Post-Acute Care Hospitals/Units

Overview of Post-Acute Care Hospitals/Units in Massachusetts

MHA MEMBER POST-ACUTE CARE HOSPITALS/SYSTEMS INPATIENT REHABILITATION FACILITIES/HOSPITALS (IRF) Five Star Quality Care, Inc. (System) 1. Braintree Rehabilitation Hospital, Braintree Satellite Braintree Rehabilitation Hospital at Metrowest Medical Center, Natick 2. New England Rehabilitation Hospital, Woburn Satellite New England Rehabilitation Hospital, Lowell Satellite New England Rehabilitation Hospital, Danvers HEALTHSOUTH Corp. (System) 3. Fairlawn Rehabilitation Hospital, Worcester 4. Rehabilitation Hospital of Western Massachusetts, Ludlow PARTNERS Continuing Care (System) 5. Spaulding Rehabilitation Hospital Boston, Boston 6. Spaulding Rehabilitation Hospital Cape Cod, Sandwich IRF UNITS IN ACUTE CARE HOSPITALS 7. The Center for Rehabilitation at Berkshire Medical Center, Pittsfield 8. Weldon Rehabilitation Hospital at Mercy Medical Center, Springfield 9. Bronson Rehabilitation Center at Noble Hospital, Westfield 10. Southeast Rehabilitation Center at SouthCoast Hospitals Group, Fall River LONG-TERM ACUTE CARE HOSPITALS (LTACH) 1. Franciscan Hospital for Children, Brighton 2. Lemuel Shattuck Hospital, Jamaica Plain 3. Massachusetts Hospital School, Canton 4. New Bedford Rehabilitation Hospital, New Bedford 5. Tewksbury Hospital, Tewksbury 6. Western Massachusetts Hospital, Westfield Hebrew Senior Life (System) 7. Hebrew Rehabilitation Center, Roslindale KINDRED HEALTH CARE (System) 8. Kindred Hospital Boston, Brighton 9. Kindred Hospital Boston North Shore, Peabody 10. Kindred Hospital Northeast, Stoughton Satellite Kindred Hospital Northeast, Natick 11. Kindred Hospital Park View, Springfield Satellite Kindred Hospital Park View-Central MA, Rochdale PARTNERS Continuing Care (System) 12. Spaulding Hospital Cambridge, Cambridge 13. Spaulding Hospital North Shore, Salem Radius Healthcare (System) 14. Radius Specialty Hospital, Roxbury Satellite Quincy Medical Center, Quincy

Massachusetts Hospitals Post-Acute Care Hospitals Acute Care Hospitals Statewide Impact* Inpatient Rehabilitation Hospital (based on Fiscal Year 2012 information) 68.78 Average Age of Patients Served 14.8 days Average length of stay for a Medicare patient 11,756 Inpatient Admissions at Massachusetts Rehabilitation Hospitals 365,937 Outpatient Visits at Massachusetts Rehabilitation Hospitals 3,268.20 The number of employees (full time, part time, and per diem but excluding vendors) $21,992,869 Annual employee benefits (full time, part time, per diem but excluding vendors) $177,822,421 Wages and Benefits (full time, part time, per diem but excluding vendors) Long-Term Acute Care Hospital (based on Fiscal Year 2012 information) 67.25 Average Age of Patients Served 25.4 days Average length of stay for a Medicare patient 10,361 Inpatient Admissions at Massachusetts Long-Term Acute Care Hospitals 73,293 Outpatient Visits at Massachusetts Long-Term Acute Care Hospitals 5,607.82 The number of employees (full time, part time, per diem but excluding vendors) $49,137,996 Annual employee benefits (full time, part time, per diem but excluding vendors) $275,971,063 Wages and Benefits (full time, part time, per diem but excluding vendors) *These numbers represent all LTACHs and IRFs in Massachusetts, except for state hospitals and three non-mha-member LTACHs. 1

What is a Post-Acute Care Hospital? Massachusetts is currently home to an array of excellent hospitals providing patients care on multiple levels. When people need surgery or are in serious demand of immediate attention, they turn to acute care hospitals. People who need intensive rehabilitation or long-term care services are able to seek such assistance from a post-acute care hospital, such as a Long-Term Acute Care Hospital or an Inpatient Rehabilitation Hospital. TYPICALLY PATIENTS SEEK CARE IN A POST-ACUTE CARE HOSPITAL WHEN THEY: n have recently undergone treatment in an acute care hospital and need short-term intensive rehabilitation services; n require assistance in recovering from a major medical problem or chronic condition; and/or n need intensive and daily therapeutic or skilled nursing care. However, given the specialized services that post-acute hospitals provide, many patients also come from their local communities including direct admissions from nursing homes, assisted living facilities, or their own residences. These post-acute hospitals provide essential services that are separate and apart from acute care hospitals. They provide aggressive specialized interdisciplinary care to medically complex patients who require extended recovery time. These patients are critically and chronically ill; they come to the post-acute care hospital because they require the kind of care and prolonged recovery time that conventional short-term acute care hospitals are not equipped to provide. Post-Acute Care hospitals prevent the costs and traumas associated with short-term acute care hospital readmissions by rapidly responding to changes in their patients medically complex conditions. After acute-care hospital inpatient care, or through the referral of a primary care physician, patients are able to seamlessly transition into essential inpatient or outpatient post-acute services. PATIENT SELECTION MEDICAL CARE SCOPE OF SERVICES TOP 5 CONDITIONS TREATED* LONG-TERM ACUTE CARE HOSPITAL (LTACH) A patient s primary need is management of multiple system failure. LTACHs specialize in medical management, providing complex respiratory services, complex wound services, and weaning acute patients from ventilators. Patients receive complex medical intervention from specialized professional staff, including 24-hour physician and intensive nursing care. LTACHs treat medically complex patients who, on average, are hospitalized more than 25 days. n Respiratory System Diagnosis with Ventilator n Pulmonary Edema and Respiratory Failure n Septicemia or Severe Sepsis with Major Complications n Respiratory Infections and Inflammation with Major Complications n Skin Ulcers with Major Complications INPATIENT REHABILITATION FACILITY/HOSPITAL (IRF) A patient s primary need is rehabilitation, along with management of complex medical conditions. Care is coordinated through a multidisciplinary team that includes specialty-trained rehabilitation physicians, nurses, and therapists. 24-hour care is coordinated through a multidisciplinary team that includes specialty-trained rehabilitation physicians, nurses, and therapists. IRFs treat acute rehabilitation services for patients who are able to tolerate three hours of rehabilitative services per day for an average length of stay of 15 days. n Stroke n Brain Injury n Neurological Conditions (e.g., Parkinson s Disease, Multiple Sclerosis) n Multiple Trauma n General Rehabilitation (e.g., Spinal Injury) Source: Medicare Payment Advisory Commission (2010) March Report to Congress 2

Acute Care and Post-Acute Care Venues LONG-TERM CARE HOSPITAL ( LTCH ) High INPATIENT REHAB FACILITY ( IRF ) SKILLED NURSING FACILITY ( SNF ) HOME HEALTH AGENCY ( HHA ) Low OUTPATIENT REHABILITATION Post-Acute care hospitals are able to treat patients with a high severity of illness and need providing them with the right care, at the right level, and at the right time. Post-Acute Defined The Post-Acute Care hospitals we discuss in this publication are often referred to in Massachusetts as IRFs, LTACHs, or Specialty Hospitals. Although post-acute is a more accurate description than the others, our hospitals do much more than treat patients following an acute care stay. Patients receive a variety of both inpatient and outpatient services. Outpatient services, in particular, are provided in a clinical setting that helps patients regain function and independence after illness, injury, or surgery. Outpatient services offer individualized treatment programs that focus on improvement of specific functional areas, such as mobility, hand function, or language skills. It is important to know that post-acute care hospitals are subject to the same level of quality, clinical, and operational oversight as short-term, acute care hospitals. LTACHs and IRFs are fully licensed by the Massachusetts Department of Public Health, accredited by The Joint Commission, and certified for participation in the Medicare Program by the Centers for Medicare and Medicaid Services. Post-acute hospitals are able to accept and treat critically and chronically ill patients from different settings. This results in fewer readmissions to acute care hospitals, overall improved quality of life, and reduced costs to the healthcare systems as patients are transitioned out of healthcare facilities and back into the community or home. 3

Post-Acute Care Hospitals: Integral to the Continuum of Care Post-acute care hospitals along with acute care hospitals, the patient s primary care physician, and others are an essential link in the continuum of care, treating the most complex, sickest patients that other facilities often cannot care for. Post-acute care hospitals strive to surpass patients goals and obtain optimal results whether the patients they treat are admitted from an acute care hospital, a doctor s office, or directly from the community. Acute care hospitals have an average length of stay of 4-5 days. Yet many patients require a longer period of time to recover from their injuries or illnesses, or need intensive rehabilitation, ventilator weaning, or care for complex wounds that may require up to two hours per day to treat. Patients who are admitted to a post-acute care hospital spend, on average, more than 25 days in an LTACH or 15 days in an IRF where they receive intensive levels of care. Patients that present to a post-acute care hospital setting have multiple complications. They are too sick to be admitted to a skilled nursing facility and require more specialized resources from an interdisciplinary team that may not be available in a short-term acute care hospital due to shorter lengths of stay. Through their interdisciplinary involvement in the patient s care, comprehensive discharge planning, and increased patient education, post-acute care hospitals are better able to manage patients complex medical needs to successfully transition them back to their homes or community residences. Post-acute care hospitals provide these intensive medically necessary services despite the fact that the Medicaid program in Massachusetts only covers roughly 71% of the cost of the services. Because of their targeted, specialized care, post-acute hospitals lower healthcare costs by reducing lengths of stay within a healthcare facility, transitioning patients home more quickly, and reducing unnecessary readmissions. Such efforts limit the number of Intensive Care Unit beds that are taken in acute care hospitals by long-term, medically complex patients. This in turn ensures that trauma and other critical care patients have appropriate access in the acute care setting. Medicare Spending on Post-Acute Care Services $30 Bil. $20 Bil. $10 Bil. Total Medicare Spending on Post-Acute Services $57.2 Billion Skilled Nursing Facilities Home Health Agencies Inpatient Rehabilitation Hospitals Long-Term Acute Care Hospitals $0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Post-Acute Care Hospital spending as a % of Medicare has been declining and now is essentially flat. Note: Numbers reflect program spending only and do not include patient copayments. Source: MedPAC June 2011 Data Book (Chart 8-2); 2011 Medicare Trustees Report (Table III.A1). 4

System Capacity, Readmission Reduction, and Reintegration into the Community Massachusetts post-acute care hospitals strive to promote quality and accessible care as an integral part of our healthcare system. They continue to see positive, encouraging results as patients receive the correct care, in the correct location, and ultimately, reintegrate into the community and avoid readmissions. 1. SYSTEM CAPACITY While patients come to post-acute facilities from many settings, post-acutes play an especially important role in reducing stresses within the healthcare system. Post-acute care hospitals have the skills, competency, and capacity to care for the ever-increasing complex patients thereby reducing acute-care hospital length of stay and opening up capacity for other acute patients. By directly admitting medically complex patients from Intensive Care Units, Emergency Departments, or the community, post-acute care hospitals ensure that patients receive the appropriate level of care as quickly as possible while simultaneously providing added access for trauma and other patients to acute care hospitals. 2. ACUTE CARE HOSPITAL READMISSION REDUCTION From the moment a patient arrives at a post-acute care hospital, the facility begins to implement an individualized discharge plan to ensure the patient returns to the community with the information, assistance, and skills needed to remain at home, in good health, thereby significantly decreasing chances of readmission. The hospital as well as post-discharge providers work with family members and the patient to educate them on how to best transition back to the community and what follow-up care will include. A thorough psychosocial assessment inclusive of family, social support, and financial need is also completed. Additionally, patient and family conferences and bedside meetings are held to ensure a comprehensive plan is made that the patient and family agree on and which is implemented at the right time in the right setting. Post discharge, the post-acute hospital contacts the patient to ensure he or she is receiving the follow-up care required, as well as to provide further assistance if necessary. Such care has led to positive results; for example, LTACH patients are readmitted 26% less frequently than patients in alternative settings, and quality indicators studied for IRF patients show improved functional abilities post-discharge compared to those patients admitted to other settings. 3. REINTEGRATION INTO THE COMMUNITY During patients stays at a post-acute care hospital, providers assist them in their recovery, ensuring that they obtain the optimal level of health and have the skills necessary to reintegrate back into the community. Reintegration begins while still in the hospital. Post-acute care hospitals have excellent relationships with outpatient and home care providers and set up early referrals for patients. They know what facilities and providers can best assist their patients following discharge and make certain that these patients and providers/ facilities are connected. Prior to discharge, these providers/facilities meet with care managers and attend patient/ family conferences. Upon leaving, patients are armed with a team of providers that help them to continue achieving successful results. Often, this team of providers includes outpatient rehabilitation from the same facility they have just left; such a system allows for seamless, continuous care and optimal recovery that follows National Patient Safety Goals. To guarantee overall success, post-acute care hospitals further assist in the transition to the community by notifying primary care physicians of the patient s move, conducting smooth hand-offs with new providers, and calling the patient shortly after discharge to make sure they are receiving the appropriate level of care. 5

LEFT: Learning to walk: Lokomat Treatment for child suffering from cerebral palsy. RIGHT: Ventilator Treatment for a patient suffering from acute respiratory failure. An Example of an Inpatient Rehabilitation Hospital Case: Stroke Rehabilitation In January 2005, Ian, a 55-year old man who lived alone, suffered a stroke. Following an acute care level stay, he was transferred to an IRF. Prior to the stroke, Ian was completely independent, living in the community and caring for himself. At admission to the IRF, his level of functioning had plummeted. He required maximum assistance, from one, if not two, providers, to perform basic tasks like walking, eating, and going to the bathroom. The IRF assembled a team of providers from different disciplines, including a physiatrist, physical therapists, nutritionist, nurses, and respiratory counselors. This team coached Ian through an allencompassing treatment plan, including speech/swallow treatment, activities-of-daily-living (ADL) training, neuro-muscular re-education, and respiratory therapy. At discharge, Ian was eating a regular diet, could dress himself, and go to the bathroom with minimal assistance. He was discharged home and also received outpatient care. The IRF helped ensure that this was a smooth transition, setting up the needed care and even providing the outpatient treatment that allowed Ian to remain with his same doctors. One year later, Ian is once again fully functional. Ian s Recovery: Before and After Treatment at an IRF 7.0 6.0 The green and blue lines show the level of function before/at admission and after admission, respectively. Zero on the scale means patients need maximum assistance. Seven means they are completely independent and need no help. 5.0 4.0 3.0 2.0 1.0 6 Walk Transfer Toilet ADL Eat 0.0

An Example of a Long-Term Acute Care Hospital Case: Medically Complex Care In 2010, Alan was admitted to an acute care hospital following a motorcycle accident. He presented with a closed head injury, mental status changes, and multiple fractures. His condition was complicated by the post-op need for a gastric feeding tube, multiple split-thickness skin grafts (which uses the two top layers of skin the epidermis and dermis), and positional orthostasis (which is when pulse rate or blood pressure changes dramatically when the body s position changes). At the point of discharge, Alan was non-ambulatory and totally dependent on others for all self-care. Within weeks of being transferred to an LTACH, Alan was able to ambulate greater than 300 feet with no assistive device, required only intermittent assistance with his self-care routine, was able to manage a regular diet, and was ultimately discharged home to continue outpatient care. Alan s Functional Outcome Measure Scores 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Bathing Community ADLs Grooming Homemaking/Housekeeping Lower Body Dressing Safety/Awareness Self Feeding Shower/Tub Transfers Toilet/Commode Transfers Toileting Upper Body Dressing The green and blue lines show the level of function before/at admission and after admission, respectively. Zero on the scale means patients need maximum assistance. Seven means they are completely independent and need no help. To best provide care from hospital to home, post-acute care hospitals use integrated and interdisciplinary care management that is disciplined, personcentered, transparent, and promotes recovery and wellness. This approach enables post-acute care hospitals to provide positive clinical outcomes and quality care, lower costs by reducing lengths of stay, transition patients more quickly, and ultimately reduce unnecessary readmissions. Lynn Nicholas, FACHE President & CEO, Massachusetts Hospital Association 7

Long-Term Acute Care Hospitals Operating in Massachusetts Franciscan Hospital for Children Franciscan Hospital for Children, located in Boston s neighborhood of Brighton, is one of the nation s most comprehensive pediatric rehabilitation hospitals. The hospital offers medical, behavioral and educational services for children with complex issues requiring interdisciplinary care. (www.franciscanhospital.org) Hebrew Rehabilitation Center (HRC) Hebrew Rehabilitation Center s 46-bed Medical Acute Care Unit is an LTACH and serves adults. HRC is nationally recognized as a leader for advanced care and rehabilitation in geriatrics with specialized areas of care in pulmonary, cardiac, and medically complex patients. The Medical Acute Care Unit is accredited by the Commission on Accreditation of Rehabilitation Facilities, provides on-site, 24/7 physician coverage, and is affiliated with Harvard Medical School. (www.hebrewseniorlife.org) Kindred Hospital Boston Kindred Hospital Boston provides care to medically complex patients in its 59-bed facility. Its interdisciplinary team provides specialized care in the areas of cardiac and pulmonary, critical care, ventilator management and weaning, pain and palliative care, complex wound care, neurology, diabetes, rehabilitation, dialysis, post organ transplant, and LVAD/heart pumps patients. Kindred Hospital Boston utilizes a hospitalist model to provide onsite physician coverage. Its specialty consultants come from the major academic medical centers in Boston as well as surrounding communities. Kindred Boston s location has direct access to public transportation, free onsite parking, and is near Boston s finest medical centers. Excellent quality outcomes and high patient satisfaction scores have earned Kindred Hospital Boston its outstanding reputation. (www.kindredbos.com) Kindred Hospital Boston North Shore Kindred Hospital Boston North Shore 50-beds, including an 8-bed Intensive Care Unit focuses on caring for the highest acuity patients in the LTACH industry, including, but not limited to, medically complex, post-traumatic/ surgical care patients. An interdisciplinary team approach to providing clinical care is key to successful outcomes. The hospital delivers a wide range of hospital services, including critical care, telemetry monitoring, 24-hour respiratory therapy, rehabilitation, dialysis, wound care, nutritional support, case management, and onsite diagnostics, such as laboratory and radiology. Board-certified physicians provide on-site, 24/7 physician coverage. Kindred Hospital Boston North Shore is dedicated to Hope, Healing and Recovery. (www.kindredbns.com) Kindred Hospital Northeast Kindred Hospital Northeast provides care for patients who are medically complex and require an extended length of stay. It supports patients through a carefully orchestrated multidisciplinary care approach. Northeast s main campus in Stoughton houses 88 beds, with a 47-bed medical unit and a 41-bed Neuro-rehabilitation Unit for patients who have had a traumatic brain injury. Northeast also has a 23-bed unit in Natick at MetroWest Medical Center. This unit provides the same services as the Stoughton campus, including ventilator weaning and management, dialysis, post organ transplant, complex wound care, cardiac care and IV antibiotic therapy. (www. khstoughton.com) (http://www.khnatick.com) Kindred Hospital Park View - Central Massachusetts Kindred Hospital Park View Springfield supports patients through a carefully orchestrated multidisciplinary care approach. Park View s main campus in Springfield houses 116 beds, with a 28-bed Neuro-rehabilitation Unit, and a 30-bed psychiatric rehabilitation unit managed for the Massachusetts Department of Mental Health. Park View Central MA is a satellite four-bed unit in Rochdale that provides the same services as the Springfield campus, including ventilator weaning and management, complex wound care, cardiac care, peritoneal dialysis, and IV 8

antibiotic therapy. The Springfield campus has 24/7 onsite physician coverage. Kindred Park View Springfield and Park View Central MA model care based on multidisciplinary, patient-centered approach. (www.khparkview.com) New Bedford Rehabilitation Hospital (NBRH) New Bedford Rehabilitation Hospital (a member of Vibra Healthcare hospital system), a 90-bed long-term acute care hospital in Southern Massachusetts (located in the far northern end of New Bedford) provides 24-hour physician coverage and offers both out patient and in-patient hospital services. NBRH specializes in the treatment and rehabilitation of patients that require extended hospitalization for the care of ventilator dependency, pulmonary rehabilitation, complex medical management, and wound care. NBRH also specializes in the latest noninvasive monitoring technology called Volumetric Capnography, which is used to accelerate the weaning process, and has resulted in a 29% reduction in the average length of time patients spend on ventilators. (www. newbedfordrehab.com) Radius Healthcare Radius offers care to patients through its 169 beds in Boston and 38-bed unit with all private rooms in Quincy. The hospital recently opened a new 17-bed private room wing in Boston. Radius offers an innovative medical behavioral program for patients with medical illness accompanied by a cognitive/behavioral/psychiatric component. It also offers a complex medical care, wound care, and a Ventilator Weaning and Management Program that has led to impressive results low rates of complications and high rates of successful weaning. (www.radiushospital.com) Spaulding Hospital Cambridge (SHC) Spaulding Hospital Cambridge is a 180-bed long-term acute care hospital located on a seven-acre campus in Cambridge. The hospital is unique in its ability to meet the complex needs of patients and their families through medical and rehabilitative programs, with specialty focus in pulmonary, geriatric, and oncology care. Spaulding Hospital Cambridge provides on-site physician coverage 24/7, as well as consulting physicians from Partners tertiary medical centers. The outpatient center at Spaulding Cambridge provides expert rehabilitation services, as well as specialty programs such as the Spaulding National Running Center and Center for Lifelong Health and Fitness. (www.spauldingrehab.org) Spaulding Hospital North Shore (SNS) Since 1975, Spaulding Hospital North Shore has provided expert medical management and rehabilitation services to help patients achieve their highest level of functioning. Its spacious facility has 120 LTACH and 40 SNF beds, and provides on-site physician coverage 24/7. SNS clinical teams are able to access a full range of medical specialists and diagnostic tests from North Shore Medical Center in Salem. Spaulding North Shore offers specialty programs in neurological, orthopedic, pulmonary and ventilator rehabilitation programs and offers 2 therapeutic healing gardens, one for ventilator-dependent patients. SNS also provides outpatient rehabilitation services in eight North Shore locations. (www.spauldingrehab.org) Patients treated in LTACHs were readmitted 26% less frequently than patients in alterative settings. MedPac Report to the Congress: New Approaches in Medicare June 2004 9

Inpatient Rehabilitation Hospitals Operating in Mass. Braintree Rehabilitation Hospital (BRH) Since 1975, Braintree Rehabilitation Hospital has gained recognition as a world-class healthcare provider. BRH continues to have a strong reputation in the community for high patient satisfaction scores as well as outstanding patient outcomes. The Joint Commission has awarded the BRH with the Gold Seal of Approval & Disease Specific Care Certification for the hospital s Stroke Program and Acquired Brain Injury Rehabilitation Program, making Braintree the first rehabilitation hospital in Massachusetts to earn this distinction. BRH is proud to offer the latest cutting-edge rehabilitation technology to give patients every opportunity to get back to their best. The Braintree and New England Rehabilitation Network consists of inpatient rehabilitation hospitals in Braintree and Woburn with inpatient satellite units in Natick, Danvers and Lowell and 12 satellite outpatient facilities to assist patients in reaching optimal recovery throughout eastern Massachusetts. (www. braintreerehabhospital.com) Fairlawn Rehabilitation Hospital Fairlawn has been focusing its efforts on physical rehabilitation since 1987 when it was the first acute care hospital in the nation to completely convert to an acute rehabilitation hospital. Its expert staff is dedicated to improving each patient s functional abilities through intensive, individualized medical and multi-faceted therapeutic services via the most current, effective technologies, equipment, and therapies. Fairlawn s longstanding community partnerships with all of Central Massachusetts s major healthcare facilities, as well as its own partnership with UMass Memorial Health Care and the HealthSouth Corporation, the nation s largest provider of inpatient rehabilitation services, only enhances the facility s abilities to care for patients and enables it to offer expert rehabilitative care to patients so that they may resume productive, fulfilling lives. Fairlawn has also received the Joint Commission s Disease-Specific Care Certification for Stroke Rehabilitation, Brain Injury Rehabilitation, and Parkinson s Disease Rehabilitation. (www.fairlawnrehab.org) New England Rehabilitation Hospital (NERH) New England Rehabilitation Hospital has been serving eastern Massachusetts for over 40 years. Highly experienced staff understand the complexity of recovery and are committed to a personal, caring approach-helping achieve extraordinary patient satisfaction. The Joint Commission has awarded NERH with Disease - Specific Care Certification for Stroke Rehabilitation and for Acquired Brain Injury Rehabilitation, awarding their Gold Seal of Approval for healthcare quality. Exceptional care is provided with focus on specific details to enhance patient outcomes as evidenced by the newly renovated Acquired Brain Injury Unit on the Woburn campus. The New England and Braintree Rehabilitation Network offers highlyregarded, innovative, quality care to patients at its inpatient rehabilitation hospitals in Braintree and Woburn with inpatient satellite units in Natick, Danvers, Lowell and 12 outpatient locations. (www.newenglandrehab.com) Rehabilitation Hospital of Western Massachusetts Rehabilitation Hospital of Western Massachusetts has been providing high-quality acute rehabilitation care to patients for 15 years. It continues to receive national recognition for this care and has been a 3-time recipient of HealthSouth s President s Circle Award for its commitment to high-quality, cost-effective healthcare. HealthSouth was also awarded Disease-Specific Certification in both Pulmonary and Stroke Rehabilitation. Being a part of the nation s largest provider of rehabilitation services, HealthSouth Corporation, staff, patients and their families have access to, and receive, the expert rehabilitative care and technology they need to get back to their lives. (www.healthsouthrehab.org) Spaulding Rehabilitation Hospital Boston (SRH) Founded in 1971, Spaulding Rehabilitation Hospital in Boston is one of the largest rehabilitation facilities in the United States, and is ranked the 5th top rehabilitation hospital in the country by U.S. News & World Report. As the official teaching hospital of the Harvard Medical School Department of Physical Medicine and Rehabilitation (PM&R), Spaulding is at the forefront of research in advances in rehabilitative care. In April 2013, Spaulding will open a new 132-bed facility, which is a national model for environmental and inclusive design. With a wide range of inpatient programs and 10 outpatient centers, Spaulding strives to continually update and improve its programs to offer patients the latest, high-quality care through its leading, expert providers. Spaulding has been awarded a Model Systems designation in three specialty areas - Brain Injury, Spinal Cord Injury and Brain Injury) Rehabilitation - by the National Institute on Disability and Rehabilitation Research. (www.spauldingrehab.org) 10

Spaulding Rehabilitation Hospital Cape Cod (SCC) As the only hospital on Cape Cod offering IRF-level care, Spaulding Cape Cod provides a higher, more intensive level of medical, nursing and therapy services than other facilities in the region. The physician-led teams of nurses, therapists and other rehabilitation professionals work together to help patients improve function and attain their greatest potential for independence after illness, injury or surgery. Since 1995, SCC has led the region in the use of advanced technologies to help patients recover from stroke and other neurological disorders. With 60 inpatient beds and five outpatient centers, Spaulding Cape Cod consistently receives outstanding marks from patients and has earned a reputation for exceptional outcomes. (www.spauldingrehab.org) IRF Units in Acute Care Hospitals The Center for Rehabilitation at Berkshire Medical Center Berkshire Medical Center s 21-bed Rehabilitation Unit has been providing care to the Berkshire community for more than 45 years. Its team of dedicated healthcare professionals strive to optimize function and attain the greatest degree of independence. The physician-led team includes clinicians of physical therapy, occupational therapy, speech therapy, rehabilitation nursing, case management, social work, and medical specialists who all work together to involve the patient and family s participation in the rehabilitation program. The journey to recovery continues after discharge from the rehabilitation unit. The team lends equal focus on providing both an intensive rehabilitation program and also a seamless transition throughout the continuum of care whether that is outpatient rehabilitation, home health or a skilled nursing facility. The Center for Rehabilitation is proud of the staff s continuous quest to attain the most current knowledge, equipment and technology to enhance the patient s rehabilitative care. (www.berkshirehealthsystems.org/rehab) Weldon Rehabilitation Hospital at Mercy Medical Center Weldon Rehabilitation Hospital, located at Mercy Medical Center campus in Springfield, is a hospital-based rehabilitation center. Weldon is a comprehensive, fully-integrated facility dedicated to improving the quality of life for people combating all types of disabilities. A full complement of therapists and certified rehabilitation nurses working with advanced technologies provide inpatient, outpatient, day, and pediatric rehabilitation services to achieve the optimal level of physical, psychological, social, and vocational functioning for patients. Weldon is accredited by the Commission on Accreditation of Rehabilitation Facilities for comprehensive inpatient, adult, pediatric and stroke specialty certification. (www.mercycares.com) Bronson Rehabilitation Center at Noble Hospital The Bronson Rehabilitation Unit is a 15-bed acute rehabilitation unit providing compassionate care in a personalized manner for more than 20 years. The interdisciplinary team provides patient-centered care to meet the individual s goals toward improved functional status in a medically supervised setting. Patient services include: amputee, stroke, hip fracture, pulmonary, multi-trauma, wound care, pain management, brain injury, and medically complex. (www.noblehospital.org/ services/rehabilitation/bronson-rehabilitation-unit.html) Southeast Rehabilitation Center at SouthCoast Hospital Group Southeast Rehabilitation Center is the only hospital-based inpatient rehabilitation program serving the Greater Fall River area. Southeast Rehabilitation Center strives to assist its patients in achieving as independent a lifestyle as possible by providing inpatient rehabilitation care for a number of diagnoses including, but not limited to, stroke, spinal cord trauma, amputation, major multiple trauma, and hip fracture with complicating medical problems. They offer patient programs with therapeutic and recreational activities; psychiatrist available for consultations; vital stim for swallow issues; and private rooms. (www.southcoast.org/southeastrehab/) 11

Post-acute care provided after a significant medical episode can result in faster and greater clinical improvements than if a patient was discharged home without additional care intervention. LEFT: Respiratory treatment: Patient being weaned off ventilator and receiving bedside occupational therapy. RIGHT: Stroke treatment: Patient receiving rehabilitation services to improve her daily functioning. An Example of a Long-Term Acute Care Hospital Case: Ventilator Weaning In May 2009, Sue received a double lung transplant and was transferred to a Long-Term Acute Care Hospital for ventilator weaning and rehabilitation. The LTACH placed her in a negative pressure room, utilized all transplant protocol, and worked closely with Sue s acute care hospital to assure the best possible outcome. Within six weeks, Sue was weaned off the ventilator and spoke to the staff for the first time. Soon thereafter, she was discharged home to her family and continues to lead a healthy, productive life. Long-Term Acute Care Hospitals Cost Significantly Less Per Day Than Short-Term Community Hospitals $2,181 $1,318 All Patients $2,542 $1,596 Long-Term Ventilator Patients $3,215 Source: Government Medicare Data (2009) $1,825 Long-Term Ventilator Patients with a Tracheotomy Short-Term Community Hospitals Long-Term Acute Care Hospitals 12

An Example of an Inpatient Rehabilitation Hospital Case: Physical Rehabilitation In 2009, Sam was a healthy 70-year old retiree who volunteered in the community. In 2010, Sam mysteriously began to feel pain in his legs and hips and had trouble walking distances and climbing stairs. When he completely lost his ability to walk, he went to the emergency room and discovered he had an extremely rare case of hemophilia. (People suffering from hemophilia bleed longer than a normal person, causing some to even bleed to death). At the time of admission, Sam was near death; doctors determined that chemotherapy could save his life. Sam immediately began treatment and soon thereafter was ready to begin physical rehabilitation. At the start of treatment, the chances of Sam beginning to bleed again were high and he still needed to receive further rounds of chemotherapy at the acute care hospital. Although he faced serious risks, the IRF was committed to helping Sam rehabilitate. When Sam entered the IRF, he was extremely weak and had been on complete bed rest for more than a month. The IRF worked with Sam s acute care hospital to provide the complex, specialized level of care that Sam needed and took the necessary precautions to minimize risks of relapse. Specifically, the hospital had extra therapists at Sam s rehab sessions in case of falls and slowly incorporated orthopedic devices. Sam exceeded his goals and left the IRF not in a wheelchair but using a walker. What Other Post-Acute Services Exist? In addition to Post-Acute Care Hospitals, other post-acute care settings exist, such as Skilled Nursing Facilities, Nursing Homes, and Home Health Agencies. These other services provide treatment to patients who do not require or who cannot handle such an intense level of care as offered by IRFs or LTACHs. Skilled Nursing Facility (SNFs) Skilled Nursing Facilities provide less intensive, but necessary care to patients, most commonly following a period of hospitalization. While SNF patients generally do not need the level of highly intensive care given in LTACHs and IRFs, they still require ongoing skilled nursing and, sometimes, rehabilitative care. Nursing Homes Nursing Homes generally provide long-term care to patients or custodial type care. Residents of nursing homes do not receive intensive rehabilitation treatments like those patients in LTACHS, IRFs, or even SNFs. Instead, patients receive support and assistance with Activities of Daily Living, such as eating, dressing, bathing, and using the bathroom. Home Health Agencies (HHAs) Home Health Agencies (HHAs) provide numerous services and follow-up care to patients in the comfort of their own homes. While patients receiving care through HHAs typically have fewer needs than patients in other postacute settings, they still require ongoing support to realize clinical or functional gains and outcomes. Assisted Living Facilities Assisted Living Facilities provide individuals rental housing combined with assistance for Activities of Daily Living such as feeding, bathing, dressing, and adminstering medication. Residents of these facilities need some various levels of aid with their day-to-day lives but are otherwise independent and treated as such. Hospice Hospice, unlike the other post-acute care services, provides palliative care. The philosophy behind hospice is to treat the patient with respect and dignity while allowing them to remain alert and pain free in an environment that they are most comfortable in most likely their homes. 13

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