Case Study: The Paramount at Somers Rehabilitation and Nursing Center (January 2020)

Patient’s Name: Mrs. Deluccia
Patient’s Age: 87-years-old
Admission Date: 09/02/2019 
Admitted From: Putnam Hospital Center
Discharge Date: 01/08/2020
Discharge To: Home
Length of Stay: 128 days
Reason for Stay: Mrs. Deluccia needed skilled PT/ OT services to regain functional independence following a hip fracture and subsequent hospitalization.
How did this patient hear about The Paramount at Somers? How did this patient hear about The Paramount at Somers? From the team at Putnam.

Details of Experience:
Mrs. Deluccia was welcomed to The Paramount at Somers for Rehabilitation and Nursing from Putnam Hospital Center following treatment for a fall at home resulting in a right hip fracture. She needed rehabilitation therapy to address her inability to ambulate and perform functional tasks independently through Physical (PT) and Occupational Therapies (OT).

Week 1- Evaluation:
In physical therapy (PT), Margaret presented with severe pain, abnormalities of gait, decreased functional mobility and strength. She is unable to return home safely and function at her prior level of functioning. She required physical therapy to restore her physical abilities through a variety of exercises for walking, bed mobility, gait training, and safety instruction to address her weakness in mobility strength and gait. She required Moderate Assistance provided by a therapist to perform bed mobility transfers and was also unable to ambulate. In occupational therapy (OT), she was evaluated to have decreases in strength, functional mobility, transfers, range of motion, functional tolerance balance and coordination. With these great deficits, she thus had an increased need for assistance from others. She required total dependent assistance from her therapist to perform transfers, minimum assistance for toileting exercises, set-up assistance for upper body dressing and moderate assistance for lower body dressing. During this treatment period, Margaret adjusted to her therapy routine and needed encouragement and cueing to participate.

Week 2:
In PT Margaret had reported significant decreases in her pain levels with the use of electrical stimulation therapy and she had adjusted well to the environment. She started coming out of her shell a little and was making friends in therapy with other patients. She also became more social with staff during treatments. Her motivation had improved and she was able to participate in gait training on the parallel bars, reaching a distance of 5 feet. She was cleared by her orthopedist to begin range of motion on her right knee. During this week, she progressed from moderate assistance to minimum assistance in bed mobility and transfers. In OT, She required total dependence assistance from her therapist to perform transfers, minimum assistance for toileting exercises, set up assistance for upper body dressing and moderate assistance for lower body dressing.

Week 3:
Margaret remained at the same functional status and required less emotional support and encouragement to perform exercises. She was able to tolerate an active range of motion on her right knee while laying on her back and in sitting positions. In addition, she was able to turn on the parallel bars while maintaining a non-weight bearing on her right leg. Margaret had been enjoying knitting in her room, reading and watching TV when she was not in therapy. In OT she progressed from total dependence to moderate assistance for transfers and lower body dressing and she remained at minimum assistance for toileting.

Week 4:
During this week, Margaret had some episodes of pain during treatment affecting both PT and OT sessions. As a result, she had fluctuating levels of participation during this treatment period. She required cueing by her therapist due to non-weight-bearing status and use of the immobilizer for standing and gait training with contact guard assistance. In OT, she progressed from moderate assistance to minimum assistance for transfers and lower body dressing and she continues at minimum assistance for toileting training.

Week 5:
Margaret reported a significant decrease in her pain, which helped her progress in physical therapy. Despite episodes of abdominal discomfort and headaches, she was able to advance from contact guard to stand by assistance for bed mobility. She continued to require contact guard for transfers because she had difficulty in therapy with following her non-weight bearing restriction. In OT, Margaret remains at minimum assistance for transfers and lower body dressing. She has difficulty with non-weight bearing during OT treatment. According to the recreation staff, Margaret has been making more friends both in and out of therapy at The Paramount. Staff report that she has begun to come out of her room and attend recreation activities!

Week 6:
During this week of treatment, Margaret has been very motivated and participating well in her PT. She had a follow-up visit with her Orthopedist, who approved her for 25% weight-bearing for 2-7 days then she can progress to weight-bearing as tolerated after 1/25/19. In OT She progressed from minimum assistance to contact guard assistance with transfers and toileting training. She is able to stand with the use of a rolling walker for support and complete clothing management (dressing/ undressing). In her visits with the concierge, she appeared to be more upbeat and positive regarding her therapy and expressed her satisfaction with her independent activities to knitting and socializing when not in therapy.

Week 7:
Mrs. Deluccia continued to be participatory and motivated in PT. Her pain had decreased due to improved weight toleration and increased balance since she was able to partially bear weight on her left leg. She progressed from contact guard to supervision for bed mobility and transfers. In addition, she progressed from contact guard assistance for ambulation, which improved from 30 to 40 feet with to stand by assistance.

Week 8:
During this week in PT, Margaret continued to participate well with no complaint of pain and weight-bearing on her right leg as tolerated. Her need for assistance with PT therapy had greatly diminished. She was recommended to be discharged and improved to set up assistance for bed mobility and transfers and supervision for walking with a rolling walker for up to 125 feet. In OT she continued with supervision for transfers toileting and lower body dressing with no changes. Margaret expressed an interest in social services that she wanted to become a resident of the paramount to live long term. Also during this time, Margaret continued to express satisfaction with her therapy and has been attending more activities to include happy hours, music entertainment parties and socials.

Week 9:
Margaret had completed her PT since she had met all of her PT goals for bed mobility modified independence. She continued to discuss with social services the possibility of becoming a long term resident. In OT, she progressed in lower body dressing from supervision to set up assistance and with walking / functional mobility, she has improved to stand by assistance. She continues to require cueing for safety during transfers especially when lowering herself to a surface she had a tendency to drop or plop herself down in an unsafe manner. She is at stand by assistance with her rolling walker and requires cueing to maneuver around obstacles.

Week 10:
During her final week of treatment, Margaret has met both her Physical therapy short term and long-term goals. She remains at modified independence for transfers, bed mobility, stairs, and ambulation. In OT, Margaret progressed to independence with transfers and toileting. She was modified independently with lower body dressing and functional mobility.

In conclusion, Mrs. Deluccia made steady progress throughout her Physical and Occupational Therapy treatments. She was discharged home at modified independence with the use of a rolling walker for functional mobility. She did not require a home health aide for assistance at the time of discharge and was able to complete all PT and OT tasks independently using good safety awareness. She made great progress over her 10-week treatment period. When she admitted she was unable to ambulate, she had a great deal of pain and weakness and was unable to perform any functional tasks without assistance. During the 10 week period, she had a good adjustment, made a number of friends and became involved in many recreation activities. Despite a few setbacks with pain and discomfort, she pushed through her many therapy sessions and made great strides. When she was discharged home, she was walking and performing all of her own functional activities at modified independence. Margaret is a perfect example of the transformation that rehabilitation therapy can achieve. In closing, this success story would not have been possible without the combined support of the other team members of nursing, social services, recreation staff, and concierge. We are very grateful to our patients for choosing The Paramount for rehabilitation and nursing care.