You’re not ready to leave the hospital after being treated for a stroke. However, the hospital says you are.
It’s a scenario repeated countless times in hospitals all over the country. In an era of managed care and understaffing, hospital stays continue to grow shorter.
Fortunately, both inpatient and outpatient rehabilitative health services are available to close the gap between when patients leave hospitals and when they are actually ready to get back to living.
Of course, with the new emphasis on rehabilitation — and the increasing complexity of the field — come new challenges for allied health workers such as physical and occupational therapists, from increasing educational demands to the inevitable trend toward sicker, more problematic patients who, in the past, would still be in hospital beds.
Fortunately, area rehab facilities report few of the staffing woes that have plagued the nursing field and other areas of health care. This month, The Healthcare News looks into this changing field and how facilities can retain the workers they need to continue to make patients well.
A Crucial Link
For patients who are in no condition to return to independent living when their acute care is completed, rehabilitation services fill a crucial gap, said James A. Lomastro, vice president of Health Services at Mercy Medical Center, which operates the Weldon Center for Rehabilitation.
Weldon, he explained, allows much initial rehabilitation work to begin in Mercy’s medical and surgical units, which is especially important for older patients who require more attention and want to regain their independence.
Indeed, rehab services are crucial for those who want to maintain an independent lifestyle but might otherwise be discharged to a nursing home for hospitalization, said Jeffrey Reed, manager of Physical and Occupational Therapy at the Transitional Care Center (TCC) at Holyoke Hospital.
And, in an environment in which rehabilitation has taken on greater importance, the extended role of allied health workers requires them to work together and understand a broader — and ever-changing — range of skill sets.
“Most therapies at Weldon are hands-on, and those practices change continually. You have to integrate more with a variety of disciplines,” Lomastro said.
He said he really noticed this trend when his father was a patient. “I noticed how many people from different disciplines came in and interacted with him — physical therapists, occupational therapists, dieticians, social workers, respiratory therapists.”
Not only do allied workers need to know more, he added, they are under greater pressure than ever before, particularly in the acute-care setting due to decreased patient-stay times. “It’s becoming, for a lot of people, more of a pressure cooker than it was before,” he said.
Indeed, according to the Centers for Disease Control and Prevention, the average length of stay for a hospital inpatient, which was more than seven days in 1980, has fallen to about five days a little over two decades later.
Part of that shift has come due to pressure from insurers to turn over patients quickly when possible. As a result, acute-care allied workers are faced with time pressures, while therapists at longer-term facilities are seeing patients arrive more acutely ill than ever before.
According to David Richer, CEO of HealthSouth Rehabilitation Hospital in Ludlow, the facility is receiving patients from hospitals sooner and sicker than in the past, so their needs are necessarily greater. That shift, he said, requires allied health workers to have better acute medicine management skills.
Hitting the Books
And, clearly, that’s exactly what potential workers in these fields are experiencing as they further their education. Careers that once required two-year certificates or bachelor’s degrees at most are increasingly requiring master’s degrees. The American Physical Therapy Assoc. (APTA) is even pushing for an entry-level doctorate program, Reed said.
“What’s happened over the years is that health care has become more complex, and the disciplines themselves have become a lot more demanding — and it’s difficult to get people to commit that much education to these fields,” Lomastro said.
Indeed, Physical Therapy and Occupational Therapy students at Springfield College, which boasts a wide array of allied health programs (see related story, page 17), generally complete master’s programs in those fields — and the college is cautiously considering whether to expand its Physical Therapy program to the doctorate level, as the APTA has recommended.
The increasing education demands are common across all allied health fields, Lomastro said, but so far, the numerous branches of rehabilitation therapy have not been hit hard by a shortage of new workers as much as other careers, such as radiology technicians — a field that, in some areas of the country, struggles with more severe shortages than nursing does.
Still, the increased education demands in rehab fields remain a concern, he added, since some people do choose careers, even health careers, based primarily on economic opportunity. Those looking for a faster return on their investment might be less likely to spend six or more years studying to work in allied health.
In allied health in general, he said, many procedures are becoming more complicated, and the work itself is becoming more fast-paced, so burnout is a factor. “We see people working in the field for a short period of time, five to 10 years, then dropping out,” Lomastro said. “We’re not seeing as many people using it as an entire career. The learning curve is astronomical, and there can be a lot of burnout.”
If there is an understaffing problem that contributes to burnout in rehabilitation health care, Reed said, it’s more of a reimbursement issue than it is a problem with the available worker pool. In short, reimbursement rates from third-party payers — Medicaid, Medicare, and private insurers — have become increasingly inequitable, forcing hospitals and other facilities to run leaner staffs than they would like.
“Rehab used to be a cash cow for a lot of health care institutions, and it’s just not the case anymore,” he said. “But in terms of the job market, we’ve got more than enough applicants.”
The need for greater education is obvious when one considers that, only a decade ago, therapists typically saw patients with one type of injury without many complications. Because of the shortened hospital stays, recovery from knee surgery might be complicated by cardiac problems on top of it. The diagnoses are familiar, but the complexity of what health workers are seeing has increased.
Meanwhile, some types of patients, including those with non-traumatic head injury and aneurysms, as well as cancer patients, are being treated in rehab facilities in much greater numbers than a decade ago.
At Weldon, Lomastro said, programs have been set up to support rehabilitative efforts. For instance, rehabilitation is often not effective on patients who are incontinent or who have severe pain. So specific programs have been established to deal with those two problems. Another program deals with dizziness, another condition that can hinder the effectiveness of rehabilitation.
Meanwhile, patients may also receive preventive rehab before surgery to help get their strength up and reduce the amount of treatment they will require afterward. In all, there are at least 10 different types of medical professionals on the team, and all are expected to work together and have a working knowledge of the other components.
At the Holyoke TCC, teamwork is also crucial, but Reed called that a positive for patients. Classified as a nursing home by the state even though most patients stay between 10 and 14 days, the center, which focuses on orthopedic recovery, keeps patients in touch with the doctors who treated them during their acute care, easing the transition from the hospital to rehab back to independent living.
That kind of team atmosphere does appeal to many people seeking therapy jobs, he said, contributing to the fact that there is no local therapy staffing crunch — yet.
“It’s fun to see patients on the inpatient side, going through transitional care, and coming back as outpatients,” Reed said.
“Given that we’re a community hospital, we get to know these folks, and we can have a relationship with them.”
In the long term, job satisfaction goes a long way, especially in high-stress careers. And that’s something that makes more than just patients feel good.