So last year at this time I was working for an LTACH (Long Term Acute Care Hospital) in Texas. We went from small town Idaho where some of the older client's goals were just to be able to go home and chop their wood for their heat to a megaplex of over 8 million people. Let's just say it was a bit of an adjustment. :)
An LTACH is where someone would go between a hospital stay and a rehab stay. They may need rehab and often transfer to a rehab facility after, but are too medically fragile to get that much therapy. They stay varies, but it can be up to weeks and months. More common diagnoses that I saw were bad infections, respiratory or cardiac failure, trauma, wounds that hadn't healed from surgeries or other issues, strokes, kidney failure and peripheral vascular disease. There were 2 floors, one which seemed to have a little more involved clients than others, and then a 12 bed ICU. I feel like 99% of the people I saw were attached to at least one tube if not ten.
When it's busy, we were running like crazy. I have never ran around
that much at a job, ever. The part I didn't like about that was then we
didn't get to know the clients as well. But when we were slow it was a
whole different story, where you can bring people down a few times for
therapy in a day if they'd like. But, it was most often pretty busy. Our saving grace were the Rehab Techs (aides). They helped us with
getting clients ready for therapy, getting them to the gym, coordinating
our schedules, etc. I couldn't have done my job without mine! We
had heard of other LTACHs that only had 1-2 therapists for a 50 place.
With pretty much all of them expected to therapy. They never were able
to keep up. That is totally impossible and unethical in my opinion. But
anyway, I'll get off my soap box.
Here's what you could expect on my caseload there.....Most everyone had IVs and catheters, a large majority had telemetry monitors. Many had wound vacs and/or oxygen, ports for dialysis or possibly chemo, some even had vent support or rectal tubes. It's a bit overwhelming at first, but you become used to it, as I'm sure they are as well. The one thing I would say that is most important is to have compassion for these patients. They have gone through so much and I feel like by this time, many people grow numb to the situation and either don't expect great care, or don't get it from staff. They've had dozens if not hundreds of medical professionals poke them, question them, cath them, check them, etc., and we need to remember to never forget that they are our number one priority and also that they are people. With stories, families, hobbies, hopes and dreams.
When in the gym we most often did exercise (97110 code to be exact) and also did things like the standing frame with PT and completed upper extremity exercises if able. One of the therapists was excellent at manual therapy, so he did a lot of that as well. When we did therapy in their rooms of people that were more stable, we did dressing or showering, toileting sometimes, transfers, bed mobility, or did exercises there. When they were more unstable, we'd do things like range of motion, sitting at the edge of the bed, and possibly simple tasks like grooming or following commands. Also here we would sometimes put them on the tilt table (if appropriate) and provide a lot of education for the client and their family. Many are very medically fragile, so we are constantly monitoring blood pressure and telemetry. Some of my patients could not even handle transferring to the edge of the bed without their blood pressure going crazy. At times co-treats were totally necessary in order for it to be safe and most effective for the patient. Our CEO/Administrator wanted everyone in the gym if they were able to which obviously isn't appropriate for all, but when they could, it was nice for the clients to see others that were going through similar situations and many formed friendships, shared stories, or had competitions.
Often our patients were put on hold due to their lab values. In the morning, the first thing I would do is check my list, then check those charts looking for that morning's labs. The most common ones I was looking for to be in normal limits were their Sodium, Potassium, INR, and Hemoglobin/Hematocrit. Depending on their diagnoses, I also looked at their White Blood Count, Ammonia, blood sugars, BUN, Creatine, Magnesium, their ABGs (Arterial Blood Gases), and others. We had a little cheat sheet that one of the OTs made that we all wore with our name tag so we knew what to look for which was SUPER helpful. Sometimes we had clients also receiving dialysis (which was in the building, so it was super nice---many have to leave their facility) and they were sometimes too weak or tired to do therapy. Some unfortunately, passed away during their time there as well, which could be a whole different post another time.
I really enjoyed working in this environment, but I think the best part of it was my co-workers. The therapists were all a ton of fun and didn't love everything about their jobs, but their patients were important to each and every one of them and they were always 'client-centered'. They worked as a team and helped each other out whenever needed. I often think back to work there and miss the day to day craziness. But I'm thankful at the same time that I was lucky enough to be with them for 13 weeks. :)