Case Study: The Paramount at Somers Rehabilitation and Nursing Center (January 2019)

Patient’s Name: Steven Casado
Patient’s Age: 33-years-old
Admission Date: January 4, 2019
Admitted From: Hudson Valley Hospital Center
Discharge Date: January 25th, 2019
Discharge To: Home
Length of Stay: 22 days
Reason for Stay: Muscle weakness, abnormality of gait and mobility, acute appendicitis with localized peritonitis, COPD (Chronic Obstructive Pulmonary Disease)
How did this patient hear about The Paramount at Somers? Communication with case manager.

Mr. Steven Casado entered Hudson Valley Hospital Center on December 17th, 2018, for a laparoscopic appendectomy complicated by pulmonary edema and ARDS (Acute Respiratory Distress Syndrome) which resulted in requiring mechanical ventilation. Previous to hospitalization, he was living at home with his parents and employed at the Veterans Administration in Montrose, New York.

Steven was referred by the hospital case manager and came to our community, The Paramount at Somers Rehabilitation and Nursing Center, for rehabilitation therapy for muscle weakness to regain his strength, balance, mobility, and functioning so he can return home.

Upon evaluation from physical therapy, he was unable to ambulate. He was transferring at a minimum assistance (Min A) level from his wheelchair to bed, on all surfaces, and needed extensive assistance with rolling side to side, supine to sitting and sitting to supine. He was unable to support himself via dynamic balance and needed a rolling walker to stand upright.

One of the most important obstacles that Mr. Casado needed to overcome was to successfully complete walking 10 steps so he could get into his house. In addition, he could not be safely discharged home with a wheelchair since his home is not set to any Americans with Disabilities Act compliances/standards.

Moreover, when evaluated by occupational therapy, he had a decreased ability to perform lower body dressing, complete toilet transfers and standing to complete hygiene and grooming and standing for all activities of daily living (ADLs). He also had decreased mobility secondary to neuropathy in feet, foot drop and overall weakness due to his recent surgery. Steven progressed through three distinct stages of treatment and intervention.

During week one, Steven worked on standing, walking, reaching exercises, and ADL exercises. He also was given bilateral ankle-foot orthotics (AFOs) to assist with his foot drop. In addition, he was given electronic stimulation (E-Stim) therapy to passively contract and strengthen his leg muscles.

During his second week, he became more medically stable and made improvements to include: ambulating with a rolling walker, standing with a rolling walker using one hand to balance and successfully completing lower body dressing. During his third week, he was able to ambulate with moderate independence with AFOs in place, improve balance further to using one leg, and was able to climb stairs.

Steven worked really hard in his therapy sessions, working on standing, walking, and reaching exercises. During this time his progress was slow but steady. He continued with his exercises as prescribed by his therapists in between therapy sessions.

Steven was fitted with bilateral ankle-foot orthotics which greatly improved his foot drop. Aside from therapy, Steven was anxious to make sure he was eating correctly and managing his diabetes. Julie, the patient concierge, partnered with dietary and nursing to ensure his food preferences were met and his medication regiment was explained to him to make him feel more at ease.

During this time, Steven’s medical condition became more stable and was able to progress to begin walking with a rolling walker. His balance improved as he was only holding on with one hand and was able to complete lower body dressing on his own. While seated, he was able to dress himself completely unassisted. Steven was determined to follow through on his therapists’ plan of care set out for him daily.

During his last week, Steven made the greatest progress toward his rehabilitation goals. He progressed to walking with a rolling walker with modified independence. His balance improved to standing on one leg with minimal upper extremity support. He was walking around The Paramount with modified independence by using only his walker or wheelchair as an assistive device.

The major success was revealed when Steven was completing more than five sets of twelve 8” steps and was able to be discharged home safely without the use of a wheelchair. He has successfully been able to get himself upstairs, is able to take a shower unassisted, and most importantly -he is able to safely attend his appointments and outpatient rehabilitation now all independently.

Post discharge, Julie reached out to Steven to see how he was transitioning back home. Steven shared he was keeping up with outpatient therapy and exercising at home. He was grateful for the support he received at The Paramount. Steven was very happy with this stay.

He also shared and if he had to come back, he wanted Kamal (Charge Nurse), Michael (CNA) and Renee (CNA) to take care of him. They made sure his stay a good one.

In conclusion, Steven is a perfect example of how commitment, hard work and determination can help you to succeed in your rehabilitation goals. It is at the core of the CareRite mission to provide and foster unprecedented levels of Rehabilitation and Nursing needs to our patients. All made possible by our caring and committed healthcare professionals to get our patients back to their fullest potential.