Joey Wahler (Host): It's an important rehabilitation option. So, we're discussing swing bed care. Our guest is Melissa Lynam. She's a registered nurse and Director of Nursing. This is Valley Vitals, brought to you by Carson Valley Health, where we go beyond the checkup with real conversations from the experts you trust. Thanks so much for joining us. I'm Joey Wahler. Hi there, Melissa. Welcome.

Melissa Lynam, MSN, RN: Thank you so much for having me.

Host: Great to have you aboard. Appreciate the time. So first, in a nutshell, Melissa, what exactly is swing bed care, and what are the main ways in which it differs from being in a regular hospital bed or going straight to a nursing home or rehab facility to do rehabilitation?

Melissa Lynam, MSN, RN: Swing bed is really just a type of transitional care that we offer here at Carson Valley Health. It's designed for patients who are really—they're medically stable, but they're just not quite ready to go home yet. They're not ready to leave acute care. They might need additional nursing care, rehabilitation, or just some additional support before they can go home.

We do things like education for new ostomies. We do therapy, long-term antibiotics, complex wound care. So, just things that really can't be managed independently at home, the patient is stable and they become a resident here at the hospital. So if you really just think of it as a bridge between the hospital and home.

Host: Great analogy. Okay, understood. So that being said, who's the swing bed program at Carson Valley Health really designed for most? What are a few most common scenarios where it would be needed for that?

Melissa Lynam, MSN, RN: Overall, it's just really designed for people who are improving medically, but they need a little bit more time. So, some common examples are people who have had a hip or a knee replacement. Their surgery went well, but they still need some physical therapy. They need help managing stairs and doing their ADLs, like taking a shower and getting dressed, and , they can get occupational therapy or physical therapy.

Another example would be somebody recovering from a stroke and learning how to adapt and relearn new daily activities like dressing or bathing meal prep. We also see patients who have been hospitalized long term for things like sepsis, pneumonia. They were really sick, and they're deconditioned and weak. So, they really just need more intensive therapy to get back to their baseline.

Host: So Melissa, you mentioned stroke there, and stroke is an interesting part of this, right? Because oftentimes the brain works in mysterious ways in post-stroke when someone's doing rehab. It's not quite clear immediately how long it might take for them to regain their old self, so to speak. And that means being better safe than sorry and possibly swing bed care, right?

Melissa Lynam, MSN, RN: Strokes are tricky because the defects that are caused by a stroke depend on where the injury occurred in the brain. So, swing bed is really great. We can offer different types of therapies of physical therapy, speech therapy, occupational therapy. A patient might not be able to get back to their baseline functioning. So in the Swing Bed program, we can really help them maybe learn their new baseline, and we can also work with the family to help the family learn how to adapt and work with the patient on daily activities of bathing, mobility options, things like that. So, swing bed is a really great option for post-stroke patients.

Host: What are some signs a patient may not be quite ready to go home safely after an illness, an injury, surgery, stroke, which you just covered, even though they no longer need that intensive hospital care?

Melissa Lynam, MSN, RN: Yeah. So, a good example of how we can help kind of bridge the gap between being ready to go home safely and not needing acute intensive medical care is with a patient who's had a joint replacement. Generally, those patients go home and they start physical therapy for an hour at a time, a few times a week.

The patients that join the swing bed program need more intensive therapy. So, they need more help, getting dressed and bathing and getting in and out of bed, navigating mobility. They might have stairs or a certain layout at home that we need to teach them how to navigate. So really, in the swing bed program, they're going to be seeing a physical therapist or an aide every day.

They're also have a nurse and a CNA assigned to them to help take care of them 24/7. So, they really have a medical clinical personnel helping them 24/7 as they're getting out of bed and sitting up in a chair and bathing. So, they're really just getting more intensive therapy. They just need a little more help than standard joint replacement type of patients.

Another type of patient we see is complex wound care. People can change a Band-Aid at home, but sometimes they can't change wound vacs or do really complex dressing. So, we help those types of patients too.

Host: For someone who's been in swing bed care and then is preparing to go home finally, what basic lifestyle changes or home safety tips do you usually recommend to prevent setbacks or of course hospital readmission?

Melissa Lynam, MSN, RN: It depends on their diagnosis. In the example of a joint replacement, we work with the family. We want to make sure that they don't have a lot of throw rugs, you know, on the floor that things that they can trip on. We want to make sure that the bathroom has— they might need bar supports in the shower or for the toilet.

We want to make sure there's good clearance for their walker to navigate through hallways and different floor coverings, right? Of course, people can't change the floor coverings at home, so we can teach them, you know, pay attention when you're going from a wood floor to maybe the carpet transition or tile. We ask them how many steps they have to get into their house and how they're going to navigate getting into their house and in and out of the car and things like that. So, it really depends on their diagnosis, but we work with the patient and the family and ask about their environment and give them the tools and education they need to stay safe when they're at home.

Host: A couple other questions for you. I would imagine there are times when some patients are disappointed to learn that they're not quite ready to go home on their own just yet. And so, for those just entering swing bed care, how important is simply for you and yours just being encouraging and positive so that they don't get discouraged?

Melissa Lynam, MSN, RN: People do always want to go home. They want to go back to their space and their routine. But there is something that people respect about being able to be in a rehab type of program that's still in the hospital. They feel really safe. They feel really well cared for. An alternative for these patients is to sometimes go to a skilled nursing facility, or like a nursing home.

And so, when faced with the option of a nursing home versus being able to stay in the hospital, a lot of patients really respect that they're going to have a registered nurse and a CNA assigned to them at all times, and our staff is really encouraging to these patients, and sometimes we have to maybe get a little pushy and remind them what their goal is and their goal to be able to get back home. But we have a really great team and really great staff that our patients and families respond well to.

Host: Pushy in a good way, right?

Melissa Lynam, MSN, RN: Pushy in a good way. Yes

Host: Absolutely. Now, how about families and loved ones trying to offer support? I'm sure you deal with them a lot. What practical advice do you give families, caregivers who want to support their loved one during swing bed recovery, but you want to make sure they don't get burnt out too though, right? Because oftentimes it can become kind of overbearing going through this.

Melissa Lynam, MSN, RN: It's a stressful time for everyone involved, and we really want to make sure that the family has the education that they need to take care of their loved one. When people are struggling with not knowing what to look for or not knowing if their loved one is safe or has declined or is improving, it can be mentally stressful.

Um, you know, when they're not sleeping well, it's harder to provide care. So, we remind them that the best way to care for their loved one is to care for themselves. And while their loved one is in the swing bed program, we encourage visits, of course, and we want them to learn how to navigate things once the patient goes home. But we also encourage them to go home and rest and have a break and trust that we're here keeping their loved one safe and taking really well care of them so that they can rest and get home ready and be at their strongest when , their loved one gets home.

Host: And in summary here, Melissa, you've done such a great job breaking down some of the details. What's the most important point you want to get across to those joining us about Swing Bed Care? Maybe there's a common misconception or something that people don't understand from the outside the way you do from the inside.

Melissa Lynam, MSN, RN: People don't know about swing bed. It is not a common program or option that exists in larger acute care hospitals. You more see it in rural areas and rural hospitals. So, really just people knowing that it exists and knowing that it's an option. There is sometimes a misconception that because their loved one is in the hospital, that they're going to still have hospital-level care.

But we adapt because we treat swing Bed patients like this is their residence. It's their home for the time being. So, we encourage them to be in their home dress. We don't want them in a hospital gown. We encourage them to bring things in from home that might help them make them more comfortable, even if it's a comforter from their bed. It's hard for people to separate that they're in the hospital, but it's a lower level of care. So, understanding and acknowledging that the program exists, and that even though it's physically in the walls of the hospital, it's not acute level medical care

Host: Understood. Well, folks, we trust you are now more familiar with swing bed care. As Melissa points out, it's not available everywhere or even in most places, but it is available here. Melissa, good luck to you and yours. Keep up all your great work, and thanks so much again.

Melissa Lynam, MSN, RN: Thank you so much. Have a good day

Joey Wahler (Host): You too. And for more information, please do visit carsonvalleyhealth.org. Please be sure to subscribe to our podcast and share and connect with us on social media as well. So,, stay tuned for more engaging discussions. If you found this episode helpful, please do share it on your social media. And thanks so much again for being part of Valley Vitals. Let's move mountains.