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

Patients Age: 59
Admission Date: 8/1/17
Admitted From: Westchester Medical Center
Discharge Date: 8/25/17
Discharged To: Home
Length of Stay: 24 days
Reason for Stay: Total Left Hip Replacement
How did Patient hear about The Enclave at Port Chester? Hospital

Details of Experience:

Valerie was admitted to The Enclave at Port Chester Rehabilitation and Nursing Center on August 1, 2017 from Westchester Medical Center after undergoing elective total left hip arthroplasty due to her history of osteoarthritis. The interdisciplinary team, including the nurses, social worker, and doctor warmly welcomed Valerie into her new environment, making her feel at ease and comfortable.

Upon admission, Valerie was assessed as requiring extensive assist of two for bed mobility and transfers, extensive assist of one for mobility on the unit, and extensive assist of one for dressing and hygiene. Additionally, Valerie was a 10/10 on the pain scale, requiring strict pain management. Marlene, her physical therapist, and Marissa, her occupational therapist, coordinated with the nursing staff to initiate a pain management regimen to allow Valerie to maximize her time spent in therapy.

The warm family-like atmosphere at The Enclave contributed to a comforting environment, where Valerie felt secure in the hands of the staff and made immediate progress. She regained her upper-body and lower-body muscle strength, allowing her the ability to increase her functional mobility. After only ten days, she could perform personal hygiene under supervision and could safely ambulate one hundred feet under supervision, using a rolling walker. As her pain intensity decreased over time, Valerie’s progress steadily increased, allowing her to become more comfortable and advance in therapy.

Valerie was discharged back home on August 25th, 2017, a different person compared with when she arrived. Her pain intensity decreased to 3/10, transfers and mobility could be performed independently and she could safely climb 15 stairs with stand by assist and walk 350 feet with a rolling walker! She could also perform ADL’s, such as dressing and personal hygiene independently. The Enclave team was thrilled to be able to see Valerie return home functioning as she had before her elective surgery and we wish her continued good health!

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The Enclave & Alzheimer’s Foundation of America Host CEU

The Enclave was proud to co-host a CEU with the Alzheimers Foundation of America on Thursday, August 17th. The CEU, “Understanding Young Onset Alzheimer’s Disease” was presented by Molly Fogel, Director of Educational and Social Services for the Alzheimers Foundation of America. The evening welcomed healthcare professionals from varying backgrounds and offered educational resources for those who make a difference in the lives of those The Enclave community serves. Thank you to all who attended the informative event!

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

Patients Age: 91
Admission Date: 5/18/17
Admitted From: Local Skilled Nursing Facility
Discharge Date: 7/16/17
Discharged To: Home
Length of Stay: 59 days
Reason for Stay: General de-conditioning due to bilateral osteoarthritis of knee
How did Patient hear about The Enclave at Port Chester? Local Skilled Nursing Facility

Details of Experience:

Domenic was admitted to The Enclave at Port Chester Rehabilitation and Nursing Center on May 18, 2017 from a local skilled nursing facility where he spent two weeks recuperating after an inpatient hospitalization due to uncontrolled pain in his knee, which impacted his ability to safely ambulate, contributing to his general de-conditioning. Because the pain to his knee limited his functional mobility, Domenic was advised that he would likely need long term care and recommended to The Enclave for short term rehab, with the possibility of transitioning to long term care.

Upon admission, the interdisciplinary team at The Enclave introduced themselves and worked with Domenic to develop an appropriate care plan that would minimize pain in order to enable him to maximize his time with therapy. The physician, social worker, nurses and therapists all warmly welcomed Domenic, easing his transition to the new environment. Domenic was assessed as requiring extensive assist for ADL’s including hygiene, dressing, toileting, and all functional mobilities including transfers, bed mobility and ambulation. He could walk a distance of 15 feet with a rolling walker and extensive assistance of one.

Our director of therapy, Mylene, introduced a unique modality, diathermy, for the first twenty minutes of every therapy session, to offset the pain and allow Domenic to participate in therapy. She and the nursing team worked closely to ensure that Domenic was experiencing no pain both during and outside of his therapy sessions. With fewer complaints of pain, Domenic flourished in therapy and after three weeks could maintain standing balance for two minutes unaided and could walk a distance of fifty feet with a rolling walker under contact guard assist. Along with strong family support, this initial success raised Domenic’s spirits and expanded goals were set to increase his independence and functional activity tolerance.

In addition to the stellar clinicians overseeing care, Domenic also benefited from the social interactions with other residents and programs within the community. Specifically, as a veteran of the army, he enjoyed the veterans program, including a round table chat with fellow veterans at The Enclave, who shared their stories and perspectives among the select group. The encouragement and inspiration shared by this select club, played a tremendous role in Domenic’s drive to get better and functioning to the best of his abilities.

Upon discharge, Domenic could safely ambulate 350 feet with a rolling walker, could perform transfers and bed mobility independently and could climb 12 steps, surpassing his initial long term goal of eight steps. His standing duration increased from 15 seconds supported upon admission to over 10 minutes unsupported upon discharge, allowing him to perform ADL’s independently, such as toileting, and included additional functions such as meal preparation which he had not been doing in the recent past. Although he would have been welcome for long term care, Domenic was thrilled to be able to return to living with his family and community to enjoy his newfound independence.

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The Enclave Supports Veterans

The Enclave was honored to host a round table chat, inviting resident Veterans to share their stories, laughs and tears. Veterans, serving from World War II through the Korean and Vietnam War, were in attendance and were treated to light refreshments. The unique bond maintained by our Servicemen was evident throughout the hour-long discussion, the mutual respect of a select few.

We are honored to support our Veterans!

 

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

Patients Age: 62
Admission Date: 3/17/17
Admitted From: Phelps Memorial Hospital
Discharge Date: 6/27/17
Discharged To: Home
Length of Stay: 100 days
Reason for Stay: Severely Sprained ankle, general de-conditioning, history of multiple sclerosis, Bipolar disorder and schizophrenia
How did this patient hear about the Enclave? Phelps Memorial Hospital

Details of Experience:

Shirley came to The Enclave at Port Chester Rehabilitation and Nursing Center on March 17, 2017 from Phelps Memorial Hospital following an inpatient hospitalization for a sprained right ankle and general de-conditioning. Initially, it was discussed that Shirley would be a candidate for long term care. The staff focused on supporting Shirley and ensuring excellent outcomes with hopes of assisting her back home. Upon admission, she was evaluated as requiring extensive assist of two for bed mobility, toileting, personal hygiene and transfers, in addition to being non-ambulatory. During initial skilled physical therapy, her legs buckled. Due to her history of cognitive impairment, the staff strived to build a positive rapport with Shirley, comforting her so that she would be able to fully participate in therapy and not be hindered; this was an opportunity they were excited to embrace!

The entire team at The Enclave worked alongside Shirley to ensure her comfort. Kayla, her occupational therapist, began working on increasing her muscle strength, while the physical therapist worked on increasing her endurance and lower-body muscle strength. To address concerns of pain, the therapists introduced e-stim, diathermy and ultrasound modalities to complement her standard routine, which helped to alleviate a lot of her pain. With determination and patience, Shirley began to make noticeable progress.

The nursing team often went above and beyond to redirect Shirley in ensuring her personal safety. Our psychiatrist and psychologist also made themselves greatly available to Shirley so that she could share her thoughts on her course of treatment and care plan. With the support from the clinical team, Shirley was offered guidance and education as to the expected outcomes of her healing journey, enabling Shirley to relax and be more trusting of the staff.

In the beginning of May, an x-ray was performed on the right foot revealing no acute fracture, at which point her weight bearing status was upgraded to full-weight bearing. The positive news, along with all the encouragement from the team, improved Shirley’s demeanor and outlook. She became increasingly participatory and motivated to engage in therapy, responding well to redirection to maintain attention to task. By the end of May, her gait was significantly improved while ambulating supported by walker, due to her improved muscle strength. She could now perform transfers from different surfaces with stand by assist.

Despite being admitted for potential long term care, Shirley was able to return to her community after a three month stay! Upon discharge, her muscle strength returned to her baseline of 4+ for lower and upper body, she is now independent with hygiene, grooming and feeding, and can ambulate with a rolling walker independently for short distances; for long distances she requires light supervision. Debbie, her social worker, arranged for her to receive home care for ten hours a week to offer additional support services as she transitions back home. Shirley was sad to leave us but was grateful for the staff’s ability to return her back home. We wish her all the best!

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