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Wellness for the Subacute Patient

October 1, 2004
by root
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Wellness programs can work in this setting, as well; case experiences by Tobi Schwartz-Cassell
BY TOBI SCHWARTZ-CASSELL

An increase in interest in the wellness concept has been the impetus for even more specialized programs. The Cardiopulmonary Conditioning Program was established by Terence Schiller, MD, at the Medford Care Center in Medford, New Jersey. Its sole purpose is "to cut down on the facility's rehospitalization rate," says Program Coordinator Vickey Elstone, LPN. "We'd like to help our subacute patients achieve a healthier, more comfortable, better quality of life. And it's a team effort by our physicians, RNs, PTs, OTs, SLPs, dietitian, and social services." While performing conventional therapy, the facility's therapists also teach cardiopulmonary patients efficient ways to perform everyday tasks while conserving energy and avoiding shortness of breath.

"During therapy, the therapists teach the patients breathing techniques. I continue the instruction later on at bedside. We monitor their vital signs closely, including pulse ox [pulse oximetry], in an effort to increase their endurance and overall physical conditioning," says Elstone.

The package is completed by the nurses who review with the patient and family members the meds, their side effects, and their proper administration, as well as any insulin and nutritional information specific to diabetics, colostomy care, and so on. "We pretty much do whatever we need to do for everyone, no matter what their condition. That's one of the special things here-the teaching part," notes Elstone.

An added aspect to the program at Medford Care Center is a brand-new 1,200-square-foot gym. Director of Rehabilitation Shiv Shah, MPT, chose the equipment for the program, including a treadmill with a specialized geriatric arm; a recumbent bike with geriatric aerobic, cardiovascular, and manual programs and a large display for the exerciser; and a stepper that can be used either sitting or standing.

"We're hoping to continue to expand on our wellness concept, so hopefully the teaching aspect will grow, as well," says Elstone.

Wellness may be a good idea-but who's going to pay for it? The surprising answer is that if wellness is incorporated into the normal therapy and nursing routines, it is picked up as part of the overall inpatient stay by Medicare. "The services provided for the patients are already calculated into the different RUG categories," says Medford Care Center MDS Coordinator Sally Corpuz, RN. "So the services just add up. If the patient is solely on medical monitoring without rehab, it will go to the Clinical Category. If they're on rehab, it will go to the Rehab Category."

It really comes down to redirecting our thinking in terms of planning patients' days. Perhaps we can take that a step further-as Field suggests, maybe we should start referring to subacute facilities as "short-term wellness centers."



Tobi Schwartz-Cassell is a healthcare/business writer based in Cherry Hill, New Jersey. She is coauthor of the book Adding Value to Long-Term Care: An Administrator's Guide to Improving Staff Performance, Patient Experience, and Financial Health (Jossey-Bass, Inc., available from www.elderclinical.com). For more information, call Schwartz-Cassell at (856) 751-2997. To comment on this article, send e-mail to schwartz-cassell1004@nursinghomesmagazine.com. For reprints in quantities of 100 or more, call (866) 377-6454. For more information on wellness programs, contact:

Reimbursement for Wellness Programming
Cheryl Field, MSN, RN, CRRN, Director of Clinical and Reimbursement Services, LTCQ, Inc., Lexington, Massachusetts, (781) 457-5914

The Care Map
Kathleen Sullivan, RN, MN, CS, CRRN, Assistant Director of Nurses, Greenbriar Terrace Health-care, Nashua, New Hampshire, (603) 888-1573

The Vitality Program
Peggy Buchanan, Front Porch Corporate Vitality Program Coordinator and Director of Fitness, Aquatics, and Physical Therapy; and Roseanne Bezdek, Vista del Monte Health Center Vitality Program Coordinator, both at Vista del Monte CCRC, Santa Barbara, California, (800) 736-1333

The Cardiopulmonary Conditioning Program
Vickey Elstone, LPN, Cardiopulmonary Conditioning Program Coordinator; Shiv Shah, MPT, Director of Rehabilitation; and Sally Corpuz, RN, MDS Coordinator, at Medford Care Center, Medford, New Jersey, (856) 983-8500
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