Case Study: Bethany Center for Rehabilitation and Healing (January 2021)

Patient’s Age: 78-years-old
Admission Date: 01/13/2021
Admitted From: Stonecrest Medical Center
Discharge Date: 02/02/21
Discharged To: Home with daughter
Length of Stay: 20 days
Reason for Stay: The patient fell twice at home and had a UTI.
The patient’s daughter met with the caseworker at the hospital, the caseworker referred her to Bethany.

Details of Experience:
Imagine one day feeling great and being independent and the next you feel weak, cannot walk very well, and cannot think straight. That is what Ms. A was experiencing. She shared that, all of a sudden, one day, she woke up and felt weak and did not have good balance. That led her to several falls at home. The second fall she experienced, she hit her head just so slightly. It wasn’t hard enough to do damage, but just enough to leave a little cut on her forehead.

The daughter of the patient took her to the emergency room at Stonecrest, where they diagnosed her with a UTI and that is the cause of her confusion and falls. While at the hospital, she received an IV of Rocephin for the UTI and fluids for her electrolyte imbalance. Ms. A stated she believed she was in the hospital for about four days before being admitted to Bethany.

Upon her arrival at Bethany on January 13th at 5:15 pm, she was greeted by the Care Transition Coordinator Nurse, the Concierge, and the nursing staff that would be taking care of her for the night. The nursing staff completed their initial evaluations, along with the Concierge. The therapy department met with her first thing the next morning. During their new patient evaluation, Ms. A shared that her goal was “to be more independent with daily life”. She said, “I don’t like relying on other people to take care of me”. The therapist assured her that is what they are there for, and when discharged, she would be more independent.

Ms. A was involved in therapy five days a week for one hour a day. Physical therapy set short-term goals for her, which included: perform functional transfers with supervision, safely maneuver in/out of bed, and safely ambulate on level surfaces 100 feet using the rollator, and decrease the risk of falls by increasing her score to a 21/28 on the Tinetti Assessment. All of those goals were targeted to be met by January 24th. Long term goals were also set and include: safely perform functional transfers with modified independence, safely ambulate on level surfaces for 250 feet with a rollator, maintaining good balance, decreasing the risk for falls by increasing her score to a 26/28 on the Tinetti Assessment, and ascend/descend 4 steps x 5 in preparation for her staircase at home. These goals are targeted to be met on January 31st.

Ms. A was very excited to be working with therapy and looked forward to it every day. Due to restrictions, at this time, most of her therapy treatments had to be conducted in her room. On January 15th, Ms. A was able to ambulate around 20 feet inside her room with the assistance of a walker and therapist. She was able to transfer herself to the toilet with the help of a side rail in the bathroom. By January 19th, she was able to ambulate up to 150 ft in the hallway using her walker. She also was able to perform dynamic standing balance activities, such as washing hands, brushing hair, and brushing teeth for one minute at a time. At this point in therapy, she has exceeded her goal of ambulating and performing functional transfers! On January 24th, after meeting all of her short-term goals, physical therapy started implementing her long-term goals, in preparation for her discharge date. Ms. A stated, “I was nervous about the stairs, but I knew they would take good care of me and make sure I was safe”.

She was doing so well in therapy. Ms. A continued to work with therapy every day and meet all of her short-term and long-term goals. The concierge met with her right before discharge and she shared “I am so thankful for all the staff at Bethany that helped me get back to where I was”.

The team wishes Ms. A the best, as she discharges to home.