Bob Underwood, MD (Host): Welcome to Arbor Health and Life Podcast. I'm Dr. Bob Underwood, and with me is Dr. Mark Hansen, Director of the Post-Acute Care and highly respected physician at Arbor Health, as we talk about post-acute care and the bridge between hospital and home. Dr. Hansen, welcome. Thanks for being on today.

Mark Hansen, MD: Thank you for having me.

Host: Yeah, absolutely. So you are the Director of Post-Acute Care. Can you differentiate for us skilled nursing facilities, swing beds, and extended care rehab? What's the difference between those things?

Mark Hansen, MD: So a skilled nursing facility is more what a lot of people would call a nursing home, that's more chronic care. It's where you might go to live rather than to rehab. So you might not see doctors as often. You might not see therapists that are working with you to strengthen you or anything like that.

You are just there to spend time because you're not able to be at home. Swing bed is what we use in some hospitals. It really is kind of a confusing term, but it is beds that can be used as a full on hospital care bed, or it can be transferred to an extended care rehab bed. So the bed can be swung either way, meaning it can be one designation or the other.

So we like to use the term extended care rehab, because a lot of people don't know what swing bed actually would mean.

Host: I could see how that would definitely be true. So how is this different where you are in Morton from other rehab options that are in the area or just in the community as a whole.

Mark Hansen, MD: We're a critical access hospital and we have these extended care rehab beds that are where people might come to prepare them to go home. A lot of times if you are in the hospital and you're sick and then you're finished with your hospital care, you are not strong enough to go home immediately.

You've been really sick and you're not used to being up, getting dressed or fixing your own meals, you require more strengthening or you require more time. That's the purpose of the extended care rehab. At our facility, I would say a difference compared to other places is we're small. A lot of people say it has a more of a family feel.

Everybody, even the patients get to know the people working with them over time, and a lot of people really appreciate that. It feels more like home to them.

Host: And that's gotta be phenomenal, especially for the purposes that you serve. So what are the kinds of patients that would typically benefit from this kind of post-acute care? What kind of diagnoses might they have? What are they working on?

Mark Hansen, MD: There's a variety. A lot of times, it is things that do require a little bit more time to get ready to go home rather than just a two or three or four day hospital stay. So that might be people who have had surgery, like a joint replacement, like a hip or knee, and because of other illnesses or something, they cannot go home.

They're not ready to walk. They need more time where they have the care. And during the time that they would spend here, they get to go through physical therapy where a therapist works with them. Occupational therapy where again, a therapist gets them ready to do the duties they will need to do at home, like getting up their steps into their house or getting dressed or getting to the kitchen to fix their meals, things like that.

So the goal really is to get ready to be at home. Some other things that we see are uh, people with an illness and infection that requires IV antibiotics. The oral antibiotics are not strong enough, so they can't go home and just take a pill. They need IVs and you can't do IVs at home in most cases.

So they have to stay here maybe for a week, maybe two weeks, getting that IV antibiotic several times a day to treat their condition.

Host: Now the thing that you were talking about before, we often refer to as activities of daily living. Things that a lot of people might just take for granted, but other people, especially the kinds of patients you described, might have to work on those things so that they can be safe and take care of themselves at home. So what does a patient's day or journey look like when they come into post-acute care at Arbor Health?

Mark Hansen, MD: So I start saying the room is going to look quite a bit like a hospital room. It might be a little bit less formal and feel a little bit more like home. But you're in a hospital bed, in a room. And then in the day what I really like is we have team rounding, not at the bedside, but the whole care team.

So that's the doctor, the nurse, pharmacist, billers, the physical therapy, occupational therapy, pharmacists. I don't know if I left out anybody, but we all meet as a team, and I really like that because we discuss your case as a patient, and that's anything from are the medications the best that we can do?

Is the therapy going well? How are things going with rehabilitation? Getting ready to do those activities of daily living, like you said. So that starts the day. And then from a patient's perspective, you are going to have maybe the physical therapist come in, work one-on-one with you, getting you up trying to walk, if you've got a knee replacement or if you're weak or if you've had a stroke. Then we get occupational therapy. Another therapy I didn't mention earlier is wound care. Some people have really chronic, difficult to treat wounds that require special bandaging, and so we have wound care specialists, they'll come in and redress that wound. That can happen in the day. That really would be, I think, how a typical day would go is different therapists coming in and out working with you.

Bob Underwood, MD (Host): Yeah. And I was going to ask how do you make sure that the patients, your team, makes sure that the patients have the best recovery experience possible? I think you just described that. It really is a team approach and making sure that you're meeting the personal needs of that individual. I've been to the website and I've seen at least one testimonial. Can you share any success stories that really kind of shows the impact of post-acute care, for any particular patient?

Mark Hansen, MD: I don't know if I have a particular story, but I can share that a lot of the feedback I get, people are really happy that it feels small to them, it feels more like home, and I think that's important because they are going home. That's the goal. And the more it feels like home, the more success. They will have. The whole act of preparing them to go home, is really what we go for.

Host: How do you measure whether or not the care that you're providing is really working and you're doing the job that you're setting out to do? What's the evidence that shows that that's working?

Mark Hansen, MD: Our therapists work with that all the time because they're wanting to show, they have to show that you are making gains. So they're doing measurements every day of how far you can walk, how successful you are at getting dressed, or if it's wound care, we're measuring the size of the wound. Is it getting better with our treatment? That's the ongoing things. Maybe I'm misunderstanding, but the other part of that question is how do we know we're doing a good job? We like to do surveys. We like your feedback and we want to hear how your experience was. If it's good, that reinforces what we do.

If there's things we need to work on, those are action points that we can go back and say, could we have done this better?

Host: Absolutely. and I think that that feedback is really important in today's day and age. Just getting the understanding of what they and their family members might have thought about the care. How do you incorporate potentially family members in that care experience that the patients may have?

Mark Hansen, MD: I think that happens a lot. It's mostly informal in my experience, and that is family members will be in the room when I'm coming by, and I like that. I like a team approach to things. Talking to them about what their expectations of home will be. It, it's really dependent on family because if you are family at home and you're a big, strong person and you can help,

that's good, but maybe you're not. And so you're going to need the patient to be ready to do things more on their own. And so those are factors that we take into consideration as far as when you go home, how you go home, what you might need at home.

Host: And that's wonderful. I mean, it's just such a great asset for the people in the Morton community. Is there anything else that you'd like to add? You know, what sets Arbor Health's approach, apart from others or things that you're especially proud of, just anything you'd like to add as we end.

Mark Hansen, MD: I do like the team approach. I feel like on all the levels from Doctor on down to even just the people that are cleaning the room or coming by, there is a team feel, and that's our goal is to have people see that team, it's a team trying to get them ready to go home, trying to get them better.

It's not just one person doing that all. And I think we do that a good job at that here at Arbor Health, and I'm proud of that.

Host: What resources do the patients have after they've been discharged and they do go home?

Mark Hansen, MD: We have a case manager that works on that, that helps with that planning. So when they do go home from our extended care rehab, they might still need more things. So we have home health nursing. We will get set up to have a nurse come out to your house to evaluate, maybe even continue doing physical therapy in your home if you're not able to come back to a facility.

We have outpatient physical therapy and outpatient wound care here at Arbor Health. So sometimes after you go home, you would come back to that as an outpatient, maybe twice a week or so to continue that therapy as well. And then our providers in the area as far as getting connected to a local healthcare provider, we try to set that up the best we can so that your care doesn't just stop as soon as you go home.

Host: Dr. Hansen, thanks for being on today. We really appreciate it. It's a great resource for the community.

Mark Hansen, MD: Well, thank you for having me.

Bob Underwood, MD (Host): And for our audience, for more information about the Extended Care Rehab program at Arbor Health, go to myarborhealth.org/extended. This has been another episode of Arbor Health and Life. Don't forget to subscribe and leave a review, and as always, take care of your health.