Make the little you have available go a long way
Make the little you have available go a long way
Community resources may help fill gaps
Insurers are pushing to get pediatric patients discharged from the rehabilitation hospital as soon as possible. But at the same time, many plans limit outpatient therapy treatments to 100 or fewer visits a year.
"More and more therapy is not being approved on a long-term basis. When a child comes to your facility, you have to have the experience to get a good picture of what their trajectory of recovery can be expected to be, and you have to plan from there," warns Eileen Sherburne, RN, MSN, CRRN, rehabilitation clinical nurse specialist at Children’s Hospital of Wisconsin in Milwaukee.
When severely injured children are discharged home, the ideal situation is for them to receive treatment from a physical therapist, occupational therapist, and speech therapist five days each week.
If the insurance provider limits the number of outpatient visits it will cover per year, these children may not get enough therapy if their condition is severe. When this is the case, the hospital’s therapists work with the outpatient provider to come up with creative approaches to the problem. For instance, the occupational therapist also may work on cognitive problems for which the child typically would see a speech therapist.
"We try to make sure all of the issues are addressed but keep the number of therapy sessions at a minimum," Sherburne explains.
In addition, she advises parents about community resources that may be available for their child. Those resources include:
1. The school system.
Federal laws mandate that local school systems must accommodate handicapped children. If you need to support your drive for help from the school system in your area, refer to Public Law 94-142, the Education of the Handicapped Act of 1975, and the Americans with Disabilities Act of 1990 in addition to other federal laws that require states to provide education and related services to children with disabilities.
Although school systems often are financially strapped, they are willing to work with the children and provide whatever services they can, says Sheila Hickey, LSW, social worker at the Rehabilitation Institute of Chicago.
The staff at duPont Hospital for Children in Wilmington, DE, work with the schools to accommodate the needs of the young patients, says Roslyn M. Gleeson, MSN, RN, CS, spinal dysfunction program coordinator. If a school has no elevators, for example, she asks administrators if they can move the child’s class to the ground floor.
Often someone from the hospital will go with parents to meetings with school officials to discuss making arrangements for a child’s education.
"When we work with kids from rural areas, we find their local systems don’t know how to get someone who is a paraplegic back in school We act as consultants to help them do it and to help parents learn to negotiate the system," Hickey says.
2. Home exercise programs.
Parents must learn the importance of a home exercise program to supplement what goes on during the therapy sessions. They also need to continue the exercise program after the child is discharged, Sherburne says.
3. Community activities.
Once children have recovered medically, community activities such as swimming or gymnastics can help them become more functional, Sherburne says.
She remembers one boy with a head injury and brain tumor who learned to play a clarinet in a marching band. "It was incredible therapy. He had to learn to organize, to march, and to participate in a group effort."
4. Special activities for the disabled.
The Special Olympics and wheelchair sports are other outlets that give disabled children an opportunity to participate. Be creative and look at what kinds of normal outlets will include the kids in activities with other kids their age, Sherburne advises.
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