About two weeks ago, OARF (Ohio Association of Rehabilitation Facilities) sponsored a CARF 2013 update provided by Christine M. MacDonell, Managing Director of the Medical Rehabilitation Accreditation Area of CARF.
In this ’2013 New Standards Review’ and discussion of most frequently cited standards and how to comply with intent, Christine brought greater than 30 years of dedicated passion to the art of providing rehabilitation with a focus on quality and results – the foundation and reason any of us entered rehab professions no matter how long ago.
When practicing with expectations driven by rehabilitation professionals and their consumers, rehab providers set themselves apart from the med/surg world of standard acute care practice. This is what CARF standards emphasize; the specialty area of practice intended for the population we treat. We have to recognize our differences and behave and manage the plan of care in the specialized way even we would expect if our loved ones were the patient. Accreditation, although not mandatory, is the level of care being sought in a healthcare continuum that also is focusing on quality and results. If you feel your program has lost touch with that reality, maybe it’s time to realign your mission, vision and values specific to the rehabilitation population you treat.
With pay for performance and outcomes driven expectations, it’s hard to imagine the leap to accountable efficient care if providers continue to drop the rigors expected to treat the specialty populations served in an inpatient rehabilitation unit. Whether that unit is small or large it is the population served that deserves the unique care provided by the interdisciplinary team. The workflow and documentation to support that unique level of expertise is often lost or not evident in the standard ‘med/surg’ linear documented care.
I have heard time and again that units within hospitals struggle to maintain their identity, often railroaded to behave and accept staff without the experience and background of rehabilitation expertise. This makes it even more difficult to fulfill the training and education for the patient and care-givers that often absorb 24-hour patient care in lengths of stays shorter than 16 days. Imagine packing everything we know or have practiced for a specific specialty into a learning curve of two weeks or less – keeping patient safety foremost and expecting lasting outcomes without returns to an acute care environment to manage what may have been missed.
Patients are entering rehabilitation units with significantly more ‘burden of care,’ higher acuities and functional impairment that leaves them mostly dependent on the caregiver in greater than half of their ADL functions. The rehab level of care may not have the intensity of a one-0n-one critical care unit but it does have the hands on intensity to provide significant input and practice to the 12 mobility and five cognitive areas significantly impaired in the populations treated.
If the interdisciplinary team is truly not acting in concert with all expectations that create barriers to the anticipated discharge plan, how is that focus providing results and how will your outcomes meet expectations? In revisiting CARF standards, these core concepts and intents emphasize the unique practices and expectations toward our professional standards and intent. Practicing toward those expectations leaves no doubt that the level of care is uniquely special to the profession of rehabilitative medicine – returning the patient to the community as often as possible with less impairment and a plan to manage residual needs with the resources available.