Day Rehabilitation Makes All the Difference

Gary Castel almost died twice after he had a stroke last May. He survived huge odds, only to face a new and frustrating fight in his recovery.

He needed intensive physical rehabilitation, but insurance would not
cover his stay at an inpatient rehabilitation unit. He had already spent two months in a North Dakota hospital after suffering a hemorrhagic stroke last May while working on the railroad.

“I wanted him in Genesis Rehab because I had always heard such wonderful things,” says his wife, Mary Castel. “But when we finally flew him home in late summer, insurance denied our request for inpatient rehabilitation.”

Her 58-year-old husband, who couldn’t walk, talk or eat on his own, was deemed “bedridden” -- a label that seemed defeating for the once strong and independent man she had married. She had faith he would no longer be bedridden, if only he had therapy.

“I believed in Gary. My family believed in him. It felt like the rest of the world had given up on him,” Mary says.

The solution came in November with the opening of the new Day Rehabilitation Program at Genesis Medical Center, West Central Park, in Davenport.

The program, the first in Iowa and the only one in the Quad Cities region, serves as a bridge for patients who no longer require hospitalization but still need intensive, regular rehabilitation after a serious illness or injury. Patients continue the necessary level of therapy during the day, and then return home at night and to daily life.

The program would fit Gary Castel’s needs. And best of all, insurance would cover it.

A Transformation

In just several weeks at the Genesis Day Rehabilitation Program, Gary has undergone a dramatic transformation after months of “wasting away in bed,” his wife says.

For three hours a day, several days a week, he receives physical therapy, occupational therapy, speech therapy and therapeutic recreation, in addition to nursing care and the oversight of a physician who specializes in physical medicine and rehabilitation.

His wife also receives education about his care and moral support from a rehab team who understands how to help.

“The amazing people at Genesis believed in Gary and gave him the chance he needed,” Mary says. “Now, he believes in himself. Before, he would say ‘I can’t.’ Now he comes home and says, ‘Guess what I did today!’ We have a long way to go, but I know we’re going to get there.”

The Program

The Day Rehabilitation Program at Genesis fills a much-needed gap between inpatient and traditional outpatient rehabilitation services. Located in a newly renovated area on the West Campus hospital’s second floor, the program has a sunlit open gym area, exam rooms for nursing and physician care, a kitchen to learn activities of daily living and a courtyard for outdoor therapy.

“The program is for people who can live at home but still need the intensive therapies of more than one discipline and also require nursing care and the oversight of a physician,” says physical therapist Susan Bode, who helps lead the program.

“Patients tend to be happier if they can stay at home, and their rehabilitation process tends to go better. Plus, there’s a substantial cost-savings to the hospital and payers.”

Patients with neurological diagnoses, such as brain injury, stroke, spinal cord injury, tumor resections and multiple sclerosis, comprise about 57 percent of the patients served by Genesis Physical Medicine and Rehabilitation. These are the same patients best served by day rehabilitation programs.

Once patients like Gary no longer need this intensity of rehabilitation services, they will transition to a traditional outpatient clinic.

“We call it ‘Going to Class,’” Mary Castel says of her husband’s trips to day rehabilitation.

“Now, Gary has a future. Instead of wasting away in bed, he’s up and moving. He’s going places. He’s getting the intensive treatment he would have had with the inpatient program, but he gets to go home at night. Thanks to his therapies and the nursing care he receives, we can also accomplish more while he’s at home.”

Gary, who is tired but optimistic after three hours of intense therapy, agrees: “I like the program. It will help me get back on my feet.”

With emotion, Mary Castel describes the utter hopelessness she felt when her husband returned to Davenport after two months in the North Dakota hospital. With no other alternative, she put him in a nursing home despite knowing it was not equipped to give him the level of rehabilitation he needed.

Over the months since his stroke, he had deteriorated. His head drooped more. He became depressed.

When insurance ran out on his nursing home stay, she tried again to have him go to the inpatient rehabilitation unit at Genesis -- only to be denied coverage a second time. Scared to death to care for him alone, Mary took him home and enlisted the services of a home health agency for his nursing care and therapy.

That’s when Gary began to make some progress, she says, and a home health therapist told her about the opening of the new Genesis Day Rehabilitation Program.

“Gary has made excellent gains,” Bode says. “When he came here, he wasn’t walking at all with a walker. Currently, he’s using a left platform rolling walker and progressing to a quad cane. The goal is for him to be able to walk in his home with just the assistance of his wife.

Bode adds, “Mary has been a great advocate for him. Another aspect of the Day Rehabilitation Program is to train and educate the family with skills that they can carry over at home. Mary is very eager to learn and to encourage him to do as much as he can.”

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