Case Study: The Emerald Peek Rehabilitation and Nursing Center (October 2017)

Patients Age: 77
Admission Date: 10/26/2016
Admitted From: Hudson Valley Hospital Center
Discharge Date: 10/28/2017
Discharged To: Assisted Living Community
Length of Stay: 367 Days
Reason for stay: Admitted for palliative care

Details of Experience:

When Judith Herbst came to The Emerald Peek Rehabilitation and Nursing Center, she was admitted through our Palliative Care Program. She was stricken with uterine cancer and expected to be with us for one to two days at most. Her family came from across the country to be with her. We made her comfortable and created a separate living environment for her family, including a microwave, couch, bed and round the clock food and drink service. Her family told us stories of how fiercely independent Judith once was and how tough it was to see her like this. When Judith began to show improvement after the first week, we brought the interdisciplinary team together and met with the family. The family was told of the team’s decision: She should not be on palliative care; she should transition to be a sub-acute rehabilitation patient. When we informed Judith of this, she stated, “All I want to do is walk. Please, get me up and walking.”

Months 1-3 of the Patient’s Stay

Once Judith became strong enough to come off of palliative care, the team knew two needs for Judith had to be addressed: socialization and rehabilitation. Our Rehabilitation Director ensured that Judith’s Rehabilitation plan had reachable short term goal, but with one long term goal in sight: ensure Judith could ambulate independently. Our Physical Therapist, Tom, set short term goals of bed mobility with supervision and becoming able to sit and stand. Within her first four weeks, Judith was able to sit and stand with minimal supervision and able to perform bed mobility with a minimal assist of one person. Within the next three months, Judith continued her strengthening; including improving her balance and becoming able to perform bed mobility with only supervision. These two tasks lowered her fall risk and helped her improve her confidence and self-esteem.

Socially, Judith was moved into a semi-private room with a roommate who shared a lot in common with Judith. Judith also attended many activities, including graduating from our three month “Lifelong Learning” Program, where she attended classes on gardening and cooking, which are two passions of hers.

Months 4-11 of the Patient’s Stay

Judith continued her challenging rehabilitation program, with short term goals set at being able to stand and pivot in and out of bed to her wheelchair minimal assistance and continuing to improve her standing balance from Fair to Fair+ unsupported. Her long term goals were now set: Ambulate 100 feet with the assistance of a rolling walker, improve her standing balance to from Fair+ to Good- and improve her core strength, which would allow Judith to transfer in and out of bed fully independently without the aid of a positioning bar. Over the course of the next few months, Judith surpassed everyone’s expectations. Not only did Judith meet her short term goals, she far exceeded them. She worked hard with the Physical Therapy team to be able to transfer in and out of bed to her wheelchair with no supervision as well as improved her standing balance to Good+.

Judith also became a mentor to other rehabilitation patients. She requested to have new admissions stay with her, so she could help them acclimate to the community. Judith also began taking trips out to see family and friends, beginning with hour-long lunches to all-day excursions.

Within a week of Patient’s Discharge

The team has always been inspired by Judith’s determination and commitment to her rehabilitation. It was a joyous occasion for us all when, a week before her discharge date, she ambulated 150 feet with the aid of only a rolling walker. She was also now able to sit to stand with no assistance at all. The team was very honored to be part of Judith’s journey from a palliative care patient to successful graduate of Emerald Peek’s Rehabilitation Program. She was discharged on October 28, 2017. When leaving Emerald Peek, Judith said, “I cannot believe I am going home. It was one year ago when I thought I would have to say goodbye to my family. Look what you all have done for me. I will miss you all so much!”