As a nationwide leader in rehabilitation services, HealthSouth Corporation has been known in the medical community for over three decades and operates 120 hospitals around the nation. In 2015, the company, already present in the state of Florida, expanded to Central Florida, bringing an exemplary level of post-acute care to the region with the opening of HealthSouth Rehabilitaion Hospital of Altamonte Springs. With 12 offices and hospitals located in other regions of Florida it had built a solid reputation for its comprehensive approach to rehabilitation of patients, including those dealing with traumatic injuries that require extensive rehabilitation services. With the opening in Altamonte Springs, HealthSouth provided new options to the Central Florida community, options to benefit patients with acute care needs and their families committed to getting them back home, getting them back their independence and living life to its fullest.
Leading the nation in rehabilitation, HealthSouth accounts for 20 percent of the beds in the nation. The 50-bed, all private room, hospital in Altamonte Springs is often close to capacity, with the hospital seeing over 1,800 patients since it opened its doors in the fall of 2015.
For Robert E. Kent, DO, PM&R, Medical Director of HealthSouth Rehabilitaion Hospital of Altamonte Springs, the numbers are not surprising, it was about filling very specific needs in this area. “We were able to shape our hospital to the population of Central Florida. Rehab beds were at a shortage here with the aging population and the stroke rehab need, those living with multiple sclerosis, local veterans as well as those battling Parkinson’s disease. We decided to keep our approach broad, but at the same time specialize in neurological rehabilitation to focus on these patient populations.”
Dr. Kent, a physiatrist with a subspecialty in interventional pain management, joined the HealthSouth team in 2015. A Central Florida native, he was drawn to the endless possibilities that would result in bringing an established hospital system to a growing and aging community. “Being such a large corporation, HealthSouth has rehab down to a science, we have resources and each hospital can function and operate and focus on specialties needed in our patient population.”
“The Upswing of Medicine”
The Altamonte Springs facility employs a staff of more than 170. Dr. Kent and physiatrists Dana Clark Kuriakose, MD, PM&R, and Eliam Fuentes, MD, PM&R, maintain individual private practices and extend their services to include patients at HealthSouth. They are quick to point out what sets their teams and their services apart. First is clearing up a the misconception, that because “rehab” is in the hospital name, that it is the same as a skilled nursing facility.
“At a skilled nursing facility a patient’s stay is a lot longer and they have approximately three to five hours of rehab a week. At HealthSouth, we are a hospital and as such we are regulated to do three hours of therapy per day,” explains Dr. Kuriakose.
Because of the intensity and scope of services, the average patient stay at HealthSouth is just 10-14 days. The therapy is intentional, focused, multidisciplinary and effective. HealthSouth reduces the number of readmissions to acute hospitals up to 60% better than skilled nursing facilities and home therapies.
“The biggest thing is to educate our patients about is that they’re not going to spend all day in bed. The goal here is to be out of bed, in the gym and working towards independence. For some that is terrifying and for some that is a welcome change,” says Dr. Kuriakose. “We almost take a second seat as a physician, because the real goal is to get their therapies and ultimately transition them home.”
The HealthSouth Patient
Most HealthSouth patients are admitted from local acute care hospitals, although some are referred from home or other long term care facilities. Patients admitted to HealthSouth face complex situations resulting from stroke, spinal cord injuries, amputations, traumatic brain injuries, ALS and neurologic cases. HealthSouth Altamonte Springs is also one of the few facilities in Central Florida certified in LSVT programs designed for Parkinson’s Disease. In addition, the facility is currently seeking Joint Commission certifications in stroke and brain injury.
For all patients though, regardless of their injury, there is a common denominator. Patients and their families must be committed and able to handle the intense rehabilitation they will undergo at HealthSouth.
“If you have a complex patient with many medical co-morbidities, it is a challenge to do therapies outpatient or at home,” explains Dr. Fuentes. “Most patients cannot tolerate home therapies and some think they can’t tolerate three hours of therapy, but many can and they do.”
Before a patient is admitted, he or she undergoes preadmission screening. Nurses do a CMS guideline screening, patients are then evaluated by a physiatrist and physical and occupational therapists.
“Every patient is exposed to multiple therapies. Patients engage in physical therapy and we see how they perform. If they can tolerate it, it’s a good predictor of their success in an inpatient rehabilitation facility,” says Dr. Fuentes.
Planning discharge at admitting
For HealthSouth patients, discharge planning begins at admitting.
“What we want to do is make a roadmap at the highest and safest level possible. Our case managers begin planning ahead at day one. As soon as a patient is medically stable they begin therapy. Research shows that the sooner a patient begins therapy, and starts moving after an acute event, the better they will recover. Ultimately, that is our goal,” says Dr. Kent.
This includes case managers planning ahead for everything from durable medical equipment to dialysis treatments, so that when patients can return home they have everything that they need to sustain their rehabilitation success.
For patients, being part of an acute care facility means that they will move around and benefit from it. HealthSouth prides itself on extremely low infection rates, half the benchmark for national rehab hospitals.
“This is exceptional, especially considering we are working with post surgical patients,” says Dr. Kent. “We also have very low wound rates, thanks to an excellent wound care team that rounds daily.”
The “Team Conference”
At HealthSouth the multi-disciplinary team is charged with executing a road map that will get patients out of their hospital bed and home. HealthSouth has all the specialties of an acute hospital including infectious disease, cardiology, gastroenterology, internal medicine, neurology, neuropsychology, psychology, wound care, nephrology and in house dialysis.
These specialists, comprising the team, meet two to three days per week in what is called the “Team Conference”. Working cohesively as a group in these “team conferences” they ensure that patients are getting all of the services they need to get them home faster, healthy and infection free.
“The ‘team conference’ is similar to a tumor board in a cancer center. We discuss the small things that will impact our patients,” explains Dr. Kent. “We all sit around the table and review a patient’s progress and their benefits and deficits.”
At the table you will find the entire team including the physician, a pharmacist, physical therapist, occupational therapist, speech therapist, registered dietitian, nurse and a case manager. The first team conference takes place within the first week of admission after the patient has fully been assessed. Together the 15-20 members of the team come up with one solidified idea to make a patient more functional with the ultimate goal to start addressing a patients needs early on.
“It’s a meeting of the minds,” says Dr. Kent. “Every portion is so valuable and will help the patient turn the corner.”
Physiatrists – the Quality of Life Specialists
Physiatry is a specialty that began during war time, caring for the military during the first and second World Wars. The physiatrists at HealthSouth point out that while not as well known in the United States as in other countries, it is a specialty that is growing exponentially.
“What we have found in this specialty is that not only do we learn valuable lessons from veterans, but overall better options and outcomes are due in great part to the patients who came before them. Battle wounds became a learning ground for those treating patients with the most profound and traumatic injuries,” says Kent.
For those who have made their careers in physiatry, such as Drs. Kent, Kuriakose and Fuentes, it is a specialty of the heart. Each has a unique path that led them to this field.
Dr. Kent spent part of his residency at the poly trauma unit at James Haley Veterans’ Hospital in Tampa treating traumatic brain injuries. For him, overseeing a patient’s rehabilitation from a devastating injury and observing their strength, and the strength of their families recommitted him to the specialty.
“These patients made me fall in love with the specialty all over again. These patients had multiple traumatic injuries, from TBI’s to spinal injuries, burns and amputations. To be part of the team that helped them find their new normal was incredibly gratifying. I consider physiatrists the quality of life specialists in medicine.”
For Dr. Kuriakose the speciality is incredibly rewarding because she can oversee a patient’s progress. “We get to see patients over a long period of time, their progression and as they move back into the community.”
It was while in residency at Harvard that she treated Boston Marathon bombing victims and witnessed first hand the strong sense of support within the rehab community.
“This support is invaluable for patients. I consider it a privilege to be a part of the team that gives them the physical and emotional tools to regain their independence.”
Dr. Fuentes understands first hand the life changing effects of rehabilitation. At the age of two his daughter suffered a stroke and became a patient at HealthSouth in Puerto Rico.
“I changed my career goals after that. Other specialities don’t have the ability to see the direct results of treating complex issues. My daughter was completely dependent when she became a patient at HealthSouth Puerto Rico. And now, here we are years later, she is a normal 11 year old and has recovered completely. I often share this story with my patients. It helps us create a rapport. I don’t presume to know what every patient is feeling, but I’ve been there in a hospital, crying and I have been in their shoes.”
At HealthSouth, the physiatrists and therapy teams work in tandem, providing an acute rehabilitation facility that offers patients the ability to be monitored and have their therapy directed from all angles. This aids in overall positive outcomes and patients return to an independent, albeit perhaps new normal, life.
The gym, located in the center of the facility, is a focal point of a patient’s time at the facility and boasts the most advanced equipment. Patients can move easily from one modality to the next during their multiple visits to the gym each day. Modalities include partial weight bearing equipment, to gate training, to IREX, a new modality that is a virtual reality therapy system which uses immersive video gesture control.
For Dr. Fuentes and his colleagues time spent at HealthSouth is a critical component to a patient making important strides in his or her recovery.
“I would advise them to trust our care and providers. We have the best therapy teams, we have the best nursing teams and we have an excellent team of doctors dedicated to our patients.”
HealthSouth Altamonte Springs has plans to eventually expand beyond its 50 rooms, to meet the growing needs of the Central Florida community. For its current and future patients, and the Central Florida medical community, Dr. Kent hopes they will embrace the incredible value of acute rehabilitation.
“It’s the upswing of medicine,” he says. “With the work we are doing here, we can make it so patients don’t have problems later on. Very very small things can make big differences later on – think of it as the butterfly effect with medicine.”
With the commitment of its staff, therapists and physicians, HealthSouth Altamonte Springs continues to spread its wings, and reach those with acute rehabilitation needs. In turn they provide patients with a road to recovery in order to return home, to a new normal and regain a level of independence despite their injuries.
By Katie Dagenais