Recovering from a critical illness or an accident can have a huge impact on a person’s life, both physically and emotionally. After an acute care stay due to an illness or accident the goal of our interprofessional health care team at The Salvation Army Toronto Grace Health Centre (TGHC) is to maximize the patient’s rehabilitation potential, enhance patients’ abilities, decrease a patient’s length of stay, as well as improving a patient’s outcome and function. All of these factors contribute to helping a patient gain back their independence so that they may have a successful integration back to the community or home.
As well as recovering physically, patients also need to accept and deal with what happen to them emotionally, and can experience a diverse range of emotions at various stages of recovery. For instance, towards the end stage of rehabilitation patients may feel anxious and overwhelmed about returning home or back to the community. Although working towards returning home or the community is a primary goal it is very common for a patient to wonder if the level of independence they have gained back during rehabilitation will enable them to cope once they return home. To support patients prior to their discharge the TGHC created the RBC Safe-at-Home Program.
With the generous support of the RBC Foundation, the TGHC’s occupational therapy team was given an opportunity, in the early stages of the TGHC’s infrastructure renewal project, to develop an initiative to promote independence for patients transitioning back to the community. The RBC Safe-at-Home Program was developed to help patients practice activities of daily living (ADL), such as bathing, dressing, toileting and grooming, within an independent suite. A room in the Post Acute Care Rehabilitation unit at the TGHC has been designed to simulate a bachelor apartment–like setting. The room incorporates a bathroom, kitchenette, living room and bedroom, and includes amenities like a microwave oven and a television. Prior to discharge patients can practice their ADL independently within a safe environment.
This flexible program allows patients to be by themselves for a few hours, a whole day, or even for an overnight stay. During their stay, an occupational therapist assesses the patient and reviews their progress.
Patients in the RBC Safe-at-Home Program enjoy all the support of a hospital setting while being able to practice living independently, all of which prepares patients to avoid feeling overwhelmed at discharge.
Bruce, a bilateral transplant (double-lung) patient from University Health Network’s Toronto General Hospital, was admitted to the TGHC’s Multiple Organ Transplant Rehabilitation program. Bruce also participated in the RBC Safe-at-Home Program and shared his thoughts about living independently in the room before his discharge.
How long did your rehabilitation last at the TGHC?
Bruce: I arrived on April 26, 2018 and was discharged on May 31, 2018; so just over a month.
Bruce during your rehabilitation did you feel overwhelmed about being ready to return home?
Bruce: When I first came to Toronto Grace I was in a wheelchair and needed assistance with transferring from a bed to the wheelchair or walker, as well as other activities of daily living. I’ve always prided myself on not giving up and to try my best, but I was discouraged and thought I should be moving along a lot quicker…so in a way you’re always thinking about going home and how you’re going to cope.
Towards the end of your rehabilitation you had gained back your independence and you were able to use the RBC Safe-at-Home Program room, how long did you stay?
Bruce: I was in the room for 24 hours.
What do you think about the RBC room?
Bruce: I think the RBC room is a very useful tool. When you’re in a hospital room you are provided with health care by the health care staff and you don’t really test yourself. You aren’t sure about your progress or what your limitations are?
When you were in the RBC room were you able to gage your progress?
Bruce: While I was in the room I made a point of not calling the nurses. By not calling the nurses I was able to prove to myself that I could do more. I guess what I’m saying is that I realized that I could do more than I thought I could. When I was on my own I had to get up and do things like getting dressed and undressed, go to the bathroom or have a shower. This allowed me to see what I was able to do on my own and verify that my mobility had increased.
So you did take a shower?
Bruce: Yes. It may seem trivial to talk about been able to take a shower on your own, but when you’re at that stage in your rehabilitation where you need assistance to help you shower you could very easily become apprehensive about your ability to shower safely on your own.
In the 24 hours you spent in the RBC room were you able to sort out any feelings you may have had regarding your ability to be on your own?
Bruce: Spending the night in the RBC room reinforced for me that what I was doing was measuring my ability for the next step towards returning home. Once I was able to establish to myself the level of independence I had gained it gave me the confidence that things were going in the right direction.
Would you say the RBC Safe-at-Home Program helped with your rehabilitation?
Bruce: Yes, but overall the Toronto Grace was a place for me to receive rehabilitation and gain back my independence after my lung transplant, and I think the health care staff did that in spades.
The TGHC would like to express to our acute care partners, as well as our community services providers that our RBC Safe-at-Home Program supports our patients before discharge with a meaningful and practical approach. By practicing activities of daily living on their own in an inpatient environment, patients will be more prepared to perform them independently in the community resulting in fewer resources allocated, fewer emergency room visits, as well as fewer acute care admissions.
Thank you for the generous support of the RBC Foundation for making this new Program a reality.