David Siegelman

With New York City being the epicenter of the COVID-19 pandemic, many here discuss the new norms of social distancing and infection control in terms of limiting rehabilitation services and not promoting functional mobility. While these realities are of primary importance, it is not why any of us entered the field of rehabilitation. Therefore, why does this need to be the new norm?

The importance of rehabilitation and wellness services are greater than ever. Residents have likely endured physical, social and emotional effects associated with limited physical stimulation and interaction over the past couple of months. This does not need to be the new norm but rather we must lay the foundation of “re-inventing rehabilitation and wellness services” for the future.

   There are multiple concepts to consider when evaluating services and fostering change.

  1. What post-acute care services will be demand? Over the past two months we have admitted a more medically compromised population. This includes those who were directly affected by COVID-19 and those who may have delayed services to prevent hospitalization. Additionally, throughout the NY Metro region, hospital systems are reporting a significant population requiring prolonged mechanical ventilation. In the meantime, some of our more traditional clientele, may be seeking alternative courses for their rehabilitation recovery. As post-acute care providers, we have seen this trend over the past 5-10 years but will now need to push our clinical skills even further.
  2. How is our organization positioned to handle the changing role of population health? The Centers for Medicare & Medicaid Services has provided the 1135 three-day waiver at this time. Through best practice protocols, and partnerships with other post-acute providers, we can provide high-quality outcomes without the need for the unsubstantiated three day hospitalization. Additionally, this can be done without exposing potential patients to communal areas like the emergency department or physician offices during the pandemic.
  3. What are our technology capabilities now and into the future? The traditional methodology of rounding to identify changes in status will no longer meet the social distancing guidelines. Therefore, incorporating in potential artificial intelligence technology algorithms will be needed. From a short- term rehabilitation standpoint, how will you involve families and caregivers to ensure a safe transition? Use of technology for family training, home safety evaluations and discharge education need to become the new standard of practice. Additionally, while therapist are accustomed to being hands-on, what can we do to limit potential exposure to our residents and staff? Technology provides options for minimal lift environments, gait analysis, etc.

Change is not new to therapists or other post-acute care providers. We have seen dramatic changes in our reimbursement models, regulatory requirements and outcome measures. While none may be as dramatic as we currently face with the COVID-19 pandemic, the same principles of adapting remain. As a patient advocate, clinician and leader, I suggest “reinventing rehabilitation and wellness” become the new norm as opposed to just accepting what is handed to us.

David Siegelman is vice president of rehabilitation services for RiverSpring Health in Riverdale, NY.