The Palomar Health Rehabilitation Institute opened a few weeks ago and is gradually expanding the number of patients that it treats. This 52-bed acute rehabilitation hospital is unique in San Diego County and only one of two in California that does what it does: help acute patients transition from hospital to home without being transferred to a skilled nursing facility.
The newest expansion of Palomar Health is adjacent to Palomar Medical Center although it is a stand-alone building housing a 52-bed acute rehabilitation hospital whose intended patients suffer from neurological disorders, stroke, brain injury, spinal cord injury and amputation.
The day I visited and spoke to Chief Executive Officer Natalie Germuska, RN, MSN, the institute was treating 15 rehab patients. Germuska said they were waiting on several permit approvals before they can begin taking Medicare patients. They expect these in the next few weeks. At which time they will expand toward their 52 bed limit. “We’re figuring to be half full by the beginning of next year. People are waiting for this to open fully,” said Germuska.
The institute provides physiatry; physical and occupational therapy; speech-language pathology; rehabilitation nursing; internal medicine; medical and surgical subspecialty consultation; and nutritional services. Most patients will come from Palomar Medical Center, UCSD Medical Center and Scripps.
In the continuum of acute care the top of the heap is a hospital acute care facility, such as Palomar Medical Center.
- Long Term Acute Care Hospitals(LTAC)-Long-term care hospitals (LTCHs) …
- Sub-Acute Care/Transitional Care. …
- Inpatient Rehabilitation. …
- Skilled Nursing Facility (SNF) …
- Intermediate Care. …
- Home Health Care. …
- Hospice Care.
Inpatient Rehabilitation is where the Institute fits in that continuum. One of its goals is to help patients transition faster from hospital to home, often without the intermediate level of skilled nursing facility.
“Our goal,” said Germuska, “is to send eighty to ninety percent of our patients home. We want them to be able to walk or take a wheelchair out of the institute. The average stay at the Institute is 10 to 12 days. “The goal is for patients not to have to pay so much money. How do we spend less medical dollars and be more effective. That’s the question we always ask.”
Palomar Health President and CEO Diane Hansen praised the new facility on the day it opened, “This dream took 10 years in planning and execution to make a reality.”
Acute rehabilitation is called for with patients receiving at least three hours of rehabilitation a day, at least five days a week—divided into 60-90 minute sessions depending on patient needs. Most patients spend an average of 12 days at the institute. The national benchmark is to send 78% of the patients directly home, instead of to a skilled nursing facility, Germuska said. Palomar Health has maintained an 83% discharge-to-home rate, reducing the number of patients needing to be transferred to long-term acute care or a skilled nursing facility.
The medical director for the Rehabilitation Services Team is board certified Dr. Angel Chang. It is staffed with Registered Nurses and CRRN’s (Certified Rehabilitation Registered Nurses.)
CEO Germuska showed me the ADL Suite, a transitional living apartment that simulates a return to normal life by allowing patients to begin resuming daily living tasks. It has a bedroom, living room, laundry room, kitchen and bedroom for loved ones to spend the night with the patient. It is intended for patients who are ready to be discharged.
There is a dining room where patients and their visitors will be able to go to eat once there are enough patients to open that wing.
A separate wing of 12 units secures traumatic brain injured patients from the rest of the patient population. This floor is secured so that brain injured patients can have dining and a therapy gym.
A dedicated “gym” is unlike any gym you have ever seen. It includes a powered exoskeleton that allows patients to move freely in hospital settings. The Institute is the only one in the state to have an exoskeleton.
Form follows function, and the institute “was built for rehab patients,” said Germuska. Other facilities, she notes, don’t have staff trained for acute brain injuries. “That is something that will bring patients here” from other healthcare systems. “We want to be the primary rehab facility for San Diego County, which is underserved for this need.”
The 58,000 square-foot, two-story building will serve an estimated 1,200 plus patients per year and be operated through a joint-venture between Palomar Health and Kindred Healthcare. This is the 22nd such facility that Kinkaid has built since becoming the pioneer in such facilities.
The partnership says, Germuska, “doesn’t just provide great care it is a great idea and concept for how to partner to serve the community.”