Recovering from surgery or a serious illness is a challenging journey. As an experienced nurse advocate, I have seen firsthand how advocacy can lead to better outcomes and a positive rehabilitation (rehab) experience. 

Here are some practical steps to help you, your loved one, or friend navigate this critical time effectively and safely.

Know your level of care 

Rehab facilities vary depending on the need of care. The hospital physical therapist (PT) will be the expert in how much therapy you require and can tolerate in rehab. 

Acute rehab. Daily therapy of 3-5 hours from multiple therapists (PT, OT-occupational therapy, ST-speech therapy, and others) with good recovery potential by the patient is best suited in an acute rehab hospital (and there is only one in the Coachella Valley). Acute rehab requires insurance approval, so start asking early in your hospital admission for this possibility, contact your insurance company and work with the hospital case manager for placement. 

Skilled nursing facilities. SNFs, a lower level of intensity in therapy, are located in some hospitals locally, as well as nursing homes and assisted living facilities. It is important to do your research in advance and choose three facilities with a minimum of three stars from www.medicare.gov/care-compare. Note that if beds are full, you may not get your first choice. Work hard with therapy in the hospital to show your strength and good rehab potential; any problems in the hospital may result in the denial of your choice rehab.

Healthy habits for rehab accommodations

Ensuring your accommodations are safe, secure and comfortable should not be taken for granted. Here are tips to consider:

Safe bed environment. Keep bedside items organized and close (i.e. call light clipped to your blanket, bed controls close – and ask how to use them, glasses, dentures, hearing aids, and urinal for men). Personal items within reach will help prevent falls from bed – and do not try to get up alone! (Note: be careful not to leave any personal items on your food tray that may disappear when the tray is picked up; this can be costly if your hearing aids or dentures are lost!)

Pressure sore prevention. To prevent sores on heels and buttocks, it is essential to change positions often.

• Up-to-chair. Unless physically impossible, have all meals in the chair to prevent choking episodes (you will have to ASK for help). Do this about 15 minutes before meals arrive on your unit or staff will be too busy. 
• Walk often. Participate in all therapy sessions and if PT deems safe, walk with visitors. (*Note: your insurance is receiving updates on your progress and if you are refusing therapy this will lead to denial of your continued stay and lead to placement elsewhere that you may not want.)
• Skin care. If you are immobile and have difficulty changing positions, ASK for help keeping your skin soft with lotion. ASK to have your position changed every two hours and keep heels elevated and off the mattress. In rehab, you may only get a bath/shower twice a week unless family/friends help you, so take steps to prevent pressure sores that can complicate healing and delay your discharge home. 
• Blood clot prevention. If you are immobile due to surgery or a severe illness such as pneumonia, prevention starts in the hospital and should continue into rehab. ASK what clot prevention protocols are being utilized, both in the hospital and rehab, and ASK early in your stay. ASK what bed exercises can you do to prevent blood clots if you are unable to stand/walk. Pressurized boots are sometimes used but make sure they are not only on your feet/ankles but also turned on and functioning. Medication such as a blood thinner should also be considered, so discuss with your doctor. Recognize the symptoms and report them immediately: shortness of breath, back pain, warm/red areas that are sore to touch in a calf or arm.
• Know your medications. Medication errors are a top harm issue in both hospitals and rehab. Keep a copy of your medication list at your bedside and ASK which ones you are receiving as they are dispensed to you throughout the day. Know why new medications are added and how they will be given – and update that medication list. (*Note: new medications are often started in the hospital but not needed in rehab and can become a problem if not stopped. Watch and ASK about your medications.) A recent client of mine could not participate in rehab therapy for days without his blood pressure dropping – because he was prescribed three medications in the hospital that should have been dropped when he transferred to rehab.

On any given day, the order and importance of these practical steps can change. Critical to all of them is COMMUNICATION. Notice I emphasized often to ASK. As new viruses continue to surface or worsen, and with the current health care workforce shortage, you must speak up for yourself or your loved one on a daily basis. Share your concerns, ask questions and express your preferences. Your health care team relies upon your feedback to provide the best care possible, so do your part and be your own advocate.

Dr. Porter is CEO/Founder of MyHealth.MyAdvocate in Palm Desert. She is an experienced health care professional with over 30 years of nursing practice dedicated to advocating for patients, families, and caregivers. For more information, call (760) 851.4116 or visit www.myhealthmyadvocate.com.

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