Before explaining what makes Rehab Without Walls ® home and community neuro rehab different from home health care, we must note upfront that one program is not better than the other. They just serve different types of patients. So how do you determine which option is more appropriate? For this blog, we’ve asked two staffers who have worked both in both settings to share their thoughts: Cathi Peterson, the specialty account representative for Nevada, and Dana Eriksson, a speech-language pathologist based in Phoenix.
“One of the biggest differences between [home and community rehab] and traditional home health care is that in order for a patient to receive home health care, he or she must be considered to be homebound,” says Peterson. “That is not true for us. We require the patient to be medically stable with a potential for rehabilitation. We work with a very different population and our goal is to actually get them out of the house and back into an active, productive life. We create and implement a program tailored to achieve a functional outcome for each patient.”
With Rehab Without Walls home and community rehab, the setting for therapy includes the home but also stretches into the patient’s broader community. “We like to say we provide rehabilitation wherever life happens,” says Eriksson. “This can include the patient’s home, backyard, neighborhood, supermarket, gym, workplace, school or wherever they go beyond the home.”
The foundation of the Rehab Without Walls home and community rehab program is functionality – setting functional goals that relate to the patient’s real life and using both proven and innovative interventions to achieve those goals. Home health care, on the other hand, may teach patients coping strategies, but it may not be possible to get the patients back into their lives. “It comes down to quality of life,” says Eriksson. “Many of the individuals seen in home health care may not have potential to become independent. At Rehab Without Walls, we focus on life skills in addition to the physical recovery from illness.”
Unlike home health care companies, Rehab Without Walls generally does not accept Medicare for home and community rehab. We work with many private insurance plans, government agencies, the military, MCO’s and workers’ compensation companies. In fact, our model, with its focus on returning to a productive life, is particularly appropriate for workers’ compensation cases.
Home health care generally has shorter lengths of stay; sometimes it offers stopgap measures in-between admission to different facilities or is used directly following a hospital discharge. Patients generally stay with Rehab Without Walls for a longer period of time. The team spends intensive time upfront – as much as five to six hours a day, five days a week, if necessary – then tapers off as goals are met and functionality increases. In addition, home health care is generally delivered in 45 to 60-minute increments. Rehab Without Walls visits can last several hours depending on the focus, for example, a co-treatment or a community outing.
Home health care takes a multidisciplinary approach to care in which each therapist delivers therapy in individual sessions with little interaction with other team members. Notes are usually not shared among the different treating professionals. Rehab Without Walls®, on the other hand, uses an interdisciplinary team approach that may include co-treatments along with ongoing consults, brainstorming and group problem-solving. Team case conferences are held on a monthly basis with all professionals on the case in attendance. Here they meet with the family, report on progress and describe goals set for the next treatment period. The patient receiving the services, as well as family members, has the opportunity to receive feedback directly from treating therapists and provide feedback as far as what goals are a priority. During the treatment process with Rehab Without Walls, there can be more than one clinician working with a patient at a time if that is what the patient needs; in home health care this would be considered duplication of services. Further, in home health care, the case is led by a case manager/nurse and in Rehab Without Walls it is run by a clinical coordinator; both are different specialties with different certifications and different approaches.
Both Rehab Without Walls and home health care work with a variety of diagnoses and conditions. Rehab Without Walls is particularly suited to complex cases with a psychosocial and/or neuropsych component that need multiple layers of care, for example, spinal cord injuries, stroke and traumatic brain injuries.
Physicians can take an active role in the Rehab Without Walls treatment team and are an integral part of the monthly team meetings. Physicians working with home health care companies receive regular patient progress reports but on the whole have less day-to-day input.
Home health care takes a fairly structured approach based on best practices. Rehab Without Walls uses best practices as a baseline then personalizes the plan of care to reflect the patient’s life and goals. This means that no two plans are exactly alike.
“We have a lot of flexibility in our approach as long as it brings results,” says Eriksson. “We specialize in out-of-the-box problem-solving. When developing the plan of care, we are allowed to get as creative as we need to be. For example, we’ll tap into the patient’s hobbies and incorporate them into treatment. This helps with motivation and allows the ability to measure gains post illness or injury.”
Each program uses very different criteria for measuring outcomes. Home health care looks at medical outcomes. Rehab Without Walls looks at functional outcomes. Rehab Without Walls is also concerned with durability of outcomes – for patients to maintain gains, retain maximum independence and avoid rehospitalization. “Rehab Without Walls is extremely outcome focused,” notes Peterson. “Our teams work hard to get our patients to where they both want and need to be in their lives.”