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Bill Klaproth (Host):  Meet Kris Bykerk, Senior Vice President of Corporate Operations with Community Physical Therapy Associates, a preferred provider for the Alden Network.

Kristine Bykerk (Guest):  We don’t do one stop shopping, one size fits all. That’s not what we are about. We are about finding out what do you want to home to. What do you want to be able to do? What haven’t you been able to do? And developing a program together, to get you where you want to go.

Bill:  This is the Alden Network Podcast, Healthcare Solutions for Seniors. Today, Kris Bykerk talks about rehab and therapy after an orthopedic surgery and explains the role of short-term rehabilitation and post-acute care centers.

Kris:  The point of short-term rehab is to provide more intensive therapy in order to get you to your fullest functional potential.

Bill:  And that starts by first completely understanding your surgery and rehab.

Kris:  Sit down with your surgeon and find out what’s going to happen during the procedure, how long is it going to take, what’s the rehab after? How many times a day will I have rehab? How long will I be in the hospital? What happens if things don’t progress as they should? And then also, a lot of times there are things called preoperative classes and that’s exactly what it sounds like, it’s going into a class before you have the surgery because when you know what to expect, such as okay I know I after I have the surgery, it is going to take me six to eight weeks to walk without anything or I know it’s going to be hard for me and painful to get up and transfer to different surfaces or go to the bathroom for about a week after surgery. As long as you are prepared for that and have that expectation; your rehab is going to be all the much better. And also, during those classes, in addition, if you are having some type of lower extremity or leg type surgery and you are going to have to be walking with crutches or a cane or a walker; you will learn to do that beforehand because obviously, it’s easier to learn before surgery than after surgery.

Bill:  And preoperative education has proven results.

Kris:  And quite honestly, the best practice literature that’s out there in the rehab field right now, indicates that there is very strong positive impact between the amount of preoperative education that you get and its reduction on anxiety, stress, pain management and overall achieving better outcomes.

Bill:  And when is it necessary for someone to use a post-acute care center?

Kris:  First and foremost, is you need to be safe. People might think, it’s like okay yeah, I’m ready to go home. I’ve got my husband who can help me, or I have a son or a daughter who can come over; but you really need to step back and think how often are those caregivers going to be available? You might need someone whenever you get up and say you need to get up and go to the bathroom and there is no one there to help you, what are you going to do? There is also what kind of assistive devices do you need and when I say assistive devices I mean do you need a cane to walk. Do you need crutches? Do you need a walker and how well are you able to maneuver that, as well? And also, when we talked earlier about these functional assessment tests, that should really be the driving force of are you ready to go home or do you need more intensive therapy in a short-term post-acute rehab setting. And again, just to restate; those tests are just a series of maneuvers that you would normally do during the course of the day. Speed up your walking, slow down your walking, bending over to pick up an object, getting dressed and undressed, reaching for objects overhead. So, tasks that you normally do throughout the day and when you go through these tests; you will get a very clear indication; is there a fall risk, is there a balance risk, is there a safety issue? So, when you look at the results of those functional assessment tests; that’s largely what’s going to drive okay are you really ready to go home or not even though you might think you are. But in reality, you have an objective test that has been done. It’s not my opinion. It’s not your opinion. It’s what the test is saying that no, you are not quite ready to go home yet.

Bill:  And what about a family member that just doesn’t want to go to a post-acute care center?

Kris:  Quite honestly, one of my favorite ways of answering that question is I’m not saying that they can’t go home. The test is saying that it is not safe to go home and at that point too, the therapist might want to take that patient with the family members present and go over that functional test. Heh, let’s reach to this object, let’s bend to try to pick up this object, let’s vary the speeds that we are walking at, let’s test our balance and really then when they see that they can’t successfully perform those maneuvers; that’s usually a wake-up call. It’s not as just a simple as watching someone walk with a walker or crutches down the hallway with the therapist. There is a lot more involved in it and those tests, those demands that we put on patients; that’s what’s going to be your answer and most of the time if they can see that they can’t, that will sway the opinion.

Bill:  And is it accurate for people to consider post-acute care centers as nursing homes?

Kris:  They are not that at all. They are very much designed like high-end hotels. You will walk in and you will see that they’re carpeted, beautifully furnished and well-decorated. They often have programs such as fine dining, where everyone goes and eats in a dining room together with chefs. There are usually internet capabilities. They have closed channel cable stations within the facility themselves and that’s largely used for educational purposes. So, even though you might be in and you have had a knee replacement or a shoulder replacement or a hip replacement, whatever the case may be. You can also get educated on things such as wellness, returning back to activity, that type thing.

Bill:  And generally, how long is the stay at a post-acute care center?

Kris:  When you look at the whole surgical procedure and how medicine has progressed; surgeons, years ago, it was they used to do everything. An orthopedic surgeon, they would do hips, knees, shoulders, whatever it was kind of one stop shopping if you will. But throughout the years, as medicine has improved; these surgeons have become specialists in a given area. So, you have a surgeon who might only do knees or hips or one that might just do wrists or shoulders or what have you. And by doing that specialization; they get very, very good at the procedure. It is like something that you or I would do. Once you do it over and over again, you become better at it and you get quicker at it, the time goes down that’s required to do the task. So, you combine that with the fact that anesthesia has also improved over time. We are seeing a lot done with spinal anesthesia now and also the implant and when I say the implant, if you are having for instance a total knee or a total hip replacement; they insert a new metal joint and that’s called an implant or a prothesis and over time, those also have become much better designed and easier to fit in during those surgeries. So, when you combine all those, usually the average length of stay right now is anywhere generally speaking, from about one to four days. And how well you can get up and move and function as we talked about earlier, that determines after that point, are you going to be able to go home and receive services in your home or in an outpatient setting or are you not quite ready, are you not safe enough to go home and function yet.

Bill:  And for the person who wants to go home but may be struggling with therapy and is getting frustrated. How do you handle those situations?

Kris:  What we do, is we give you the confidence to say yes, you can do these things. We start in little steps. We progress step by step and show you that yes, you do have the ability to do this task. Let’s break it down and let’s start with this step and once you can achieve that, we are going to move on the next. And then the next. So, it’s a very controlled environment. You have a therapist with you for safety reasons until you feel comfortable and can see for yourself that yes, this is something that I can do.

Bill:  And Kris, shares an example of that.

Kris:  It’s one of the neatest things that I had ever seen in the clinical setting. There was a patient who we treated, who had had her knee replaced and she had been at the facility, short-term post-acute facility for about a week and hadn’t yet progressed to walking. We were just working on standing tolerance because obviously, you have to be able to stand before you can walk. So, she was only able to stand over the course of the week for about 2 minutes and that was it. And just could not break that barrier. And so, the therapist spoke to her and said tell me what it is, what do you want to do, what are your concerns, what are your goals? And her concern and her goal was as simple as I want to get home because I want to be able to go back to making grilled cheese sandwiches for my grandchildren when they come off. My daughter drops them off once a week and that’s my everything. That was her driving force. So, once we reiterated to her okay, you can get back to that, but this is why we have to increase how long you can stand because once we get that; then you can progress to walking. And then you are one step closer to your goal. And once she heard that; honest to God, she stood, stood for 12 minutes. And why that was, is she finally saw this is why I’m doing what I’m doing here because it is going to help me achieve what’s important to me. So, that’s really what these centers will do. They will take your concerns and goals, incorporate them in very intensive therapy in terms as we talked about the edema, the pain management, exercise protocols and advancing gait or when I’m saying advancing gait, advancing how you walk. You might start with a walker and we might be able to progress you onto crutches or a cane, but that’s the point of this more intensive therapy, to get you at your fullest functional level.

Bill:  And that type of coaching and patience takes empathy on the part of the therapist.

Kris:  I think that’s the whole reason why people went into this field is you want to help. You want to help people return to their best functional self and by knowing what makes them tick, what do they want to do, what do they want to get back to; that’s the key. It’s not really where I want you to get as a therapist; it’s where do you want to go and how can I help you get there.

Bill:  And what about the training and experience of the staff?

Kris:  At the facilities we have licensed physical therapists and physical therapist assistants, licensed occupational therapists and occupational therapy assistants and licensed speech language pathologists. And there is various training that’s required to become licensed. There is a mandatory amount of continuing education hours that each discipline needs to do every two years in order to keep their licenses current. So, we do have the ability – you have got to keep current in what’s going on in the field. There are in-servicing programs that we have within our own company within Community Physical Therapy which will also help increase that base of knowledge. There is a training program obviously, that we put our therapists through when they start at one of our facilities. So, they are familiar with the inner workings of the facility and the department itself and what we need them to do. There are not strict regimented protocols in terms of day one you do this, day two you do this. Each therapist has the autonomy and the professional discretion to determine what type of treatment is right for each patient at what point in time.

Bill:  So, each patient gets an individualized plan.

Kris:  You and I could both have a knee surgery. It will affect us differently because I’m sure we have different things that we like to do in life, so just having one standard protocol isn’t going to work. So, yes, everything is individualized to meet your own unique concerns and goals.

Bill:  So, when it comes to cost and insurance, what does someone need to know?

Kris:  Unfortunately, it is a very complicated question and it doesn’t have an easy answer. And that’s because there are so many different health plans out there, insurance plans. You and I could both have Humana insurance or Blue Cross/Blue Shield or United but within those companies themselves; there is just a myriad of different plans. So, each one might cover things differently in terms of co-pays or length of stay, but generally speaking, if you have traditional Medicare and you have had your three day qualifying stay and you are not ready to go home yet, you are not safe and you are just not there functionally yet; in most cases, for those traditional Medicare patients, the stay is paid at 100% meaning you pay nothing for the first twenty days. And then after that point, there are various co-pays that start to kick in and those scale up as the days go on. If you have nontraditional Medicare coverage such as Medicare HMO or you have more traditional insurance plans; they often too have a short-term benefit, but it might vary in terms of what you pay out of pocket and how long you might be able to stay. So, either before you leave the hospital or as I said earlier; you can pick up the phone if you have got one in mind and call. That should be able – someone should be able to verify that to you, saying this is what you’ll pay for this amount of days. If you go on to homecare or outpatient therapy, again, different plans pay differently. And at that point, if you are in a short-term post-acute rehab facility; they can verify those benefits for you. But again, the same thing holds; you are also free to call a provider that you want to go to and say heh this is my insurance can you tell me what it covers.

Bill:  And Kris shares her final recommendations for a successful postoperative rehab.

Kris:  You know again, I think just getting yourself informed is key. Because when we know what to expect; it eliminates or largely negates the fear we have, the anxiety and the stress that we have. Don’t be afraid to say this is what I want to get back to do, these are the things that concern me. These are things that I need addressed. So, don’t be afraid to bring those up to your medical professional whoever they are, your therapist, your doctor, your nurse. That’s why we are there. So, that’s what you should do. So, don’t be afraid to advocate for yourself, be honest, be open and look for a place that will give you the ability to have input into your treatment plan. So, in other words, what’s important to you? What tasks do you want to get back to? And once we know that then okay, this is how the treatment plan is going to get you back to that. So, find a place that is willing to let you have input as well. No one knows yourself better than you.

Bill:  And we would like to thank Kris Bykerk for her time. The Alden Network has nearly 30 short-term rehabilitation and post-acute care centers throughout Chicagoland and southern Wisconsin. For more information, visit www.thealdennetwork.com , that’s www.thealdennetwork.com. This is the Alden Network Podcast Healthcare Solutions for Seniors. Thanks for listening.