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Neurology Day Rehabilitation Program (NDR)

Alixis Van Horn, MSN APRN-C Jennifer Nardi, MSPT Dawn Gordon, MOT, OTR/L Rachael Levy, MA, CCC-SLP Neurology Day Rehabilitation Program (NDR) NDR: Evolution Model Program at sister facility Focused on neurological injuries Secondary goal of collecting data Support 3rd party payment for rehab as a clustered service NDR: Development Needs Assessment: Gaps in service Population in geographic catchment Competition NDR: Development Identify stakeholders Build a vision and values Initiate team building Creating culture Skill mix NDR: Values Comprehensive Acknowledge all domains impacted Cohesive Work as a team Holistic Treatment driven by the patient Promote Coordination of Care NDR: Translation of Values Comprehensive: What are the deficits?

party payment for rehab as a clustered service . NDR: Development Needs Assessment: ... 4 weeks – 18 months • Rolling admissions . Barriers to Enrollment • Transportation ... • Resistance to suggestion • Mixed population • Varied interests . Groups • Cooking • Crafts • Tai chi

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Transcription of Neurology Day Rehabilitation Program (NDR)

1 Alixis Van Horn, MSN APRN-C Jennifer Nardi, MSPT Dawn Gordon, MOT, OTR/L Rachael Levy, MA, CCC-SLP Neurology Day Rehabilitation Program (NDR) NDR: Evolution Model Program at sister facility Focused on neurological injuries Secondary goal of collecting data Support 3rd party payment for rehab as a clustered service NDR: Development Needs Assessment: Gaps in service Population in geographic catchment Competition NDR: Development Identify stakeholders Build a vision and values Initiate team building Creating culture Skill mix NDR: Values Comprehensive Acknowledge all domains impacted Cohesive Work as a team Holistic Treatment driven by the patient Promote Coordination of Care NDR: Translation of Values Comprehensive: What are the deficits?

2 What are the goals? Who else is involved? What additional supports and resources are needed? Insert photo of space NDR: Translation of Values Cohesive: Strong commitment to the Program and the team Foster constant, meaningful communication Systems and infrastructure supports Accountability NDR: Translation of Values Holistic: Embracing the patient as a whole person Acknowledging concerns Including family and loved ones Education and support NDR: Translation of Values Coordination of Care: Other HCP s and their plan Referrals Communication of concerns, changes Advocacy Ancillary Services Initial Goals 25 enrollees Stable staff Emerging Goals Ancillary services Offshoot programs Specialize staff Fundraising Ancillary Services Social work Psychotherapy Neuropsychology Massage Driving evaluations Ancillary Services WISH LIST Music therapy Animal therapy Peer counseling Vocational counseling Spasticity clinic Animal Therapy Harbor Grace Outreach Working with UMASS residents Clinical rotations for students Stroke support group Collaboration with Neurology NDR.

3 Screening Neurologic injury Preferably under 12 months since injury No underlying dementia No active substance abuse Active MH dx under care of psychiatrist Continent or with caregiver assistance Physical Therapy Land and aquatic LiteGait LSVT BIG Neuromuscular electrical stimulation AlterG Bionic Leg Simulated environments Occupational Therapy Land and aquatic Task and environmental simulation BTE Simulator II Neuromuscular electrical stimulation Cognitive interventions Driver readiness skills Speech Therapy Cognitive interventions Memory interventions Executive function interventions Dysphagia therapy LSVT LOUD Assistive voice technologies Simulated environments Nurse Practioner Care coordination Neurologic management Seizures, spasticity, depression/anxiety, PBA Education Support for families and patients Additional Offerings Groups Graduation Social outings Program Statistics ~150 referrals, only 5 inappropriate About 60% enrollment rate LOS: 4 weeks 18 months Rolling admissions Barriers to Enrollment Transportation Distance Variable schedule Frequency of appointments Variable onsite time Need for assistance Cost Caregiver burden Stigma Barriers to Enrollment Insurance benefits Medicare: cap for Speech and PT $1940, cap for OT $1940.

4 After cap is reached, will extend to $3700 Only for medical necessity Reduced patient cost in the presence of a secondary payer Barriers to Enrollment Medicaid/MassHealth Visit limits per year or re-assessment period Multiple insurance plans with varying coverage No copay Barriers to Enrollment Managed Care Accept most commercial insurance Policy dependent Visit limits per year or re-assessment period Copay on most primary plans Who We Serve Traumatic Brain Injury Gabrielle Gifford Stroke Dick Clark Metastatic or Primary Tumor Senator Ted Kennedy Movement Disorders Ataxia Huntington s Parkinson's Multiple Sclerosis Spinal Cord Injury Christopher Reeves Others Anoxic brain injury Parkinson s Plus AVM

5 Ruptured aneurysm Seizure disorders Working Census Between 20-25 at any given time Average 10 patients per day Waiting list X 6 months, average of 5 pts Program Challenges Scheduling Group Attendance Staff Retention Program Challenges: Scheduling Fixed supply Variable demand Coverage Program Challenges: Scheduling Accommodating requests Unrealistic expectations Popular time slots are limited Program Challenges: Group Attendance Cherry picking No shows Resistance to suggestion Mixed population Varied interests Groups Cooking Crafts Tai chi Meditation Yoga Coping skills/support Program Challenges: Staff Retention Internal vs. external culture Opportunity for growth Demand for flexibility Pay scale Infrastructure Challenging Cases: KJ 49 yr old MWF, athlete, high functioning, independent Highly motivated patient Anxious family in functional denial Challenging Cases: KJ Unreasonable or unrealistic expectations Transportation Breakdown in communication What We Learned Pay now or pay later Setting realistic expectations Communication is key People adapt to change over time Challenging Cases: CH CH: older, WWF, retired, living independently Poor attendance, short notice changes Unrealistic expectations Challenging Cases.

6 CH Concerns over HCP s motives and intent Suspicions reported to state Family meeting: progress stressed Withdrawal from treatment What We Learned Advocacy can be uncomfortable Try to find common ground Protect the patient Challenging Cases: PM PM: elderly, WWF, matriarch role 3 adult sons Entrenched family relationship dynamics Challenging Cases: PM Lack of buy-in No follow through at home Dissonance about goals Intra-family discord What We Learned Our ability to influence longstanding family dynamics is limited Patient goals drive treatment Meet patients and families where they are


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