Redefining Rehab: Serving Bob

Many in the home medical equipment services industry wonder why the “high-end” rehab community is constantly trying to differentiate itself from “the rest of HME.” The answer is really quite simple: Rehab is more service-intensive, has a higher risk factor in the payment area and requires more trained professionals to achieve the desired clinical outcomes and expectations of the prescribing physician and the customer. As one prominent rehab provider is fond of saying, “If rehab were easy and profitable, everyone would be doing it!”

To understand what goes into providing rehab and assistive technology, let's follow one consumer as he works his way through the process, from the day his physician prescribes a power wheelchair to the day when he and his provider agree that their goals have been met.

Our demonstration is based on the real case of “Bob,” who has been released from the rehab hospital after sustaining a spinal cord injury that left him with quadriplegia. While Bob's needs are more complex than some, they illustrate the elements that go into providing appropriate rehab products and services.

Bob's injury is such that he has minimal control of his right hand, poor trunk stability and no strength, voluntary movement or sensation from mid-chest down. He is 19 years old. He wants to return to college and perhaps go on to law school. His physician has expressed his desire to see Bob live as independently as possible but worries about pressure sores (he had two while in rehab) and breathing complications brought on by poor posture and positioning. With this in mind — and documented in Bob's medical record — Bob is referred to the rehab program's seating clinic.

The seating clinic must now define Bob's abilities and limitations, familiarize him with options to address his needs and work with him to decide who will take responsibility for which steps in the process.

A comprehensive assessment of Bob's physical status is performed, generally by a physical or occupational therapist (PT/ OT). A thorough review of his medical record provides the long-range prognosis so that whatever is provided will continue to be appropriate as Bob moves from the acute to the chronic phase of living with his disabilities.