Sherri-Chronic Care 慢性护理

Introduction and Context

• Speaker 1 acknowledges Laura and a dietitian and OT's absence
• Focus given to insights into long-term and post-acute care for patients awaiting facility or home care placement
• St. Joe's Hospital retrofitted a hotel with two-patient rooms and recreation space
• The retrofitted hotel helped with overflow due to behavioral issues, high care needs, or lack of support

Post-Acute Care Programs

• Post-acute care are programs within hospitals for patients needing enhanced services, but not acute care
• Programs on specific floors tailor care for patients not ready to return home
• Programs are referral-based using SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound)
• Complex Care is a program focused on patients needing wound, palliative, or specialized equipment care, in stable condition
• Rehab Program provides faster-paced rehab for more independent patients, like those recovering from fractures or joint replacements; it lasts 3-4 weeks

Patient Demographics and Needs

• Post-acute care patients often have complex medical histories, such as neurological conditions, end-stage kidney disease, or long ICU stays
• Patients may present with multiple comorbidities, leading to individualized care
• Functional decline, especially in seniors, leads to rehabilitation to regain independence
• Decline can occur by a combination of physical, cognitive, and emotional factors
• Some patients become institutionalized after long hospital stays, requiring boundary-setting and emotional support

Role of Recreation Therapists

• Recreation Therapists (RTs) provide crucial post-acute care through personalized interventions
• RTs improve patients' physical, emotional, cognitive, and social well-being through structured activities
• Interventions include group and one-on-one sessions, and discharge planning
• RTs create individualized care plans based on assessments of patients' interests, abilities, and goals
• RTs collaborate with healthcare professionals like physiotherapists, occupational therapists, and dietitians
• Activities are scheduled such that they complement physical therapy sessions
• RTs help patients manage emotional challenges through support and promoting leisure activities
• Activities like painting, pottery, and music therapy help patients express themselves and cope

Discharge Planning and Community Resources

• Most patients discharge to homes, but RTs create discharge plans for patients needing high supervision
• If family works during the day, RTs may suggest day programs or home care services
• RTs assess patients for community day programs, considering language barriers, travel distance, and wait times
• RTs often communicate with programs for smooth transition and share relevant patient information pre-discharge

Specific Recreation Programs

• Group Programs engage the physical, social, emotional, cognitive, and spiritual
• Pottery, painting, and trivia focus on meaningful activities to promote patient well-being
• Physical Programs use creative approaches such as pottery
• Physical Programs incorporate physical benefits without patients realizing it such as hand strength and coordination improvement
• Adaptive Programs ensure participation for patients with physical limitations such as bariatric patients needing designated spaces or special equipment
• Community Integration mimics community-based programs like the Hamilton Public Library or senior centers
• Leisure education prepares patients for life after discharge with resources and activities

Challenges and Adaptations

• COVID-19 forced recreation therapists to rethink programs
• Pandemic forced recreation therapists to limit group dining, created virtual programs
• Recreation therapists had to adapt programs to safety protocols and maintain social interaction
• Programs are adapted based on patient energy levels, medical conditions, and emotional states
• Patients undergoing dialysis may do better with afternoon activities
• Recreation therapists emphasize flexibility with program schedules and activities based on patient feedback or changing conditions

Team Collaboration

• Recreation Therapists attend daily huddles, rounds, and family meetings as part of the allied health team
• Recreation therapists collaborate with other healthcare professionals for holistic care
• Communication with team members is crucial to coordinate care and avoid scheduling conflicts
• Asking physiotherapists to see a patient before a group activity ensures the patient is physically ready
• Recreation therapists advocate for recreation therapy, promoting leisure and recreation in patient well-being and recovery

Documentation and Scope of Practice

• Recreation Therapists document interventions, including group notes, one-on-one sessions, assessments, and discharge notes
• Documentation is essential for tracking patient progress and ensuring continuity of care
• Documentation done through the hospital's electronic charting system ensures all patient interactions are recorded and accessible to the team
• The electronic charting system helps recreation therapists communicate with healthcare professionals and update patient progress.

Examples of Successful Programs

• Engaging patients physically and creatively, pottery boosts self-esteem and accomplishment
• Painting can be adapted to skill levels and abilities and becomes a therapeutic outlet
• Trivia is a modificable cognitive and social activity, tailored to patients' interests
• Therapy dogs and music enhance patient engagement and provide support and reduce stress for patients

Emotional and Psychological Support

• Recreation therapists help patients navigate grief, loss of independence, or changes in family dynamics
• They provide a safe space for patients to express their feelings
• Programs designed to promote emotional well-being and normalcy by connecting patients to others and reducing loneliness

Leisure Education and Discharge Planning

• Recreation therapists focus on leisure education to help patients reintegrate into the community, by teaching about local resources
• Local resources include community centers, libraries, and recreational programs
• Discharge planning involves assessing patient needs and connecting with resources: day programs, senior centers, etc
• Recreation therapists collaborate with social workers and home care coordinators

Adaptive Equipment and Supplies

• Equipment ensures all patients participate in activities
• Equipment includes cardholders or specialized seating for bariatric patients

Rapport Building and Patient Engagement

• Building rapport comforts patients, especially those discouraged or low
• Gradual patient engagement through a low and slow approach allows comfort and support
• Simple, low-pressure activities transition to more complex tasks as patients become confident and engaged

Conclusion

• Recreation therapists in post-acute care are flexible, adaptable, and creative, by adjusting programs based on patients' needs
• Their role extends beyond physical rehabilitation to include emotional support, leisure education, and discharge planning, as well as patient transitions back to the community
• Collaboration with the healthcare team and community resources is essential for comprehensive care and patient transition

Therapeutic Recreation in Post-Acute Care – SJHH

• Sherri Llewellyn presented the Therapeutic Recreation post-acute care information for SJHH
• TR at SJHH locations include Charlton (Complex Care, Rehab, ALC, Medicine, AMH), SHF, and West 5th, with approximately 55 therapists
• Post-acute care programs at SJHH are specialized and referral-based
• Patients in these programs are no longer "medically active"

Types of Post-Acute Care at SJHH

• Complex Care is up to a 90-day stay for medically stable but complex patients
• Rehab is shorter at 3-4 weeks
• Alternate Level of Care is a variable stay, as patients wait long-term care or other placements

Common Diagnoses in Post-Acute Care

• Hip/Knee fractures or replacements, end-stage renal disease, complex medical concerns
• Neurological conditions, Infection/Sepsis, physical deconditioning

Impact on TR Interventions

• Limited room time due to wound care, seating needs
• Dialysis schedules & side effects, pain & pain medication times
• Balancing TR with other therapy needs and psychosocial factors such as low mood, health and adjusting
• Medication effects & institutionalization, mental health considerations due to secondary diagnoses or pre-existing conditions

TR Intervention Examples

• Group & 1:1 interventions, group programs on physical, cognitive, emotional, social and spiritual health
• Independent leisure resources, leisure of education to prepare patients and allied health team collaboration (meetings & documentation)

Therapeutic Recreation Considerations

• Programs are organized with consideration of time of day, and adapting groups for individual or smaller formats
• Variable session lengths
• Consideration of program and activity through sensory, family, adaptive equipment, building rapport and mimicking real-world activities

Working in an Allied Health Team

• Seating Tolerance as Nursing & OT mange skin and recreation therapists enhance with engagement
• Dietary & feeding considers dietitians and recreation therapists, where TRs ensure safe food consumption during activities
• Psychosocial and Cognitive: support provided through social workers, TRs for famiy
• Observe group participation, assess physical abilities