In most of my long-term care career, I’ve witnessed short-term rehabilitation (STR) residents housed together, but occasionally facilities have scattered them throughout the building. I don’t know the reasoning behind dispersing residents, but from my perspective, dedicated rehab units work better.
My thinking is based on the fact that people entering rehab are almost invariably in the middle of a life crisis (see The stress of nursing home admission) – as are their family members – and that staff members are often stretched to the limits of their capacity to manage their responsibilities.
Keeping rehab residents together is better because:
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STR residents lodged together find a group of peers in the same situation as themselves, which can be enormously reassuring in anxiety-provoking times.
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Co-housing makes it more likely that STR residents will develop stress-reducing friendships and find a team of peers to support their progress in rehab. The ability to form friendships with peers is one of the major strengths and selling points of long-term care.
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Being around LTC residents can be alarming for STR residents, who usually have fears that they’ll “never get out.” Observing others being discharged upon completing rehab can ease their apprehension.
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STR residents, who are frequently younger and more cognitively intact, can feel isolated on LTC floors that have fewer people with whom to engage socially, and none in their particular situation. This increases their depression and anxiety.
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Family members can benefit greatly from talking with other families in similar situations. They’re much more likely to meet other families “in the trenches” on an STR unit. Yes, there are families on the long-term floors, but they’re in marathon mode while STR families are sprinting through a crisis that has reordered their lives.
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STR residents have very demanding physical, emotional and discharge-related care needs. The staff members on rehab units are familiar with these needs; the long-term floor staff members are not. It’s stressful for staff and a set-up to fail to place occasional short-term residents on long-term floors.
More specifically:
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STR residents need the higher resident-staff ratio of STR floors due to their medical acuity and their anxiety over their (often) sudden disability.
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Social workers can plan discharges more efficiently if they can move from room to room to discuss crucial, time-sensitive details with residents and their families. It’s unreasonable to expect a rehab social worker on the East wing to service a single short-term resident on the West wing or to ask a social worker with a heavy caseload on the long-term floors to shift focus to the very different tasks specific to discharge and short-term care.
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Rehab therapists and their transporters can gather residents for services more quickly if they’re on the same unit. They’re also less likely to tie up the elevators on transport and to affect the flow of recreational and other activities.
Facilities have excellent reasons (such as maximizing reimbursement or responding to the demands of the local hospital or community) for bringing in more rehab residents, but it may be better to develop a new rehab wing than to haphazardly scatter STR residents throughout the building.
More training is likely to be needed to properly manage STR residents and a particular unit or staff member may be better suited to transition to STR services.
To improve the quality of care and the experience of residents, families and staff, consider the emotional and practical impact of changing the resident population and seek feedback from direct care team members.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.
