Rehabilitation in home setting improves outcomes

Brain injuries heal faster, better outside institutions

Olsten Health Services’ annual outcomes study for Rehab Without Walls Program found that patients with brain injuries heal best in a natural setting.

The goal of the company’s Rehab without Walls is to improve the progress of rehabilitation clients over those recovering in the more traditional programs, and found settings such as inpatient acute care rehabilitation, sub-acute care, or skilled nursing facilities.

Study results

The study reviewed cases of 592 clients who received rehabilitation services for spinal cord injuries, traumatic brain injuries, or cerebrovascular diseases. It examined nine areas of rehabilitative progress at three stages: when clients were admitted to Rehab Without Walls; upon discharge; and three months after completing the program.

The focus of Rehab Without Walls is equipping clients with the skills they need to take part in daily home, school, and work activities more independently and with less supervision. The program is supported by Olsten’s network of 400 offices and 80,000 health care professionals, and offers adjunct services.

"Providing services in the client’s natural environment is not only clinically appropriate, it is also a more cost-effective form of health care delivery because it does not involve the added overhead of bricks and mortar," says Ann Kent, assistant vice president of Strategic Marketing for Olsten Health Services.

Costs escalate

Olsten’s study shows that Rehab Without Walls is a cost-effective alternative to hospitalization. The median cost per Rehab Without Walls client was $10,619 for the entire program. Since most clients spent approximately two months in the program, the daily cost is $176.98. This contrasts sharply with average per-day hospital costs of $1,872, as cited by the National Association for Home Care. In addition, in-hospital treatment is often followed by outpatient therapy, also at significant cost.

The study shows some of Rehab Without Walls outcomes are:

• Home supervision. When beginning the program, 74% of clients required someone to live in their home to provide supervision and assistance around the clock. Upon discharge from Rehab Without Walls, this number dropped significantly to 20%. Three months later, only 13% required such assistance.

• Limited home supervision. Clients who were able to function well unsupervised for an eight-hour period increased from 18% upon admission to 61% at the end of the program, and 67% three months later. This outcome has positive implications in that it allows a family member who is responsible for the client’s care to work outside the home, rather than take a leave from work or hire outside caregivers.

• Supervision in the community. A vast majority (80%) of clients needed constant supervision at the outset, but increasingly fewer fell into this category upon discharge (30%), and three months after the program ended (26%).

• Productive activity. Upon admission, 88% of clients demonstrated no productive activity. Upon discharge, 33% were employable, and three months later, 35% were employable.

• Personal activities of daily living. The survey measured a client’s ability to perform common, everyday activities, such as washing or brushing one’s hair. Upon admission, 82% of clients needed some supervision, but upon discharge, only 40% required the same amount of supervision. Three months following completion of the program, the percentage was lower by another four points.

• Communication/cognitive issues. Upon admission, 72% of clients needed strategies or devices (such as a day timer) to compensate for memory or organizational deficits. The group strongly shifted to a more independent communication ability upon discharge and three months after discharge, at which times 66% and 76%, respectively, were able to communicate their needs with only intermittent coaching or were totally independent.