Levels of Care

The care a patient receives on Madonna's RDP is very individualized, following an interdisciplinary care plan. However, there are some basic things a person might expect during their stay.

Pre-Admission Most patients come to RDP from within Madonna's system. In that case, the OP Nurse visits with the patient and family while they are still inpatients to explain what to expect, and answer any questions. About 25% of RDP patients come from an acute care hospital or other provider. In that case, typically the case manager or social worker from the acute care hospital talks with the OP Nurse to make the referral. Patients are then scheduled for the first day, which is made up of comprehensive assessments.

First Day The first day in RDP is a busy one focused upon assessment and treatment planning. We require a family member to be present this first day so they may meet the team and have input into the goals, needs, and scheduling preferences. Starting with OP Admissions, where all of the necessary registration materials are verified and signed, the patient is then scheduled for multiple assessment sessions. Depending upon each individual's specific needs and physician orders, he/she will meet with a registered nurse, physical therapist, occupational therapist, speech-language pathologist, therapeutic recreation specialist, neuropsychologist, and/or social worker. These professionals will take physical tests and measurements and solicit input regarding those things that are most important to the patient and family member. Each session is 45 minutes long. In between, if necessary, a rest break may be scheduled as well as a lunch break. Before the patient leaves, they will have a schedule of appointments for the remainder of the week, have an idea of the main goals that will be worked on, and will know about how long they might expect to be in RDP.

• Subsequent Days: Once the evaluations are completed, a schedule is determined based upon the individual patient's needs, insurance benefits, and preferences of the patient and family. Many of our patients begin 5 days per week and then taper to 3 days per week as they gain strength and skills. After the first day, patients report to the RDP day room, where they will find their name tag and personal schedule. Lockers are provided for personal items. Throughout the day, patients are involved in both individual and group therapies as necessary. Therapies generally occur in the gym area, Independence Square, Therapeutic Pool, ADL Suite/Kitchen, in the Vision Clinic or out in the community depending upon specific needs. Our younger patients may spend a few hours in the Therapeutic Learning Center. Recliner chairs are provided in the RDP day room, should a rest period be necessary. Lunch break happens over the noon hour. Some patients buy lunch in the cafeteria while others prefer to bring something from home. A refrigerator and microwave are available in the RDP Lounge area. After lunch, therapy resumes. The OP Nurse may perform skilled procedures such as intermittent catheterization, wound care, monitoring of blood pressure or lab work, and is available to answer questions or provide education. The nurse may also help facilitate appointments with one of Madonna's rehabiltition physicians if necessary during their stay.

Special Activities: Weekly there are other activities that patients may be involved in, as appropriate. These include:

• Opportunities to participate in an Adaptive Sports & Recreation outings such as golf, tennis, basketball, bowling, billiards, or fishing

• Many patients near the end of their stay in RDP get tested for driving

• Several group sessions are available on various topics of interest,such as support groups, adjustment, self-advocacy, liesure education, and holistic approaches including massage, aroma therapy, and other topics.

• Independent Living Skills group, which involves hands-on community based activities aimed toward regaining skills necessary for living independently such as grocery shopping, meal preparation, way finding, and accessing community transportation.

• Vocational Rehabilitation - A Rehabilitation Counselor from the Nebraska Department of Vocational Rehabilitation comes to Madonna to begin the process of transitioning back to work or school. There are also opportunities to simulate work activities within Madonna for those with return to work goals.

End of the Day It is not unusual for the therapists in RDP to ask patients to practice specific things at home during the evenings. This "homework" is very important for reinforcing new techniques learned in therapy. Feedback to the therapists regarding how the task went at home will also help guide future treatment.

Communication Each week the RDP treatment team meets to discuss each patient's progress, plans and goals. One team member, assigned as the patient's Primary Therapist, will meet with the patient before the meet to solicit input, and then after the meeting, to relay what was discussed. Additionally, a family conference may be held if requested.