Case Study: St. James Rehabilitation & Healthcare Center (December 2020)

Patient’s Age: 83-years-old
Admission Date: 09/07/20
Admitted from: St. Catherine’s Hospital
Discharge date: 11/05/20
Discharged to: Home with family care
Length of stay: 59 days
Reason for Stay: Fracture of the pelvic area extending to left side acetabulum. A decrease in strength, transfers, reduced ability to safely ambulate, reduced balance, increased pain, and need for assistance.
How did the patient hear about St. James? Used CMS rating while in hospital.

Details of Experience:
Mr. Lee C. is an 83-year-old Navy Veteran, who is always willing to help and loves to stay active. Before his hospitalization, he was living alone at home, supported by his family in the community. His wife had recently been moved to a long-term care facility, so much of his time was used traveling to and from her new home for visits. Lee was hospitalized at St. Catherine’s Hospital due to a fall, resulting in a pelvic fracture extending to the left acetabulum. While in the hospital, both Lee and his family researched a list of skilled nursing facilities and chose St. James Rehabilitation and Healthcare Center.

Lee was admitted to the St. James community on September 7, 2020. Within an hour of arrival, Lee was welcomed and evaluated by the unit nurse. Within twenty-four hours, he was evaluated by the interdisciplinary team; including case management, social work, integrative therapy, and therapeutic recreation, who worked to tailor an individualized care plan. Lee’s goals with physical therapy were to increase lower left extremity strength, increase dynamic standing balance, safely ambulate five feet and negotiate one to three stairs. His short-term goals with occupational therapy were to complete hygiene and grooming tasks, safely perform toileting tasks, perform upper and lower body dressing with the use of adaptive equipment and perform bed mobility tasks. All of these goals were to be accomplished while maintaining special precautions for his lower left extremity injury.

The amount of work that was laid out before Lee was daunting, but by summoning some of the strength he used in his Navy days, Lee was up to the task. He worked hard day-after-day and week-after-week. Due to his injury and the time needed for healing, much of his work involved strengthening his arms and upper body, while his legs healed. As per Ed, his physical therapist, Lee started with weight-bearing only to “toe-touch”. Lee was apprehensive to put any additional weight on his leg and was continually encouraged by Ed to progress towards full weight-bearing on his leg. Nicole, his occupational therapist, worked with him to improve control over his activities of daily living. Within one month, Lee was able to ambulate ten feet and he was able to stand with moderate assistance after previously being completely unable to do so. During this time, he was supported by the wonderful social workers, therapeutic recreation team, and integrative therapists, utilizing several supportive techniques from brief motivational interventions to aromatherapy. Lee enjoyed the snack and coffee carts in the morning and afternoons and was assisted by the staff with several in-person and window visits. During one of these visits, he was able to see, for the first time, the sonogram picture of his new great-granddaughter.

Throughout his time at St. James, Lee progressed well and made big strides with the rehabilitation team towards reaching his goals and transitioning back home to his family. His physical therapist, Ed, worked with him to regain weight-bearing status on his leg, and by the middle of his stay, he was able to complete some lateral movements. He went from needing complete assistance to transfer in his chair to needing minimal assistance. Lee could be seen in the hallway working on his upper body and pulling himself along in his wheelchair, speaking with neighbors and staff members. Lee’s positive attitude was a much-needed presence on the floor and was always available to have a quick chat. His work with the rehabilitation team continued to progress, and he was soon able to walk a maximum of forty feet with modified independence and twenty-five feet, on average. His work with Nicole in occupational therapy also saw significant improvements and he progressed towards requiring minimal assistance to accomplish most of his activities of daily living.

Lee, his family, and the team at St. James planned for him to return home with home care nursing services and additional support provided by his family. Reflecting on his time with St. James, he shared, “Ed and Nicole were fantastic! The time they spent with me was incredible”, adding, “They were unbelievable!”

St. James is happy to be a part of his journey back home.