Rehab in the Great Outdoors

Therapeutic spaces restore body and soul

Vol. 32 • Issue 4 • Page 8

On a clear, crisp spring morning, Tom Johnson heads outside for a walk after breakfast. With his sights set on a bench surrounded by vibrant gardens, he maneuvers a winding path surrounded by rolling hills dotted with budding trees.

Although it sounds like Johnson must have the type of backyard that belongs in the pages of a home magazine, he is exploring the grounds of his temporary residence: St. Andrew’s Village.

A continuing care retirement community in Indiana, Penn., St. Andrew’s Village recently opened an outdoor rehabilitation space as part of a $10 million transformation project. As Johnson recovers from a hip replacement, he is one of many residents enjoying the expanded features on the newly renovated campus.

A planning committee met frequently for several years to map out the campus overhaul, with home-like attributes topping the wish list of features. The team designed two large outdoor courtyards, each with a different purpose.

“We planned the new courtyard areas as a place for the residents to socialize, enjoy the outside, and visit with family, but also to provide a backdrop to practice real-life chores and activities they do at home and in the community,” shared Audra Palmo, MS, NHA, healthcare administrator at St. Andrew’s Village.

All outside areas are directly accessible from the healthcare center’s four neighborhoods. The courtyard adjacent to the community’s short-term rehab neighborhood serves as an outdoor therapy clinic. The unit features 30 beds dedicated to short-term post-acute admissions, with about 85% of patients discharged to home following an average length of stay of 14-21 days.

“The rehab team played a large role in the planning process,” explained Brian Parks, executive director of St. Andrew’s Village. “We met to understand their needs for the outdoor space, and discussed challenges identified during patient home evaluations.”

Aside from its rehab components, the courtyard is aesthetically pleasing, which has its own merits. “Many factors can limit residents’ willingness to engage in therapy,” explained Amanda Shore, COTA, director of rehab at St. Andrew’s Village. “Individuals are more enthusiastic about participating in therapy when their surroundings feel less institutionalized and more home-like.”

Rehab in the Great Outdoors

The courtyard at St. Andrew’s Village functions as an extension of the rehab gym, allowing residents to identify goals they must tackle before heading home. “The outdoor rehab area is the biggest element that sets our campus apart from others,” said Shore. “We have numerous ways to provide treatment to our residents, beyond typical exercise in a gym.”

St. Andrew’s resident Marlin Ressler works on ADLs with Mary Russell, COTA/L. (Photo courtesy St. Andrew’s Village)

The rehab department consists of 9 physical and occupational therapy practitioners and one speech-language pathologist, plus PRN employees as needed. “We love having an in-house rehab model,” Parks shared. “It helps us identify and follow through on our residents’ needs.”

Home evaluations reveal useful information for therapists, including how safe patients will be when they go home, and what challenges their homes present. Therapists perform home evaluations early in the stay to identify needs such as a graded sidewalk from the driveway to the front door, Shore told ADVANCE.

Obstacles therapists identify during home evaluations are simulated at St. Andrew’s. A patient who performs a lot of community ambulation, for example, will need to practice walking on sidewalks and stepping up on curbs. Residents practice on various terrains and surfaces in the courtyard, an area designed to meet the needs of all ability levels.

Surfaces available to challenge ambulation include grass, mulch, river rocks, and stepping stones. “The walking path that winds throughout the courtyard is intentionally not level, so residents can walk up and down various grades,” Shore observed.

According to Parks, getting to the mailbox safely to retrieve mail was one need that kept popping up in early discussions. “Patients often have to navigate a rough dirt path or a small hill to reach the mailbox,” he said.

St. Andrew’s Village replicated those challenges with a mailbox on site, surrounded by challenging terrain such as a stepping stone path. Retrieving mail is an activity that OT and PT can work on together with a resident. A physical therapist helps the patient navigate the terrain and balance while completing a task, and occupational therapy simulates opening and closing the mailbox and carrying the mail back.

Another feature regularly used in the new rehab area — one that Parks admits may be unique to western Pennsylvania — is a clothesline. “They’re still popular in this region, so we need to help our residents prepare for that task at home,” he said.

Occupational therapists work with residents who need to practice hanging clothes, standing in the grass, bringing the clothes down, and folding them in a laundry basket.

Additionally, because residents aren’t discharging to city living, many need to prepare for all the chores and tasks that go along with maintaining a yard. The courtyard has rakes and hand shovels to prepare for lawn and gardening activities. A handful of raised garden beds allow residents to plant, weed and water gardens throughout the summer.

According to Palmo, St. Andrew’s occupational therapists assist residents in outdoor dining activities. “Residents can learn from eating outside at a table with a different height and surface than they are used to,” she explained. “Plus, they can practice balancing and carrying their food to the outdoor dining area and placing it on the higher table.”

Feeding the Soul

“Our residents are excited when they get to leave the therapy clinic and go outdoors,” said Shore. “There is a notable difference in attitude because they feel like they have stepped into the community. The transformation has made the campus home-like.”

Residents are thrilled to be in the fresh air, complete tasks they perform in their yards at home, and experience things outside the walls of the rehab gym.

“It’s great for their mood, and they feel refreshed and energized when they can exercise outside,” stated Palmo. “For many of our residents, it’s about maintaining the dignity of completing the simple tasks they have waiting for them at home.”

The planning committee discovered that residents aren’t the only ones hankering to get outside. “We found an interest among therapists to work outside on a nice day as well,” Parks shared. “Being outside is therapeutic from a different standpoint — both for staff and residents.”

As temperatures begin to warm, St. Andrew’s therapists are looking forward to using the outdoor space more frequently. But the team also uses the space during inclement and cold weather. “We can work on ambulation and educate about being more cautious in the winter to prevent falls,” Palmo said.

“We have a great team of people here,” concluded Parks. “They’re proud of the therapy they do and the outcomes they’ve achieved, so we’re thrilled that they have expanded options in which to continue their work.”