as part of Home First was Restorative Care, which seemed to offer a positive and viable alternative for some ALC patients.

“Restorative Care targets those at risk to stay in hospital because they are weakened from their treatment,” explains Discharge Planner Cari Bailey. “Once they are stable, and we have discussed this with both patients and families, we transfer them to the program to begin getting them up, out and involved. Even their mindset is turned toward going home and that helps them achieve their goals.”

The benefits of Restorative Care are numerous, according to BGH staff. “It’s a positive environment because we are working to send people home,” says Navigation Nurse Frances Kennedy, who has worked with the program since its inception. “Patients love it, it works, and people hear good things about it.”

Lorraine White, Floor Charge Nurse, agrees. “It’s a different nursing model. The program looks at wellness rather than illness, with the emphasis on patients doing for themselves. And that provides the motivation. It’s actually more time consuming, but very reaffirming for patients in terms of their improvement and return to some independence. They put their hearts into it.”

In addition, the benefits of Restorative Care are not confined to the patients. “It’s a very positive atmosphere to work in,” says Caroline Cardoso, Occupational Therapist. “Patients in the program are not in bed but up, dressed, and engaged in activities with physio, recreational and occupational therapists; sometimes in group activities to stimulate them. People improve. It gives them hope, and they achieve a better quality of life. It’s nice to see the beds used in this positive way.”

“The program is successful,” adds Physiotherapist Tanya Collins. “We’re very happy about that.” Collins is right. The success of Restorative Care at BGH is impressive, at almost 52 per cent. With the original 71 patients admitted to the program, 37 were successfully discharged to their homes. Ten converted to ALC status, one to long-term care and two to intense rehab. Of the ten moved to ALC status, all had improvements in their mobility and activities of daily living—greatly enhancing their quality of life no matter what their destination of care was.

With an aging population in this country and a significant demographic of seniors in Leeds/Grenville, the Restorative Care program should have a substantial impact. What does the future hold? “Our next stage is to hire more therapists,” says Heather Crawford, Vice President Clinical Services and Chief Nursing Executive for BGH, “and look at our nursing resources. We’ve implemented the program and it works. The challenge now is a familiar one—funding. This program was developed entirely within the existing hospital budget as there was no outside funding for it at the time.”

“Recently, we forwarded a proposal to the South East LHIN for funding to expand the Restorative Care program by offering additional resources at our Charles Street Site so we can begin the process while clients are still in acute care. This will allow us to start the treatment as soon as possible. The other expansion we’ve proposed is to have more out-patient services to continue the program after clients have gone home,” she adds.

Crawford says the response from the South East LHIN was very supportive. Just prior to Christmas, BGH received confirmation of “one time” dollars for an enhanced Restorative Care project

“We’ll keep developing and adding to Restorative Care as much as we can,” says Anderson. “This is revolutionizing rehabilitation and maximizing life. For those who can participate, it really is the better option.”