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

Patients Age: 69
Admission Date: 4/9/18
Admitted From: White Plains Hospital
Discharge Date: 5/14/18
Discharged To: Home
Length of Stay: 5 Weeks
Reason for Stay: Lower extremity edema due to cellulitis; congestive heart failure
How did Patient hear about The Enclave at Port Chester? Hospital Social Worker

Details of Experience:

Caroline came to The Enclave at Port Chester Rehabilitation and Nursing Center on April 9th, 2018, from White Plains Hospital following an inpatient hospitalization due to edema of her lower extremity caused by cellulitis. With a history of congestive heart failure (CHF) exacerbating her condition and slowing the healing process, she experienced a significant decline in her functional capabilities requiring rehabilitation to increase strength and return to her fully independent self.

After being greeted by the nurse manager and social worker, Caroline met with her therapists who would be assigned to her throughout the duration of her stay. She was assessed as requiring extensive assist of one for bed mobility and transfers, extensive assist of one for dressing and personal hygiene, and an unsteady gait requiring assistance of one for mobility. This change in her status was a challenging position for Caroline and she was eager to return to the community independently.

Cynthia, her physical therapist, incorporated a pain management regimen into her exercises to ease the pain Caroline was experiencing, particularly during exercise, so that any pain she might encounter would not limit her ability to perform daily functional activities and move around. Short term goals were established to improve her strength and endurance and to perform ADL’s (activities of daily living) with as much independence as possible. With the nursing team caring for the edema, Caroline was able to focus all her energies on the ultimate goal of getting home.

Over the course of the next five weeks, the pain was managed effectively to reach a low of 3/10 on the pain scale, allowing Caroline to regain her independence and prepare for a safe discharge back to the community. Her endurance had increased to nearly 30 minutes, allowing her to perform all ADL’s, such as toileting, bathing, and dressing independently, without needing consistent breaks. She could independently perform all transfers and bed mobility and could walk 150 feet with a roller walker allowing her to get around the house without needing a rest. On May 14th Caroline went back home to the community functioning at her former levels. We are proud to see Caroline’s progress throughout her stay here at The Enclave. We wish her the best.

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

Patients Age: 73
Admission Date: 4/21/18
Admitted From: Phelps Memorial Hospital
Discharge Date: 5/21/18
Discharged To: Home
Length of Stay: 4 Weeks
Reason for Stay: COPD exacerbation, chronic hypoxic respiratory failure, asthma
How did Patient hear about The Enclave at Port Chester? Hospital Social Worker

Details of Experience:

Maureen came to The Enclave at Port Chester Rehabilitation and Nursing Center on April 21st, 2018, from Phelps Memorial Hospital following a flare up of chronic obstructive pulmonary disease and chronic hypoxic respiratory failure. She was presented with shortness of breath on 2 liters of oxygen via nasal cannula, alert and oriented, but weak and limited in her functionality.

A weekend admission would not prevent the team from welcoming Maureen to her new community. She was assessed by our doctor, nurses, therapists, and members of administration within 24 hours of her arrival, which she found reassuring and made her feel safe. She was assessed as having general muscle weakness affecting her ability to independently perform activities of daily living (ADL’s), and would quickly become fatigued when performing even moderate ambulation with her rollator walker. She scored a 14/28 on the Tinetti assessment, indicating a high risk for falls. The therapists outlined her primary goal as being able to safely transfer in and out of bed and to have the strength to perform ADL’s while standing, so that she could use her wheelchair for lengthy ambulation.

Her physical therapist, Cynthia, guided her with safe transfer practices while working on increasing her strength and safety awareness training. Ten days into her stay, Maureen could better position herself to walk 50 feet with contact guard assist on a rollator walker and could transfer in and out of bed with standby assist. Toileting and hygiene could now be done with modified independence using a supportive device, while lower body dressing could be done with contact guard assist.

During her stay, Maureen was thrilled to take advantage of some of the community’s perks, such as the iPad, which she could use in her room, as well as the company’s complimentary car service, which allowed her husband, who no longer drives, to come visit and spend time with her. This complemented her therapy sessions by ensuring she had an overall exceptional environment conducive to recuperating and keeping her at ease.

On May 21st, Maureen was discharged back home, smiling at the quick turnaround and great success she had during her stay. She could safely climb 12 steps, could transfer out of bed independently, and could also get in and out of a car independently, giving her back freedom to move about the community. Her fall risks had decreased significantly, and she could safely ambulate on her walker 150 feet with supervision. Additionally, she could perform ADL’s such as dressing, bathing and hygiene with occasional set up assistance, giving her back her independence to function as she used to.
We are so proud to see the amazing progress she made during her time at The Enclave.

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

Patients Age: 29
Admission Date: 1/16/18
Admitted From: Helen Hayes Hospital
Discharge Date: 4/9/18
Discharged To: Home
Length of Stay: 11 Weeks
Reason for Stay: Acute pneumonia and anoxic encephalopathy following head injury
How did Patient hear about The Enclave at Port Chester? Hospital Social Worker

Details of Experience:

John was admitted to The Enclave at Port Chester Rehabilitation and Nursing Center on January 16th, 2018 from Helen Hayes Hospital. He had been recuperating since mid-December following an injury to the head, which was exacerbated by acute pneumonia, leading to anoxic encephalopathy leaving him severely compromised. With a long road ahead of him, the comprehensive nursing team and members of the administrative staff welcomed John to ease his transition into this next chapter of his recuperation.

The nurse manager Liby, met with John to assess his progress and ensure proper care would be administered as necessary. She carefully examined his tracheostomy and PEG tube site’s, which still needed attention following their being discharged shortly before his coming to The Enclave. The speech therapist, Mike, performed his assessment to improve cognitive-linguistic skills and communication abilities along with the physical and occupational therapists. Short term goals were set to increase independence with ADL’s to moderate assist for toileting and transfers and contact guard assist (CGA) for hygiene.

Liby noticed that John seemed very tired which was impacting his ability to participate to the best of his abilities in therapy. After consulting with Dr. Bhuddavarapu, the primary care physician, John was started on an IV and antibiotics to ensure proper hydration and prevent deterioration of his health. John was visibly improving and could fully take part in therapy sessions after being put on his new regimen

John began regaining his strength to perform tasks more independently and succeeded in reaching his short-term goals one week into February. He was able to perform hygiene care with CGA and lower body dressing. The next set of goals was targeted to get him increasingly independent without assistive devices, as he had been prior to his initial hospitalization. At the end of March, John was once again performing all ADL’s, including toileting, self-care, and dressing independently.

Regaining the strength needed for climbing stairs and walking unassisted took more time with the physical therapy team. On April 9th, John was discharged back home a reinvigorated person. Indoors he could ambulate entirely independently, while he would use a straight cane when walking outdoors. He could climb more than 15 stairs unaided and had improved from a mid-March Tinetti Assessment of 15/28, indicating high risk of falls, to 24/28 indicating a significant decrease in risks for falls. He could perform functional transfers independently. John was escorted out walking independently anticipating his return to living independently. It was an honor to assist John in his recovery at The Enclave.

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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 his 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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