Case Study: Glengariff Rehabilitation and Healthcare Center (December 2020)

Patients Age: 67 years old
Admission Date: 09/17/20
Admitted From: Plainview Hospital
Discharge Date: 12/27/20
Discharged To: Home
Length of Stay: 111 days (3 recertifications)
Reason for Stay: Rehabilitation
How did this patient hear about Glengariff Rehabilitation & Nursing Center? Hospital staff at Plainview Hospital.

Details of Experience:
Mr. Robert A. was admitted to the Glengariff Nursing and Rehabilitation Center on September 7th, 2020. Before being admitted to Glengariff, he was admitted to Plainview Hospital, due to a left foot wound that had advanced and brought on septic shock due to gangrene in August 2020.  This hampered his ability to walk.  He also suffered from substantial pain, a decrease in range of motion, a decrease in strength, and reduced balance.  At the hospital, they recommended subacute, short-term rehabilitation due to a decrease in strength and functional mobility, reduced ability to safely ambulate, reduced functional activity tolerance, and activities of daily living (ADL) participation.  Mr. Austin lives at home alone, with 4 steps down to the basement apartment and access to bedrooms without handrails.  He has a walk-in shower.  He was already aware of Glengariff and the reputation for rehabilitation. 


When Robert arrived at Glengariff, he was highly concerned about his lack of balance, mobility, and strength.  The slightest movements would prompt pain and he exhibited little interest in his rehabilitation.  He hoped that rehabilitation would strengthen him, but he was concerned about his ability to manage stairs and to be able to care for himself and his most basic needs.  Upon admittance, Robert was not able to walk by himself, slide or roll from side to side in his bed.  He could not support himself standing for any period, and he did not know if he would ever be able to climb any stairs or even ambulate with the help of a rollator walker, as he could not walk at all. Sitting up in bed created additional experiences of imbalance and over-exertion.  Activities in the bathroom involved complete dependence on the staff and required a Hoyer lift with 2 staff to assist. Robert even had difficulty maintaining his balance in a seated position and shift his weight while in bed, and was at risk for recurrent falls.

Within a month after his arrival, Robert started to make strides in certain areas of mobility. His strength improved, and he was able to attempt transfers from bed with maximum assistance.  He was still not able to take any steps or to hop, however, he progressed from not being able to stand at all, to being able to do so with maximum assistance.  The length of his standing was very short, however. He was still unable to climb any stairs whatsoever, but he was able to utilize a sliding board with “Contact Guard” assistance.  As the therapy continued, Robert’s goals were reset again, establishing new short-term and long-term goals for him to achieve.

With the staff coming to provide both intensive physical therapy and the concierge team keeping Robert contented with chats about his family, regular package deliveries from friends, and prepared meals, he got stronger and better able with each passing day.  Robert was part of the “Team Slow and Steady”, making improvements in his functioning every day until he reached his goals. He was so relieved by this clinical and emotional support, which helped him feel confident and hopeful.  He could focus on getting better and improving his techniques at maneuvering, sitting up in bed, toileting and bathing. His functional mobility during ADL’s also improved from maximum assist to minimal assistance over the first month. He could also maintain his balance in a seated position without any support, which he hadn’t been able to achieve when he first arrived. Though there was much work to do, he could see the horizon of independence in the distance!

The most significant part of his recovery at that point was the delivery of a prosthesis.  While he had made only modest progress to this point, he was described as “highly motivated and working towards his long-term and short-term goals and compliant with his occupational targets.” When he was admitted, Robert could not muster the strength or balance to climb any stairs and was at high risk for falls.  But by the conclusion of the second month of his stay, Robert was able to achieve mobility tasks with mere supervision and no actual assistance.  Rolling from side to side in bed and using handrails was also an achievement that month.  Robert was able to push himself up from the arms of his chair with moderate assistance and sit up with only mere supervision. He was making improvements toward his recovery.  Still, the ability to walk, hop and climb stairs was evading him.  Besides his physical challenges, he had to work to prevent his persistent difficulties from discouraging him.  “Maximum improvement is yet to be attained”, read his progress notes.  He was heartened when he was able to stand with support for 1-3 minutes in place! 

Robert advanced in the capacity he now had for completing ADLs. He could perform lower body dressing with only “Contact Guard” help up from maximum assistance just 30 days before.  His functional mobility during ADLs and his ability to transfer from bed went from minimal assist to mere Supervision. By the third month of his stay, Robert was able to sit supinely without any assistance, push arm from his arms in a chair, rise to a standing position with Contact Guarding, stand unsupported in place for just under 30 seconds, and even pivot in a standing position successfully 10% of the time.  

The most significant improvement was the receipt of a prosthesis and his ability to don and tolerate it for 2 hours.  At the close of November, with his new prosthetic leg, Robert was able to walk on a level surface for 50 feet with Contact Guard!! The demanding and hard work he had put in with the team earlier now supported his muscles for the expectation which the walking now made of him.

Training would now begin on learning to walk all over again- sequencing of gait, increased safety and balance adjustments for when he would be out in the community was priority #1.  Robert became ambitious about bed mobility, transfers from bed and chair to the bathroom with independence and strength of his muscles and his sense of purpose.

By the fourth month of his stay at Glengariff, Robert Austin had become Glengariff’s Bionic Man. He had made such incredible progress that all categories of PT were switched to Minimal Intervention or Supervised only.  He was ready for the final threshold- stairs.  Robert learned to climb them 5 in a row, after waiting 4 months to climb even one.  Wearing his prosthesis was now a regular part of his day, and he would wear it independently, for as long as he wished.  Robert could stand and pivot and walk for 200 feet at a clip!!

In every single rehabilitation category, Robert had surpassed the short-term and long-term goals of his therapists.  He was strong, he was assured, and he was walking tall! Throughout his stay, until his departure nearly 4 months later, Robert was pleased with the staff and how they cared for him.  He described them as “almost as determined as I was.”  Regarding his care, he could still now recall how many times a week he would receive care packages from the concierge that cheered him up.  He felt especially grateful for the ability to rely on the team. 

“I could never have done it without the people at Glengariff.  I feel like a new man.” He is, as he is a graduate of the Glengariff Nursing & Rehabilitation Team.