There’s No Place like Home
In this episode of Kessler Foundation's podcast, Uri Adler, MD, at Kessler Institute for Rehabilitation, presents “There's No Place like Home.” This podcast will focus on communication, motivation, spatial neglect, sleep issues, bowel and bladder management, and community integration.
This is part one of an eight part series. Listen to the series as it's posted.
Below is an excerpt from the lecture.
I'd like to welcome everybody. My name is Uri Adler. I'm the medical director at Kessler in Saddle Brook. I'm also the director of stroke services for all of Kessler. Kessler has four different hospitals in New Jersey. The theme of our conference today is “There's More to Getting Home than Walking.” And I think most of the lectures you'll see will somehow loosely fit into that theme. And we're trying to show everybody all the different things that have to be done-- or some of the different things that we can do to try to get our patients home. This block that we're having this morning-- I'm going to talk a little bit about discharge and terminations. Where do patients go from the acute care hospital, from a rehabilitation facility, and some of the barriers we have, and what we have to do to get them home in general. And following me, we'll have two lectures from-- well, three lectures from our experienced therapists: two of them by Gretchen March, one of them by Arielle Resnick. And at the end of my lecture, if I don't introduce them, just remind me and I'll tell you how this is a nice little block.
History of Rehabilitation
We're going to start out a little bit historically and talk about how things used to be, so in the good old days of rehabilitation. So maybe I started a little bit after. I've been working with Kessler for about 17 years. Before that, I did residency for five years. I have about 22 years-- and medical school before that-- mid 20 years of experience of stroke patients and where they were going. But we're going to talk about maybe a little bit further back than that and go through the years and see how things have changed. Things have changed a little bit over the last 20 years in stroke rehabilitation. So as you know, most people who have a stroke - this is still what's happening - people will go to an emergency room. Usually, they'll get admitted to the hospital for at least a short time. And then from there, we have to decide what to do. And of course, a lot of the decision about where that patient gets the rehabilitation depends on how severe the stroke was. And that's probably the overriding issue that hasn't changed so much. There have been some changes. I think the advent of TPA and our care in acute care hospitals has gotten a lot better. And people are getting better faster. And a lot more people are staying in the acute care hospital for a lot less time. And a lot more people are going home straight from the acute care hospital, which wasn't necessarily the case even 20 years ago. But how do we decide what to do? How long do they stay in each level of care?
Post-Acute Care Rehabilitation
So we're going to talk about post-acute care rehabilitation through the year. Post-acute just refers to any level of rehabilitation that you're getting or care that you're getting after your stay in an acute care hospital. And that term is used for a lot of different reasons.
So I think most of us know what a stroke is even if we can't give you the exact definition. But we know it's an acute onset of a vascular event that affects your brain that causes neurologic deficit. And it actually, as I think most of us know, is the most common neurologic problem that causes hospitalization in the United States. An ACH is what we refer to in the slides, acute care hospital. So those are places like Hackensack, like Holy Name, like Valley, where patients will go when they have acute medical issues and have to be hospitalized. These are our traditional, what we call, hospitals. An IRF, or an in-patient rehabilitation facility, is a place like Kessler. An IRF, or an acute rehabilitation facility some people call them, is classified as an acute care hospital. But it's a little bit of a specialized hospital. We're not like Hackensack Hospital where you go when you're having a heart attack. You come here for therapy. But we're treated by the government, as far as compensation, and we're classified as an acute care hospital. We're not classified as a nursing home.