Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (March 2018)

Patients Age: 29
Admission Date: 1/23/17
Admitted From: White Plains Hospital
Discharge Date: TBD
Discharged To: TBD
Length of Stay: TBD
Reason for Stay: Left foot amputation for Left foot chronic osteomyelitis. History of spina bifida
How did Patient hear about The Enclave at Port Chester? Hospital Case Manager

Details of Experience:

Harry was admitted to The Enclave at Port Chester Rehabilitation and Nursing Center on January 23rd 2018 from White Plains Hospital following the amputation of his left foot due to his history of spina bifida and chronic osteomyelitis of the left foot. The interdisciplinary team, including the nurses, therapists, and administrative team warmly welcomed him to this new environment, making him feel comfortable.

The nursing team evaluated Harry’s wound, with the goal of ensuring a safe healing process while also controlling for pain, which was 7/10 on the numerical pain scale. He would need therapy to improve his strength, endurance, gait and balance to improve his functional mobility in addition to preventing the risk of future falls. Harry was immediately informed about The Enclave’s Comprehensive Amputee Rehabilitation Program, led by Todd Schauffhauser and Dennis Oehler, both paralympic amputees, who provide additional support and training to amputees.

Marlene, the physical therapist, established short term goals of Harry being able to perform all functional transfers independently, an improvement from his current moderate assist of one. Increasing strength and endurance on the right foot required additional measures of support, as Harry was experiencing pain on his right ankle. To ease the pressure he was given an ankle foot orthosis (AFO) to aid in supporting the additional weight not being carried by his left side. These measures helped to improve his mobility so that he was independently transferring in and out of bed and to his wheelchair one month into his stay.

Due to certain issues surrounding the nature of the amputation, there were complications in properly setting her prosthesis slowing the process of beginning to walk with one. The therapy team coordinated with nursing to ensure he could tolerate wearing the prosthesis, without feeling any pain, swelling or redness for extended periods of time. While initially ambulating with a rolling walker by hopping, on March 19th Harry took his first unassisted steps with his new prosthesis. Todd and Dennis met with him to provide additional support and training for safety awareness and proper gait with the prosthesis. The renewed energy of walking independently has been evident on Harry’s face since that day, as he continues to progress towards walking on his own once again.

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Celebrating St. Patrick’s Day!

Continuing our annual tradition, The Enclave hosted a fantastic St. Patrick’s event for case managers to come and enjoy the night out. A local Irish band entertained the crowd and a few lucky raffle winners took home great prizes. Can’t wait for next years party!

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Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (February 2018)

Patients Age: 57
Admission Date: 12/8/17
Admitted From: Montefiore Medical Center
Discharge Date: 2/1/1
Discharged To: Community
Length of Stay: 5 weeks
Reason for Stay: General deconditioning due to adult failure to thrive, chronic kidney disease, History of subdural hemorrhage resulting in traumatic brain injury
How did Patient hear about The Enclave at Port Chester? Hospital Case Manager

Details of Experience:

Phil was admitted to The Enclave at Port Chester Rehabilitation and Nursing Center on December 8th, 2017 from Montefiore Medical Center where he was warmly greeted by the interdisciplinary team, including the nurses, therapists, and doctor. With a history of subdural hemorrhage resulting in hemiplegia and hemiparesis as well as chronic kidney disease, Phil was deconditioned and no longer had the strength to care for himself. The nursing and therapy teams were eager to get Phil back to his independent self.
Upon admission, Phil was assessed as requiring moderate assist of one for dressing and hygiene. Due to extensive pain in his left ankle, an 8/10 on the pain scale, he was severely limited with mobility and transfers, requiring use of a wheelchair. His physical therapist, Tim, recognized his desire to get back home and that carefully working to improve strength and endurance would help to ensure progress notwithstanding the pain.

After three weeks, Phil had passed the initial short term goals set for him. He could walk 60 feet with contact guard assist on level surfaces and could perform transfers with standby assist. He had also made great strides in occupational therapy, being able to dress himself under supervision and he could perform functional mobility during adl’s while using an assistive device. Climbing steps would be the next high bar for him to achieve in order to be able to get into his house. With the steady progress and encouragement from the staff, Phil was excited to take on the next challenge.

On February 1st 2018, Phil was discharged back to the community, a rejuvenated person with a new outlook on life. The pain had largely subsided and he had been trained to function with whatever pain remained. His static standing without a supportive device was over ten minutes, he could climb the twelve stairs needed to get into his apartment and he could walk over 150 feet independently. Phil had also regained the confidence and drive to care for himself, performing all adl’s independently, including hygiene and dressing. The staff was happy to see Phil going back home a completely invigorated person.

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Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (January 2018)

Patients Age: 54
Admission Date: 10/18/17
Admitted From: White Plains Hospital
Discharge Date: 12/6/17
Discharged To: Home
Length of Stay: 7 weeks
Reason for Stay: Right shoulder hemiarthroplasty
How did Patient hear about The Enclave at Port Chester? Hospital

Details of Experience:

Ally was admitted to The Enclave at Port Chester Rehabilitation and Nursing Center on October 18, 2017 from White Plains Hospital after undergoing elective right shoulder hemiarthroplasty due to her history of osteoarthritis. The interdisciplinary team, including the nurses, doctor, administrative team, and therapists warmly welcomed Ally into her new environment, making her feel at ease and comfortable. Shortly after her arrival, Ally was introduced to her physical therapist Marlene and her occupational therapist Jessica. After performing their evaluations, Allie was assessed as non-weight bearing on her right shoulder, requiring extensive assistance of one for activities of daily living (ADL’s), including dressing and toileting. She was also experiencing intense pain, which severely limited her functional mobility and a decrease in strength. Initial goals were established to relieve some of the pain, which would facilitate increased rehab potential. Longer term goals were designed to allow her to regain her functional independent capabilities and get back home.

Marlene patiently guided Ally to increase her strength and endurance, while taking extra care to mitigate pain. After two weeks, the pain level had decreased to 7/10 from a 9/10, allowing transfers to be conducted with standby assist and to climb four steps with moderate assist of one. A follow up appointment with her orthopedist was arranged who was happy with her progress.

One month into her stay, Ally had made tremendous gains, further enhancing her confidence and safety awareness. By this time, the pain was 5/10 so she could maximize her therapy sessions, allowing her to walk 150 feet with an SPC and standby assist and could climb 15 stairs with contact guard assist, meeting her goal. She was doing her adl’s independently with standby assist.

On December 6th , Ally left The Enclave beaming at her regained independence and excited to get back home with her family. While still feeling pain at 3/10, she could perform adl’s independently, including dressing and grooming, and could perform standing activities for up to 25 minutes while utilizing a cane

for support. She could perform functional transfers independently and walk 200 feet with an SPC. We hope to see her visiting soon, to inspire those who have helped her.

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Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (December 2017)

Patients Age: 73
Admission Date: 10/24/17
Admitted From: Phelps Memorial Hospital Center
Discharge Date: 12/12/17
Discharged To: Home
Length of Stay: 7 weeks
Reason for Stay: Acute Respiratory Failure, Hypoxia, UTI
How did Patient hear about The Enclave at Port Chester? Phelps Memorial Hospital Center

Details of Experience:

Bonnie was admitted to The Enclave at Port Chester Rehabilitation and Nursing Center on October 24, 2017 from Phelps Memorial Hospital Center following an inpatient hospitalization for acute respiratory failure and a urinary tract infection. She presented with decreased strength, mobility, and decreased dynamic standing balance resulting in impaired ability to complete basic self-care tasks, bed mobility and functional transfers. Additionally, she was on two liters of oxygen via nasal cannula throughout the day.

Within 24 hours of admission, Bonnie was greeted by the interdisciplinary team that would be overseeing her care during her stay including the doctor, nurses, social worker and therapists who began to formulate her plan of treatment and therapy. She was assessed as requiring extensive assistance of one of one for bed mobility and transfers, as well as for dressing and hygiene. The therapists were eager to work with her, as she was extremely motivated to get back to living at home. Short term goals were established to increase bed mobility and transfers to contact guard assist and to safely ambulate on level surface 75 Feet.

Shortly after starting therapy, Bonnie requested that she be allowed to remove her oxygen, which was initiated under the care of the nursing team. Two weeks after admission, Bonnie met her short term goals of performing transfers with contact guard assist and could safely ambulate 100 feet with a rolling walker. Robert, her physical therapist, established longer term goals of climbing stairs with an assistive device. On the activities of daily living (ADL) front, Bonnie could perform self care with standby assist after three weeks of therapy. She was pleased to be seeing her progress which further motivated her to continue progressing in therapy. The oxygen was also discontinued.

After seven weeks of therapy, Bonnie went back home rejuvenated and proud of her regained functional capabilities. She could now walk a distance of 350 feet with a cane, could safely climb more than 15 steps under supervision and could perform functional transfers and bed mobility tasks with supervision. Additionally, she has greater safety awareness due to technique’s learned, allowing her to perform ADL’s with independence!

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Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (November 2017)

Patients Age: 69
Admission Date: 9/13/17
Admitted From: Greenwich Hospital
Discharge Date: 11/1/17
Discharged To: Home
Length of Stay: 7 weeks
Reason for Stay: Acute hypoxic respiratory failure, congestive heart failure
How did Patient hear about The Enclave at Port Chester? White Plains Hospital

Details of Experience:

Phil arrived at The Enclave at Port Chester Rehabilitation and Nursing Center on September 13th, 2017 following an inpatient hospitalization at White Plains Hospital due to acute hypoxic respiratory failure and congestive heart failure. The interdisciplinary team, including clinicians, therapists, social worker and administration, welcomed Phil within twenty four hours of his arrival assuring him that his care and well being were the highest priority of the team.

Phil presented with decreased strength and endurance impacting his functional mobility and ability to perform activities of daily living independently. His being on two liters of oxygen via nasal cannula and also requiring dialysis three times a week were challenges the team incorporated into his care plan. Therapy established short term goals of increasing upper and lower body strength to stand for 3-5 minutes in order to increase participation in ADL’s and transfers, as well as safely ambulating 75 feet. Long term goals were tasked to ambulate 350 feet independently and perform ADL’s with modified independence, using least restrictive assistive devices.

The nursing team, led by Liby, closely monitored Phil’s oxygen saturation to ensure his health while slowly attempting to wean him off the oxygen as much as possible as his strength increased. Concurrently, Marlene his physical therapist patiently scheduled his sessions to maximize his time here and not extend his stay more than necessary. Nearly one month into his stay, Phil’s lower body muscle strength increased from 3/5 to 4/5, he could ambulate 150 feet supervised, and could perform bed mobility with modified independence. Additionally, he could perform ADL’s standing for seven minutes with supervision.

Over the next three weeks, Phil made substantial progress on multiple fronts, allowing him to return back to living in the community independently. He could be off oxygen for extended periods without feeling short of breath, although he would still use it sporadically throughout the day. He could also stand unsupported for 20 minutes, which surpassed the goal initially set for him. He met the team’s goals which included: perform functional mobility during ADL’s with modified assist, including toileting, using a rollator walker, and could walk for 350 feet with his walker. Congratulations on your incredible progress, Phil!

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Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (October 2017)

Patients Age: 94
Admission Date: 8/25/17
Admitted From: Greenwich Hospital
Discharge Date: 9/15/17
Discharged To: Home
Length of Stay: 21 Days
Reason for Stay: General deconditioning due to Hypertensive crises and orthostatic hypotension. History of kidney disease.
How did Patient hear about The Enclave at Port Chester? Hospital discharge team

Details of Experience:

Vito arrived at The Enclave at Port Chester Rehabilitation and Nursing Center on August 25th, 2017 following an inpatient hospitalization at Greenwich Hospital due to hypertensive crises. Additionally, he experienced a number of falls at home due to his orthostatic hypotension while standing, leading to general muscle weakness and impaired standing balance. He was referred to The Enclave for sub-acute care and rehabilitation, a place he was familiar with as a family member had spent some time here in the past.

The interdisciplinary team, including clinicians, therapists, social worker and concierge, warmly welcomed Vito into his new environment, helping him to feel comfortable. He was assessed as requiring assistance of one for ambulation with extensive of one for all ADL’s (activities of daily living). This included grooming and toileting. His goal was to increase his functional mobility so that he could independently perform ambulation, transfers, and ADLs.

Vito began working out with Marlene, his physical therapist; to strengthen his lower extremities which improve his gait and balance, while concurrently working on his ADL’s. The Tinetti balance test was completed and identified that Vito was at risk for recurring. Through the hard work with Marlene, his Tinetti balance score improved to a 27 which made him significantly safer in the home setting and more stable in performing ambulation, transfers, and ADLs. Therapy continued to work on dynamic balance activities while standing, bilateral integration, energy conservation techniques, and techniques to increase safety for ADL’s.

In addition to the robust therapy regimen, as a Veteran of World War II, Vito benefitted from socializing with his fellow Veterans at The Enclave, over morning coffee at the café or outside in the garden. The warm, friendly atmosphere at The Enclave played a role in keeping Vito’s spirits high so that he could maximize his time in therapy.

Three weeks after coming to The Enclave, Vito was discharged back home to his community , with greater strength and safety awareness. He could perform adl’s independently, including dressing, bathing, and housekeeping independently, as his endurance had increased to standing with upper extremity support for over ten minutes!

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The Enclave Supports Community Veterans

As an annual tradition, The Enclave provided apple pies to our Veteran heroes at The Port Chester Senior Center in recognition of their devotion to our country. The Enclave also brought along one of our very own Veterans, Sheldon, who served his country in Korea, to spend time with some of his comrades. The Mayor of Port Chester, Richard A. Falanka, and other local politicians were also in attendance!

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Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (September 2017)

Patients Age: 71
Admission Date: 6/8/17
Admitted From: Greenwich Hospital
Discharge Date: 7/1/17
Discharged To: Home
Length of Stay: 3 Weeks
Reason for Stay: General deconditioning due to dehydration, history of substance abuse, dysphagia, acute congestive heart failure
How did Patient hear about The Enclave at Port Chester? Greenwich Hospital

Details of Experience:

Eric arrived at The Enclave Rehabilitation and Nursing Center on June 8, 2017 following an inpatient hospitalization at Greenwich hospital due to dehydration from dysphagia, which exacerbated his acute congestive heart failure leading to general de-conditioning. Upon admission, Eric was greeted by the members of the interdisciplinary team who would oversee his care during his time at The Enclave, including the doctor, clinicians, social worker and administrative staff.

Eric presented with general muscle weakness, decreased endurance, and standing balance requiring extensive assist of one for functional mobility during activities of daily living (ADLs) and moderate assist of one for bed mobility and was non-ambulatory. Much to his chagrin, Eric’s diet was downgraded due to his dysphagia to a puree consistency with nectar thickened liquids to prevent the risk of aspirating.
The Speech Therapist, Mike, immediately began working with Eric to implement safe swallowing strategies with the goal of upgrading his diet to mechanical soft by discharge. With patience and determination, Eric regained strength and was upgraded to a chopped diet and thin liquid consistency after two weeks.

To facilitate improvement in ADLs, the Physical Therapist and the Occupational Therapist worked on muscle strength and mobility. After one week: his standing endurance had improved to moderate assist of one and he was able to dress and groom himself with a standby assist of one. Eric looked reinvigorated, allowing him to further progress in therapy.

Three weeks after coming to The Enclave, Eric was discharged back home a stronger, independent person. He could walk a distance of 350 feet and climb 15 steps independently. He could perform all ADLs independently, however, what really brought a smile to his face, was his upgraded diet. Now on a mechanical soft diet, he was able to enjoy his meals as he used to.

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Congratulations to Helen Spillane!

We are proud to recognize Helen Spillane, Director of Nursing, on her 20th anniversary at The Enclave at Port Chester Rehabilitation and Nursing Center!

Spillane, an incredible and integral team member at The Enclave, has been working in the clinical field throughout her whole career. Interestingly, she originally applied to be a police officer in London before she began her clinical journey. “I saw a tv commercial for nursing, and it pulled me in.”

She began nursing training in London, with an interest in oncology. Before joining The Enclave, she worked on the oncology and bone marrow units at Columbia Presbyterian. Spillane shared, “I began at The Enclave when my son was in pre-k, and now he’s a post-grad student. I’ve seen everything over the past twenty years; I love The Enclave.”

Along with working at The Enclave, she also taught a course for the nursing leadership program at Westchester Community College (she was awarded for the work she did there). While also teaching aspiring nurses, she became certified in wound care, and makes wound care rounds every week at the community. She explained, “The more education you have, the better. I’m always on the units, I’m always a nurse.”

While those at The Enclave admire and speak so highly of her work in the community, she explained that she feels that way of her staff and the community: “It’s important to listen to your staff; you have to be there for them, like they are for your residents and patients. My staff are the best, and I need to recognize them for going above and beyond.”

Spillane continued, “There is so much support here [at The Enclave]. I love my residents, and I’m happy to be a part of the CareRite family. I’m happy to motivate and encourage my team members, and it makes me happy to see my staff happy.”
Spillane has been an integral part of the clinical team at The Enclave for the past twenty years; thank you for your unwavering commitment and clinical support!

 

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