Jessie Rodriguez The Plaza Health Services at Mirador

When it comes to rehabilitation and skilled nursing care, the majority of seniors and their families are looking for an effective and comprehensive process which will get them back home with a decreased chance of re-admission to the hospital.

With this in mind, physical therapists must understand that for most families, fear of the unexpected and a lack of knowledge are always the biggest concerns at the beginning of any recovery process. When looking at patient care, the highest priority is to ensure that patients can recover quickly while maintaining as much independence as possible. This in turn highlights the importance of developing plans for patients during the initial evaluation using the input of the patient, family and physical therapist.

Benefits of home training

At The Plaza Health Services at Mirador, a continuing care retirement community in Texas, we find that it works best to treat the individual and not the diagnosis. One way we do this is by working closely with the individual’s family members in home-training situations to avoid incidents such as falls which lead to hospital re-admissions. This is especially important for the individual receiving care and their family, as hospitalization increases risk of infection, injury, immobility and a number of other health concerns. We keep this in mind by including the family in the evaluation process to ensure the patient’s goals are included in therapy.

Additionally, we find that meeting patients on their level is absolutely vital so that they can be in control of their recovery. This means understanding patients’ moods and needs. If someone is not a morning person we’ll start later in the day. In order for patients to have a successful recovery, they must be engaged in the overall process. By combining a patient’s interests and home life into each session, individuals can see a functional reason behind the exercises. This enables the individual to return home feeling confident in their ability to get back to living independently again.

Transitional Nurse Program

Our Transitional Nurse Program is highly effective. The program is designed to provide a comprehensive transition process for residents going from the hospital to skilled nursing at The Plaza and then back home, which helps decrease hospital re-admissions. This is done by having the transitional nurse available to help guide individuals and their family through the rehabilitation process throughout their stay in the community and the return home. This enables them the opportunity to ask questions and set realistic expectations with their doctors and family members before even getting started. This nurse is responsible for meeting one on one with residents and their families and acts as a liaison before and after admission into skilled nursing at Mirador. They then provide a personal connection for patients as they walk through the process.

As a whole, the nursing staff should be relied on heavily as they are the ones who will interact with patients the most throughout their stay.

Team training

In order to remain successful and current with therapy trends, training is always the most effective tool for staff. By working to specialize in specific skill sets and adapting to new ways to approach a treatment, we can provide care which allows patients to flourish in their recovery. As with anything new, finding ways to anticipate and adapt ensures successful care now and in the future. At Mirador, we focus heavily on quality customer service. Recovery begins as soon as contact is made with a patient, and we are dedicated to making sure each person feels that his or her recovery is a priority.

With more seniors now than ever before, it’s important to remember that down the road, rehabilitation will need to continue to meet the changing needs of patients. As medical treatment evolves, more patients will seek care to assist them in getting home quickly and in better shape. Being able to offer a smooth and seamless move from one phase of recovery to the next will become the expectation for all patients and not the exception.

Jessie Rodriguez is the program director for the rehab department at The Plaza Health Services at Mirador, an SQLC retirement community. He has been a physical therapist assistant and has 17 years of experience in working with seniors.