The care a patient receives on Madonna's Transitional Care Unit (TCU) is very individualized, following an interdisciplinary care plan. However, there are some basic things a person might expect during their stay.
Physician Visits: Patients are seen on admission and at discharge by a physician who specializes in Physical Medicine and Rehabilitation (called a "Physiatrist"). Additional physiatry and/or internal medicine physician visits are based on medical necessity.
Personal Care: Performing as much of one's own self-care (bathing, dressing, grooming) as possible is one way our patient's gain the necessary skills and strength to return home. An Occupational therapist teaches different ways to do things and may use of adaptive equipment for these activities, which are then reinforced by the nursing staff. Patients are encouraged to get dressed and actively engage in therapies as well as meals outside their room if able.
Clinical Procedures: Throughout the day, staff members provide necessary treatments such as medication management, nutrition supplements, bowel and bladder training, and wound care.
Rehabilitation: Most patients on the TCU will receive some combination of physical therapy, occupational therapy, and/or speech-language pathology. A treatment space and additional area for mobility training are located on the unit, where many patients receive therapy. Patients may also travel upstairs to the larger gym and other special treatment areas on the main level to take advantage of specialized equipment. Therapy is scheduled in half-hour increments, and focus on strengthening, mobility, communication, and functional skills.
Education & Training: A very important part of rehabilitation involves the patient and/or their family members or other caregivers learning about the person's condition and care needs. This is done throughout the day. Therapists teach adaptive techniques and how to use different pieces of equipment to help with self-care or other functional tasks. Nursing staff teach patients and their family members about their medications and management of other health conditions. A Nutrition Therapist may teach a special diet, a Neuropsychologist may teach some techniques for coping, or a Respiratory Therapist might teach how to manage oxygen. Family members are encouraged to stay actively involved in their loved one's care so they may have their questions answered, learn how to reinforce new techniques, and be comfortable with providing any care necessary when the patient is discharged home.
Case Management: Each patient has an assigned case manager and social worker, who coordinate the treatment plan, help drive discharge planning, and educate regarding community resources. Each day the team meets to discuss patient's individual progress, adjusting the plan as needed. The case manager shares information discussed at the meetings with each patient and/or family member, and solicits their feedback.
Meals: There are at least 3 meals per day delivered. Patients may choose to eat in their rooms or out in the common area, where they may interact with others. As patients gain more independence, they may graduate to "Independent Dining" which means they may go to the Madonna cafe and select from a wide menu of food.