What’s the Difference Between Rehab Without Walls® and Home Healthcare?

Alternatives January 22 by RWW

We must note upfront, however, that one program is not better than the other. The choice of treatment modality is totally dependent on the specific needs of the individual served. So how do you determine which option is more appropriate? When is the Rehab Without Walls® approach most useful and what distinguishes it from other forms of treatment delivered in the home? In this issue of Alternatives, we’ve asked two staffers who have worked both at Rehab Without Walls® and at the home healthcare division to share their perspective. Here Cathi Peterson, the Specialty Account Representative for Nevada, and Dana Eriksson, a speech-language pathologist based in Phoenix, address these questions.

Patient Status

“One of the biggest differences between Rehab Without Walls® and traditional home healthcare is that in order for a patient to receive home healthcare, he or she must be considered to be homebound,” says Peterson. “That is not true for us. We require the client to be medically stable with a potential for rehabilitation. We work with a very different population and our goal is to actually get them out of the house and back into an active, productive life. We create and implement a program tailored to achieve a functional outcome for each client.”

Setting

With Rehab Without Walls®, the setting for therapy includes the home but also stretches into the client’s broader community. “We like to say we provide rehabilitation wherever life happens,” says Eriksson. “This can include the client’s home, backyard, neighborhood, supermarket, gym, workplace, school or wherever they go beyond the home.”

Language

In home healthcare, the person served is called a patient. In Rehab Without Walls® he or she is referred to as the client. “We do this because the word client implies that the person served is an active partner in his or her care. I also think it empowers their performance in the program,” says Peterson.

Functionality

The foundation of the Rehab Without Walls® program is functionality—setting functional goals that relate to the client’s real life and using both proven and innovative interventions to achieve those goals. Home healthcare, on the other hand, may teach patients coping strategies but it may not be possible to get the patients back into their lives. “It comes down to quality of life,” says Eriksson. “Many of the individuals seen in home healthcare may not have potential to become independent. At Rehab Without Walls®, we focus on life skills in addition to the physical recovery from illness.”

Payer Source:

Unlike home healthcare companies, Rehab Without Walls® does not accept Medicare. We work with private insurance and workers compensation companies. In fact, our model, with its focus on returning to a productive life, is particularly appropriate for workers compensation cases.

Length of Stay

Home healthcare generally has shorter lengths of stay; sometimes it offers stopgap measures in-between admission to different facilities or is used directly following a hospital discharge. Clients generally stay with Rehab Without Walls® for a longer period of time because of the long-term vision for returning the client back to a productive life. The team spends intensive time upfront—as much as five to six hours a day, five days a week, if necessary—then tapers off as goals get met and functionality increases. In addition, home healthcare is generally delivered in 45 to 60 minute increments. Rehab Without Walls® visits can last several hours depending on the focus, for example, a co-treatment or a community outing.

Treatment Team

Home healthcare takes a multidisciplinary approach to care in which each therapist delivers therapy in individual sessions with little interaction with other team members. Notes are usually not shared among the different treating professionals. Rehab Without Walls®, on the other hand, uses an interdisciplinary team approach that may include co-treatments along with ongoing consults, brainstorming and group problem solving. Team case conferences are held on a monthly basis with all professionals on the case in attendance. Here they meet with the family, report on progress and describe goals set for the next treatment period. The client receiving the services, as well as family members, has the opportunity to receive feedback directly from treating therapists and provide feedback as far as what goals are a priority. During the treatment process with Rehab Without Walls®, there can be more than one clinician working with a client at a time if that is what the client needs; in home healthcare this would be considered duplication of services. Further, in home healthcare, the case is led by a case manager/nurse and in Rehab Without Walls® it is run by a clinical coordinator—both are different specialties with different certifications and different approaches.

Diagnoses Seen

Both Rehab Without Walls® and home healthcare work with a variety of diagnoses and conditions. Rehab Without Walls® is particularly suited to complex cases with a psychosocial and/or neuropsyche component that need multiple layers of care, for example spinal cord injuries, stroke and traumatic brain injuries. (See list for complete list of diagnoses served.)

Physician Involvement

Physicians can take an active role on the Rehab Without Walls® treatment team and are a key part of the monthly team meetings. Physicians working with home healthcare companies receive regular patient progress reports but on the whole have less day-to-day input.

Programming Structure

Home healthcare takes a fairly structured approach based on best practices. Rehab Without Walls® uses best practices as a baseline then personalizes the plan of care to reflect the client’s life and goals. This means that no two plans are exactly alike. “We have a lot of flexibility in our approach as long as it brings results,” says Eriksson. “We specialize in out-of-the-box problem solving.” Adds Peterson, “When developing the plan of care, we are allowed to get as creative as we need to be. For example, we’ll tap into the client’s hobbies and incorporate them into treatment. This helps with motivation and allows the ability to measure gains post illness or injury.”

Outcomes

Each program uses very different criteria for measuring outcomes. Home healthcare looks at medical outcomes. Rehab Without Walls® looks at functional outcomes. Rehab Without Walls® is also concerned with durability of outcomes—for clients to maintain gains, retain maximum independence and avoid re-hospitalization. “Rehab Without Walls® is extremely outcome focused,” notes Peterson. “Our teams work hard to get our clients to where they both want and need to be in their lives.”