Case Study: The Paramount at Somers Rehabilitation and Nursing Center (April 2018)

Ms. Maren Dochtermann arrived at The Paramount at Somers (at that time Somers Manor Rehabilitation and Nursing Center) on December 15, 2017, from Westchester Medical Center in Valhalla, New York. Ms. Dochtermann came to us with CVA, R MCA thrombectomy, R ACA infarct, and L hemiplegia. She was in acute rehab as of November 2017, and then they referred her to us for short-term rehabilitation.

Within the first 48 hours of arriving at our community, her physician (our Medical Director), nursing, social work, therapy (physical, occupational, and speech), administrative staff, and more greeted Ms. Dochtermann. At the point of admission, Ms. Dochtermann was dependent with all ADL’s. She had left side hemiplegia. Her pain was an eight out of ten while moving and a five out of ten when still. Ms. Dochtermann suffered impairment in balance, sitting endurance, poor trunk control on her left side, and her fine and gross motor skill coordination was impaired. Cognitively, she had difficulty following directions, impaired sense of time and tendency to loop.

For the first quarter of her stay, she was a modified max assist due to general lack of motor skills and pain. She was able to reach down and pull up one side of her pants with max assist. All ADL’s were max assist. She was able to ambulate 30 ft. along the hallway handrail with three people attending her. Ms. Dochtermann remembers her first shower as a scary experience tempered only by Angela’s amazing patience and caring touch.

Within the first few weeks, Ms. Dochtermann had a more regular PT/OT team lead by Tom and Ana, with assists by Joy, Angela, and Jimmy. Anytime she went downstairs to the Essex gym, she was always greeted with respect, support and smiles – even from professionals like Demeris, who was not her therapist but always had a smile. It was also at this time that Marilyn, with assistance by Nicole in speech therapy, worked with her on her cognitive abilities. Ms. Dochtermann was sure to point out that Marilyn was lovely and always had time for her even outside their therapy sessions.

As half of her stay ended, Ms. Dochtermann had increasing right upper extremity, trunk, and right lower extremity strength. Her endurance was improving. Her family was here a minimum of two shifts (4-6 hours) every day. Her attention and memory also improved. Her sitting to standing went from max assist to minimum assistant. Tom and Ana noticed she was gaining confidence in herself and her abilities. Her ambulation increased to mod-assist and was able to walk one step on the parallel bars. ADLs were now at a moderate assist.

The third quarter of her stay showed incredible improvements. Ms. Dochtermann cognitively could focus on the task. She had movement in her left wrist and digits. She was now ambulating 50 ft. with a narrow-based quad cane (with moderate assist). She showed active movement in her left elbow and some movement in her left shoulder. Ms. Dochtermann was able to grab and lift a cone from one side to the other!

Ms. Dochtermann wanted to be sure to recommend the outstanding care provided by two nurses’ aides, Diana and Gladys. She says it was their gentle but firm care that made her feel safe, and therefore able to focus on her physical recovery. They both encouraged her to perform more tasks on her own and helped her gain her independence. In addition, she was impressed by Adu, a certified nurse’s aide, who’s ten years of experience meant she knew what she was doing.

During the last quarter of her stay, the therapy staff continued to educate three key family members and their home health care worker on how to transfer (precautions needed with left arm extremity), walk, perform ADLs, and more.

Ms. Dochtermann’s daughter-in-law Christina said, “She learned to really trust Ana and Tom. She went from not being able to hold her head up to walking across the entire room, out the door, and to her room!” Within three days of her discharge, all ADLs and transfers went from min assist to contact guard. She was able to ambulate 125 ft. with a narrow-based quad cane. She was able to negotiate three ½ steps and two whole steps with a right handrail. Ms. Dochtermann developed a rapport with Kamal (nurse on the unit) who was always quick with her humor, treating her more like a friend than a patient. Ms. Dochtermann’s daughter, Elke, observed that Kamal humanized their relationship and successfully transcended a nurse/patient paradigm to one where both parties could accept each other as people, a nuance hard to come by in a busy rehabilitation center. She further stated that all of the staff seemed to give a little something extra, from the special flare from the food delivery employees that took pride in delivering a nutritious meal, to housekeeping, who were always sensitive to the needs of the patient and were quick to withdraw and return later as appropriate.

Ms. Dochtermann also thought it worth mentioning, that her room was covered in signs by the end of her stay. Her daughter would write or draw out two sayings, riddles, jokes, or one-liners that were hung on the wall and the window. It was intended to help Ms. Dochtermann with her left side visual occlusion that improved during her stay, as well as give her something to think about and thwart her tendency to loop. As the days passed, new signs were added until an entire wall and door were covered. Everyone who went into the room couldn’t help but smile and laugh. Ms. Dochtermann insists that her ability to laugh, goaded liberally by her daughter, is a driving factor in her rehabilitation.

Ms. Dochtermann’s attention, safety awareness, trunk strength, standing endurance, balance, range of motion, and active movement in her upper left extremity all improved by leaps and bounds while here at The Paramount. Upon discharge, home arrangements with Visiting Nurse Association of Hudson Valley were confirmed. Her pain while moving a five out of ten and no pain while still. Christina said, “You all helped her develop from a really terrifying place to a much more capable place.” We here at The Paramount are honored to have given Ms. Dochtermann the care she deserves!