110 - Utilizing a Transitional Apartment in Inpatient Rehab

Case Diagnosis: Guillain-Barre Syndrome

Case Description: The patient is a 19-year old college athlete who presented to inpatient rehabilitation after developing severe bilateral lower extremity weakness that progressed to involve both upper extremities due to Guillain Barre Syndrome. The patient was treated with one course of IV immunoglobulin and did not require intubation. The patient was discharged without rehabilitation and symptoms included decreased appetite, dramatic weight loss, and uncontrolled pain. The patient required assistance for all ADLs, including bathing, dressing, brushing teeth, and feeding. The patient was referred from the outpatient setting for inpatient rehabilitation to assist with ambulation, caregiver training, assessment for neurogenic bowel & bladder, respiratory evaluation, and optimization of pain regimen. By the end of the inpatient rehab stay, the patient and family were able to utilize the state-of-the-art transitional apartment to assist with community re-integration.

Discussions: When using a transitional apartment, the patient benefits by practicing home skills like making their bed, washing dishes, dining at the table, and more. Lingering deficits that may not be noticed in a hospital environment with constant nursing assistance can be found and addressed during this time, as the patient will quickly learn what they can and cannot do independently. In theory, this should reduce readmission rates as patients will learn how to safely address deficits as opposed to being forced to cope in potentially risky ways when discovering them after discharge. However, there is limited literature on the utilization of this type of inpatient rehab setting.

Conclusions: We believe that other rehabilitation facilities could use a similar setup to benefit patient community reintegration in select populations. Patients that would make good candidates for transitional apartment stays are ones who had a significant loss of independence prior to or during their hospital stay and who plan to be independent-to-modified independent in ADLs upon discharge.