Physician-supervised interdisciplinary team care
During your stay in the Rehabilitation Center you will often hear references to the “team.” This interdisciplinary team individualizes your rehabilitation program to meet your specific needs and those of your family. You will become acquainted with your team members and encouraged to become an active part of the team. The following is a brief description of the role for each member that may be on your team.
You, the patient
You are the most important part of the Rehabilitation Team. The rehabilitation setting is structured to provide you and your family with the ability to become actively involved in the rehabilitation program.
Take charge of your health! Helping set your goals is a major responsibility. You should know about and agree to any major changes in your care plan or goals.
You will communicate and discuss your goals with the Rehabilitation Team, participate in planning for the future following your discharge, and attend family conferences.
We expect you to ask questions, seek information and be the major decision-maker in your own care.
The Rehabilitation Team will help guide you in setting realistic goals.
The physiatrist, a physician who is specially trained in rehabilitation, will monitor and direct your care while at the Rehabilitation Center. The physiatrist will work with consulting physicians, nurses, therapists and other team members to:
- Develop your program plan
- Continually assess your progress
- Order tests and services
- Discharge you at the completion of your program
Rehabilitation Referral/Reimbursement Coordinator
The rehabilitation referral/reimbursement coordinator begins working prior to admission to the Rehabilitation Center to determine if you meet the criteria for admission and can participate in a minimum of three hours of therapy per day. If precertification is required by your insurance, this is obtained before your admission.
Rehabilitation nurses have advanced training and experience working with rehabilitation patients. The emphasis in rehabilitation nursing is to work closely with other members of the team to help you become as independent as possible. The nurses are instrumental in teaching family members how to care for your medical needs. While you are a patient, there may be medical needs that require special nursing care. The rehabilitation nurses are trained to handle these medical situations. Prevention of complications is emphasized in our nursing care.
The physical therapist is trained to work with the skeletal, muscular and nervous systems of the body. The purpose of physical therapy is to increase strength and motor coordination while improving flexibility and endurance. You will practice functional mobility skills such as walking, wheelchair mobility and getting into and out of bed and chairs. The therapist works closely with you and your family to instruct you in proper positioning and movement and to incorporate an exercise program to be continued at home. The physical therapist will make assessments and recommend use of appropriate bracing and walking devices such as canes and walkers, if needed. In some cases, the physical therapist will need to show you how to transfer into and out of a car. The therapist will schedule with your family a time to provide this instruction on using your family car.
The occupational therapist evaluates your physical, cognitive and perceptual abilities and how these factors may affect your independence in daily living. The occupational therapist may provide adaptive devices, teach new ways of performing activities, or try to reduce problems so you may be more independent. Some of the specific functions that occupational therapy addresses are self-care, upper extremity movement, proper positioning, homemaking and barriers in the home.
Persons who have damage to the brain because of stroke, head injury or other conditions often have speech, language, swallowing or other impairments. The speech pathologists will work with you to help reduce these difficult and frustrating problems. Your care may include evaluation and treatment for speech/ language and cognitive problems; a swallowing evaluation if warranted and requested by your physician; and identification of the safest means for nutrition if swallowing problems are found.
Rehabilitation Social Services
Following admission, a rehabilitation social worker will arrange to interview you and/or your family to obtain background information that will be important to the team in tailoring the treatment process and discharge plan best suited to your particular needs. The most important information is how many family members or friends live in the area and will be available, willing and able to assist you when you are discharged from the center. The interview is an opportunity for you and your family to ask any questions, voice any concerns or suggest any needs that have not already been covered by other therapists and services. The social worker can help coordinate follow-up care after discharge by providing you with lists of agencies and services which are available in your community and making the referrals after you have made your selection.
Most patients admitted to the Rehabilitation Center have special nutritional needs. The dietitian evaluates your individual eating habits, dietary restrictions or special nutritional problems and is available to help you and your family understand the basics of good nutrition. Following the dietitian’s recommendations is very important for your health and recovery. Family members and friends are asked not to give any food or drinks to you without first checking with someone on the staff.
Spiritual resources are available to you and your family. Your own clergy is welcome to visit as well. If you need assistance in obtaining ministerial services, please notify your nurse or social worker.
Please call us with questions.
If you have questions about our services, insurance reimbursement or rehabilitation in general, call us. We can be reached at (765) 502-4175 Monday through Friday from 8 a.m. to 5 p.m.