The psychology of rehab

The era of bundled payments and the Center for Medicare and Medicaid Services (CMS) pilot projects in complete joint replacements has many short-stay rehabilitation units hitting the treadmills to improve patient outcomes. One of the exciting new roles in rehab comes from an unexpected source: behavioral health.

Regardless of the quality of the rehab program services, half the battle is getting patients to do the work—to engage in their progress and stick to the program. Whether it’s a hip replacement, a stroke or a car accident, rehabilitation clients often have trouble dealing with the mental and emotional aspects of their rehabilitative event.

“They’ve been through significant psychological stress,” says Richard Juman, PsyD, Regional Director at IPC of TeamHealth, a Knoxville, Tennessee-based provider of acute and long-term care services. “They can be combative, irritable, afraid and pessimistic, and all of these things can lead to non-compliance. Rehab is intensely medical, but we have to understand the psychological trauma they’re going through, too.”

Treating the patient and the family

Person-centered care, by definition, requires providers to treat the bones and the mind, Juman says. “Mental health conditions, including depression, all have a tremendous impact on health. Addressing these issues at their root cause is part of creating quality of life.”

A psychologist is also specifically equipped to interface with families—who often struggle with the irritability their loved ones feel during difficult rehabilitation sessions and can inadvertently become be process-blockers. Just ask a physical therapist how often the families intercede in a treatment course, saying, “But she says it hurts,” or “You’re pushing him too hard.”

A psychologist, whether on staff or contracted, can help families understand the behaviors of their loved one and how to interact with them in a supportive way.

Dementia and rehab

Regardless of the reason for rehab, when dementia is part of the picture, the challenges skyrocket. Medication management—always a key part of the process—becomes paramount for rehab patients who have dementia. “Wandering, agitation, calling out, refusal to cooperate—these are all meaningful behaviors,” Juman says. “These behaviors have tended to be met with a pharmacological response, but it’s important to seek a full court press on what’s driving those behaviors.”

Targeting whole-person outcomes

The national movement toward value-based reimbursement models gives providers an extra reason to consider adding psychological services to the slate. “With the changing landscape in reimbursement, providers now have skin in the game,” he says. “So, it makes much more sense to work as an integrated team. When you integrate mental health and medical health, you get better outcomes, and it reduces the stigma of mental health.”

Another important aspect for providers is understanding that the rehab experience stays with people long after their bones and muscles have healed. “When people leave a rehab stay, they go out into the community and essentially become grassroots marketers, hopefully spreading the word to the community that the subacute rehab facility really knows what it’s doing.”

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.