By Barbara Brewer La Mere
This year marked the beginning of a contractual agreement between Glens Falls Hospital and MileStone Healthcare for MileStone’s management of the hospital’s 15-bed acute rehabilitation unit.
MileStone, a company based in Dallas, prides itself, says Regional Director of Operations Carol Arment, on being the experts on post-acute care. It has been in operation for 20 years and in that time has opened or managed more than 200 post-acute care units in 19 states, newly arriving in New York state.
Glens Falls Hospital had been serving its post-acute rehabilitation patients well since 2005 and scrupulously following the ever-changing federal regulations regarding post-acute rehab, but sought help from MileStone in taking that care to the next level. That meant getting past the point of feeling only the restrictions of the Medicare guidelines and moving on to celebrating the provisions of the regulations for customizing care to Glens Falls Hospital and its patients in the communities where they live.
Additionally, said the acute rehab unit’s medical director, Dr. Michelle Antiles, despite a great need in the local area for acute rehab without requiring patients to travel toward Albany for rehab and follow-up care, the acute rehab unit was having difficulty in maintaining a full patient census.
Arment said there is “no cookie-cutter approach” to how MileStone works with a particular hospital or other health care venue to help that facility to optimally meet its mission to the people it serves.” The company is able, however, to bring to a particular hospital’s mission “MileStone’s national perspective on how other facilities address issues, streamline paperwork, and meet the regulatory requirements. They bring an outside expert opinion, as well, to expressions of need that the unit may make to the hospital or the community.”
She said MileStone Healthcare tends not to be self-promoting in the facilities where it provides services, regarding itself as part of the full interdisciplinary team of hospital employee clinicians, striving for a perception of a seamless continuity of services. Nationally, MileStone Healthcare, in addition to providing management of acute rehabilitation units, provides consulting and management for long-term acute care services, to help hospitals most effectively provide care for patients whose conditions may remain acute for extended periods of time.
They provide nurse staffing services to hospitals, nursing homes and even a few schools. MileStone also works with hospitals and nursing homes to establish and effectively manage systems to meet the needs of geriatric patients with serious psychiatric disorders.
Both Arment and Acute Rehabilitation Unit Program Director Jennifer Bourque used the word “phenomenal” to describe the staff at Glens Falls Hospital with whom they work, with Arment going on to say that they are “people with their hearts in the right place for all the right reasons.”
Dr. Antiles said nurses, occupational and physical therapists, and speech/language pathologists were “exceptional” people, “very vested in the care of every patient, who like coming to work.” Bourque added she is quite impressed with the level of professionalism and caring among staff.
Antiles is a strong advocate for rehab services to be as locally available as possible. Especially with the aging population, some of whom no longer drive or are unable to drive until their rehabilitation has progressed. Trips from the rehab unit to relearn maneuvering one’s way around grocery stores, beauty salons, churches, and other community locations are much less relevant when they are not the ones in which the patient will actually travel once returned their own community.
From the time a patient is admitted to Glens Falls Hospital with a condition, whether it be a severe injury, stroke, or heart attack, or for a surgery with significant post-surgical recovery issues, the clock is ticking, said Bourque. Studies have shown that the sooner intensive rehabilitation services are begun, the sooner the patient will return to optimal levels of functioning.
A case manager will send a message to the rehab unit that a patient has been admitted who seems to be a candidate for acute rehab, she explained. Physical and occupational therapists, and speech/language pathologists, if applicable, do evaluations. The case manager talks with the patient and screens him or her to establish whether that person will meet the rehab unit’s criteria of being able to tolerate three hours of daily therapy six days a week and demonstrating a need for 24-hour nursing and ongoing doctor supervision.
The case manager is then in contact with Dr. Antiles to review the patient’s case. If there seems to be a good fit, a bed offer on the rehab unit is made.
Once that patient is sufficiently stabilized, they are released to the rehab unit, where, said Bourque, “Discharge begins on the day of admission.”
Patients are expected to dress themselves daily, learning, sometimes from an occupational therapist, whatever adaptations to dressing and other activities of daily living may be required, as a result of their illness or injury, in preparation to returning home at an optimal level of independence.
Nurses on the rehab unit encourage patients to care for themselves and to plan and think through safety issues before acting. Considerations are taken in therapies for such specific personalized details as on which side of the bed a patient gets in and out at home, and how many steps they need to negotiate areas within their home. Patients’ families are involved in discharge planning discussions to see ways in which the patient’s caregiver may need to be supported.
Interfacing with community agencies regarding needs for continuing therapies, home care, or environmental modifications within the home all take place before a patient id discharged. There are trips to community venues the person is likely to frequent, in order to see what adaptive considerations may need to be made. There may be suggestions of ways in which a venue can make itself better accessible to people with disabilities.
A typical day on the acute rehab unit becomes very quiet around 3:30 p.m. when most patients have had their three hours of therapy. Patients who may be who may be a little too gung-ho in their approach to regaining independence are reminded that adequate rest and good nutrition are also important components of their recovery. Those who may be discouraged with slower progress may be referred for counseling. Late afternoons and evenings are times for relaxing and receiving visitors.
The regulations for the unit require that there be 20 hours of physician contact on the unit weekly with 24-hour on-call availability. Dr. Antiles is a physiatrist, an M.D. who has completed a three-year residency in physical medicine and rehabilitation following her internship. She is part of the Adirondack Rehabilitation Medicine practice and is under contract to MileStone Healthcare for the provision of the 20 hours of care weekly.
Drs. Todd and Shawn Jorgenson of Adirondack Rehabilitation (who are brothers) provide on-call availability along with Dr. Antiles. Prior to the arrival of MileStone Healthcare, Antiles had primarily worked on the hospital’s rehabilitation unit, so it was most appropriate that she should be the physician dedicated as MileStone’s medical director on the unit.
Bourque has worked in health care for 20 years as a speech pathologist who has worked in various hospital speech departments and has had supervisory experience, taking a very interdisciplinary approach to working with team members representing other therapies.
Meghan Miskinis is a MileStone Healthcare coordinator whose position involves assessing patients from the Glens Falls area who are acute care patients at Capital District and other area hospitals. She talks to them and their physicians and family members about the possibility of coming to Glens Falls Hospital for acute rehab therapy in a location closer to home.
Word of the local hospital’s excellent quality of rehabilitative care has reached far enough away that there have recently been incoming referrals for patients at Fletcher-Allen Hospital in Burlington, Vt., and Dartmouth Hitchcock Hospital in New Hampshire, according to MileStone.
Miskinis will also be responsible for marketing Glens Falls Hospital’s acute rehab unit in the local community, through presentations to community groups and providing opportunities for people to learn how to prevent injuries that could result in hospital admission.
Additional information regarding MileStone Healthcare can be found at milestonehealth.com. Arment can be e-mailed at carment@milestonehealth.com Specific questions regarding the acute rehabilitation unit at Glens Falls Hospital or inquiries regarding Miskinis’s availability as a speaker may be addressed to Bourque at 926-9186.