At the forefront of transitional care culture change: Meadowlark Hills' Therapy Suite
In October 2011, Meadowlark Hills (MLH) opened the doors to a new wing within its transitional care household: the Bramlage House Therapy Suite. As the most recent addition to the MLH campus in Manhattan, KS, the suite is having a tremendous impact on resident rehabilitation and quality of care.
Designed for the practice of occupational therapy exercises for patients in transition from skilled care to a home environment, the therapy suite offers a functioning kitchen, dining room, bathroom, laundry area, mock bedroom, and even a small store with products on shelves and shopping carts.
"Instead of working on traditional therapy equipment using traditional therapy modalities, we use the actual things people will use when they get home," says Willie Novotny, president and CEO of MLH. "So instead of working on lower body balance and upper body dexterity, we will actually have the resident practice doing dishes and loading the dishwasher, or getting pots out of the cabinet, putting them on the stove, and mixing ingredients."
Before transitioning to the therapy suite, patients undergo an intensive therapy process similar to what is provided at any traditional rehabilitative setting, Novotny says. Once a certain level of functioning is reached, patients split their rehabilitation time between physical therapy and the occupational components of the therapy suite. MLH has carefully considered each aspect of a patient's length of stay.
"We know that our therapy suite will likely be their first experience with senior services healthcare of any kind, so we want it to be significantly different from the nursing home," says Novotny. "So folks that have had heart surgery or joint replacements or recovery from an acute illness-that's the group we created this for."
Implementing the idea and conceptualizing a design
According to Clay Myers-Bowman, vice president of advancement at MLH, the initial vision for transitional services in Bramlage House belonged to Novotny, who recognized that improvements needed to be made in the area of rehabilitation for patients with age-related decline through acute issues.
"About four years ago we came up with the concept that something different was needed between long-term care and the hospital," Novotny says. "So we decided that we would begin a hospitality-minded recovery center."
The design of the therapy suite went beyond constructing the types of rooms that patients return to once home. The minutest details were considered in conceptualizing the area, down to the copper thresholds separating different floor surfaces.
"We have those in place purposefully so that people can practice navigating over them and getting used to picking their feet up higher than they may have been accustomed to so that they don't fall, reinjure themselves, and have to go back to the hospital," says Novotny, citing vision and balance difficulties as two of the most overlooked aspects of functioning in the world outside of healthcare for seniors.
Intended to be as homelike as possible, the therapy suite allows patients to take baths, make the bed, and perform common activities that were previously their own responsibility at home. Practicing real-life situations while working with an occupational therapist is the basic concept behind the therapy suite, says Robert Dickson, vice president of clinical services at MLH.
"In a skilled setting, occupational therapists are able to address ADLs; however, they cannot address true IADLs unless they have a designated area, which is why we thought it was important to provide that in a therapy suite," he says. "Patients practice those IADLs prior to being discharged so they will be successful upon returning home or entering independent living."
The therapy suite's implementation is a significant achievement in rehabilitation and care, but did not garner much surprise given MLH's track record. The organization dove headfirst into the culture change movement, commencing several initiatives as early as 1997, Novotny says.
"We were among the first in the nation in 2001 to open up our households, which were built out of a complete top-to-bottom culture change model that puts the decision-making power with those who live there," he says.
The effects and the future
Bramlage House offers 20 rooms, with patients receiving care in various sections of the therapy suite.
"Just like in our healthcare households, the commonality that folks living there share is that it's their home. The group mentality, and why the community is so beneficial, is that we're all here to get better," says Novotny. "So that culture is maintained by the people who live there, not just the staff."
The formula appears to be working extremely well. Since opening the therapy suite, MLH has experienced decreased lengths of stay and fewer rehospitalizations, according to Dickson.
And the response from patients and family members goes well beyond numbers.
"People come up to me and say, ‘I don't think that my dad would be alive right now; you guys gave him something to work towards and he knew that he could get back home,' " says Novotny.
The success of the therapy suite has MLH already planning its next rehabilitative initiative, as the organization continues to pace culture change and improvements to patient care.
Eventually, the premise established in Bramlage House will be taken outdoors, says Dickson.
"The therapy suite contains things that people encounter day to day within a home, but we want to take it outside where people can walk on multiple surfaces, go fishing, and garden," he says. "That's where we want to see this go in the future."
In providing an outdoor rehabilitative setting, patients will be able to not only improve basic functioning, but can return to some of their favorite activities, which in turn will fuel their desire to get better, says Novotny.
"If someone enjoyed mowing the lawn, we will have a garden tractor there and part of our therapy program will be in helping that person climb back on the garden tractor to mow the lawn again," he says. "Or if someone liked to tinker around with small engine repair, we'll get a little engine and that will be part of our therapy program. Or if someone is a sculptor or a painter-anything that has to do with a pastime-if we can channel that as our equipment that we use, the therapy will function better because patients will be motivated and focused on being able to do what they enjoy."
That goal will resonate much more strongly with patients than a constant reminder from staff of the eventual need for independent function at home. Consequently, as has been the case with the therapy suite, care will improve, lengths of stay and rehospitalizations will decrease, and the culture change movement will continue to see steady and significant progress for the benefit of patients and the industry.