The David F. Bolger Post-acute Care Unit (PACU) at Christian Health Care Center offers concentrated rehabilitation therapy and skilled-nursing services to help patients transition back home following a hospitalization. A multidisciplinary team utilizes an outcome-focused approach to deliver complex clinical and therapeutic interventions to patients who come to the PACU after being hospitalized for surgery; complex medical conditions, such as diabetes or renal failure; or other illness, such as cardiac disease, gastrointestinal illnesses, renal disease, or pneumonia. Although the average length-of-stay on the PACU is 21 days, patients remain on the unit until they are discharged from the Medicare program.

A multidisciplinary-team approach
PACU patients benefit from the skills and knowledge of an Interdisciplinary Care (IDC) Team which includes physicians, registered nurses, licensed practical nurses, certified nursing assistants, rehabilitation therapists, social workers, discharge planners, activities staff, and chaplains. Although patients are assigned a PACU physician upon admission, they continue to receive care, if necessary, from their personal physician and outside medical services not available in the PACU, such as dialysis. The PACU's Coordination of Physician Services office schedules appointments and coordinates transportation for patients. A large part of the multidisciplinary-care plan involves continual input from the patient and his/her family, who are also members of the IDC Team. The team meets formally seven to 14 days after admission, depending on the acuity level of the case. Because of the typically short length-of-stay on the PACU, discharge planning begins at the first IDC meeting. In general, subsequent meetings take place on a weekly basis throughout a patient's stay.

Rehabilitation Services
Through Rehabilitation Services, a key component of the PACU, individuals work toward restoring functional abilities compromised due to surgery, illness, injury, or disease. A physiatrist and a team of skilled, licensed physical, occupational, and speech therapists provide intensive therapy in an effort to help patients return to their former residence safely and at their pre-hospital health status. Individualized rehabilitation plans are created by the Rehabilitation Services staff in collaboration with other professionals on the patient's IDC Team. The patient's overall health, age, and physical limitations are taken into consideration when developing a beneficial plan, as are physiological changes and decreases in exercise tolerance, maximum heart rate, muscle strength, joint mobility, peripheral blood flow, vision, hearing, motor speed skills, coordination, and balance.

Physical therapy can include:

• illness management and recovery,
• symptom identification,
• exercises to restore strength and balance,
• training to walk safely with or without canes or walkers,
• training to move safely from bed to chair and back again,
• the use of heat, ultrasound, and electrical stimulation modalities to assist in pain control,
• training of aides and/or family members in safe techniques for assisting in care,
• evaluating the need for splinting of the legs for minimizing loss of motion, and
• consulting with physicians and staff on other equipment needs of the individual.

• training in performing activities of daily living such as dressing and feeding;
• wheelchair prescription and management, as well as consultation on additional specialized seating needs;
• exercise to enhance the individual's ability to care for himself/herself; and
• evaluation for splinting of arms and hands for minimizing loss of motion.

• evaluation for swallowing problems,
• diet recommendations, and
• treatment for loss of swallowing and/or speech function.