CALIFORNIA SfATE UNIVETZSITY,
NORTHRIDGE
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REHABILITATION INPATIENT FOLLOW-UP,.
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Evaluation in a Rehabilitati6n Center.
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A graduate project submitted in partial satisfaction
of
the requirements for the degree of Master of
Public Health in Community Health Education
by
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Leslie Todd Bailey
May, 1975
I.
The graduate project of ·Leslie Todd Bailey is
approved:
. Committee Ch9.lrman
...
California State University, Northridge
P1ay 197.5
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ACKNOvlLEDGMEN'rS.
I
would like to express my sincere· thanks to Dr.
L. H. Glass and Dr .. ,G. B. Krishnamurty for the kind and
capable assistance they provided me throughout the development
of this thesis and for encouragingme to pursue
a career in public health education.
Thanks also to Dr.
Lawrence Sneden for his suggestions, assistance and
encouragement r. not Only With the developmen't of this
thesis, but also for encouraging me to reach for a
t'Iasters Degree.
F~rther
appreciation goes to the Northridge Hospital
Hehabilitation Center for allowing me to.conduct this
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research project under the auspices of the Rehabilltation
Committee, Iv:is. I'!Jarilyn Skelton, Coordinator.
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special note
of"thank~
who first inslpred
Also, a
goes to Ms. RoSerta Suber, M.S.W.
thi~
thesis, whose ideas provided my
theoretical fran1eworl{ and· vThose 1-rork along ·with Ns ..
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Barrie Pundyk, I'-! .S. \rf. provided the data and ideas for my
research.
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Thanks go to all the former patients of the Northridg~
Hospital Rehabilitation
C~nter
·wh_o parti.cipa.ted in this
survey.making the data available for analysls in this
project.
Finally a note of thanks to all.my friends .and family;
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especlally
Cat'herine~
Suzanne, Jennj.fer, and Jim, who
tolerated my many long absences from: affairs under..:
standing that I was irt pursuit of- high:er knowledge in .·
.an attempt to
furth·~r
of the disabled.
understand. health care problems
And. to my Grandmother, Nar·celle Maye11,
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who, having been disabled with polio for fifty years, has '!
been an inspi-ration,- not only to me, but to all those
vrho have know!l her,
for her shining example of courage,
forti tude 'a.nd determination in the face o'f multiple
hancU caps.
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TABLE OF CONTEN'i'S
. Acknowledgments.
. . .. ....... .............
~
Index of •rables
Abstract ••••
I.
III~
IV.
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•
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-•o••••••*••41•••••••••~~t•••••
vii
•
••• 0
~ e e ~ •
•••
•
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a. w 4
•
•
e & •
ft
heview of·the Literature .•
Research Methods
•
•
ft
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0
b •
•
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• ·• e
viii
• • • • • •
1
•••••••
9
•
•
•.•
~ ••••
8
e •
•
• • • • • • e • • • • • • • • • • •·• • • • • • • • •
Study Results and Interpretations
•
••••••••
«<I
V. - Implications for Community. Health Education
Conclusions
Footnotes
A·ppe11dix
A.
~ • •
Ct
81
32
50
• • • • •-• • • • ~- • • • • o • • e •·~ • • • • • •
o • • • • ~ e e e • • • • • • • •-• • • e. • e • • • ·• • • • • • •
.Bi'bliogra.phy
iii
vi
8
Introduction to Hehabilitation'of the
Disabled·
o, • • • •
•! •·• • •
e • • • •
~ •
II.
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•••.•••••.••••• ' . 8.
••
Index of Figures
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..•.••..
.........
"
•
e.
8
••••••
.,.....
•
•
•
•
.,
••
..,
• • • • ·•
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59
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60
Demographic Data Collection Instrument 60
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·INDEX OF 'l'ABLES
. ( by 'l'i tl e )
1. 0
27
Cos·t of Hospitalization in the Northridge
Rehaplli tation Center ••• • •·• ~ •.• • • • • • • • • • • • • • • • •
28
Selected Demop;raphi c · Ghare.cteri sties of
Hehe.blli tation Patients at NRC during
197/._J, "'"'•o_,,,;•••o••~··_.. ••••.••••• tt.•••.,•-~~ •.•••• ~e•••
29'
Operational Definition of Rehabilitation
Success Among Selected Variables for NRC
Pa·tien·ts .,...GI•"•••s•••&•••••·••• .. •••••e••••••••
35
4. 0
Rehabilitation Success Factor IntercorreJ:ations
40
5.0
Satisfae:tion with· NRC Services at FolloN-Up
by F'qrmer Rehab ill ta tion · Patients •••••••••••••
41
Selected Significant ·correlatio·ns among
Selected Variables •••••••••••••••••••••••••••
42
2.
o
3.0
6.0
. '7. 0
Distribut.ion or' Use of Community Health
Services by :Patients after Discharge from
the 1~ RC
8,0
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• ~ ........... ~ ••••
., • . • • • . • • • • • • •
44
Rehabili.tation Success Variables from the
NRC Patlents Related to Variables ·in Prior
Stud~ies
...............
~f4" . . . . . . . . . . . . . . . . . . . . . .,..
L~9
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e •••••• e •• ,
•••
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l'·'ledi cal Diagnoses of the· 1974 Northridge
Rehabilitation Cente~ Inpatients
••• ~ ••••••••
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INDEX OF FIGURES
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Rehabilitation Result~ at Foll6w-up
of NRC Inpatients, 1974 •••••••••••••••• 36
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ABSTHAC'J:
REHABILI'l'ATION INFA'riENT FOLLO\.<J..;UP
_Evaluation in a Hehabilttation Center
by
Leslie Todd Bailey
~[aster
of Public Health ih Community Health Education
I1I'ay , 1 9 '? 5
_The purpose of this proJect was to conduct a follow.:..
up study on patients discharged
,
.
fro~
the Northridge
Rehabilltation.Center to assess the post-bospitalizatlbn
status o£ the patients in the
logical~
phy~ical,
and vocational areas.
social, psycho-
An attempt "V-ras made to
assess fhe ~ffe~tiveness ·of the systems of delivery of
health services, the multiple measures of outcome to
determine measures of success of the programs, and
~du-
cational impltcations.
'rhe primary purpose of the study included. an attempt
·· to assess
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1 - the patient's pbysical, social, psychological, and
vocational status within one year after rec'ei vlng
inpatient
s~rvices:
2-- the degree to-which·the former patient was satisfied
with the services he had received at the Rehabilitation
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Center;
3 - the cost/benefit of the service;
4 - the relationship of reh~bilitation success/faiiure t~
the medical and demographic characteristics of the
1971-1- population.
'l1 hi s study
·i~1C1Ud.ed
a s-ystematic sampling of dis-
chargeged patients withiri the 1974 calendar year.
Follow-
up procedures included a 73-item survey for dealing with
personal data, rele.vant information from the-hospital
records, the patient 1 s evaluation of services, his status
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p~ior
to the onset of disability, and his physical, so6lal'
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psychological, community health needs, and vocational
status at follovr-up.
Ea.ch follow-up interview was con-
ducted in the patient 1 s home environment, i.f at all possible.
TheTe were onlytwo intervieWer's, thus maximizing
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interview consistency.
·rn addition to the 73-items included in the survey,
10 LHcert-type scaled i terns ·were computed to provide an
outcome measure defined as
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rehabilitatton success.
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results were summarized into five areas:
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1 - satisfaction with services
2 - effectiveness .of serVices
3 - costs
4
aftercare
5 - variables related to success
It was concluded from this study that the patients
felt they _had been successful in two areas:
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social
:relationships, and self-consciousness about disa,bili.ty.
:They felt they had been unsuccessful in all other
~reas;
employment status, physical functioning, self-care,
activities outside the home, knowledge about condition,
participation in family affairs, independent attitude
and affective outlook.
In
~ddition,
only 20% of the
patients interviewed were using any community resources
, folloNihg dtscharge from the hospital.
Results would
: seem to ind1cate that in-hospital education and
referr~ls
'1ac·k continuity in specific instructions and. documented
. referrals.
!Jiany pat1ents do not understand their disease,
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itf:J_ ·impl:tcations, the community·. res.ources a:yailable, or
·how to u·til:tze them.appropriately.
Based on preliminary
.find:i.nr;s anc1 continued evaluatior1s, additional educational
programs are being made available to each patient and a
: method of conducting an on-going follow-up evaluatio·n and
comrm.:mity resource referral system is being established.
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CHAPTER I
IN'l'RODUCTION
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Rehabilitation of the disabled
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'rhe physically disabled- have been identified through-!
out history as a group to be set apart from the rest of
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the populat:\.on.
More than 22 million persons, or 11.5
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percent of the civilian, noninstitutionalized population
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of the United States, have been limited in thei-r activit:les
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The conditions that
due to chronic health conditions.
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patients are treated for in .one institution, Northridge
Rehabilita~ion
Cerebral Vascular Accident,
Cepter, are:
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Doniinant Hemisphere", Non-Dominant Hemisphere, PostI
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traumatic Brain Syndrome, Parkinson's D.isease,
Pulmon~ry
Di sabllt ty, .Paraparesis, Thoraco=Lumbar, 'I'raumatic,
Quadriparesis, B.heumatoid Arthriti's, Post-Polio, Cerebral
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Palsy, Nultiple Sclerosis, Leg bone Fractures or operations
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and ot·her di·agnoses.
Northridge Hospital is an acute
~are
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hospital, locatel
in the San Fernando Valley and has an interisive rehabil' itation center which provides
services.
~oth
inpatient and
.
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outpatien~
~he inpatient program is _conducted, in a 20-bed
unit that will soori be e.xpanded to a 50-bed unit.
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'fhis
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center provides rehabilLtation programs which include
many therapies and advanced techniques in this field.
The specialty of rehabilitation·is a new field
compared to·other areas in medicine, since-it has only
been available in the last
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50 years.
'l'he field of rehab:ili tation had its inception a.s a
pu.blic. program in 1920, with the Smith Fess Aqt, The
Civills.n .Vocational Rehabili tatlon Act, which was to encourage states to under.take r.ehabili tation services for
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disabled civilians.
i tat ion Act of
The cu~rent legislation, the aehabil-
19?:3 has dualistic purposes.
It furthers-
humanitarian objectives by providing services to severely
, handicapped
individu~ls.
On the
econo~c
side, this bill
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keeps the federal vocational rehabilitation prdgrams
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focused on its original and proper purpose, that of pre-
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paring people for meaningful jobs, rather thah burdening
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that program with broad new medical or welfare functions
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better performed elsewhere.
Almost any illness will. result in the fieed for some
kinds of adjustment by -the patient·ana his family and in
the routine Of the home.
However, there are some ill-
nes.ses·, that .result i.n a degree of permanent di sab:l.li ty.
1\s a result, 1asting, and. perha.ps extensive, personal and
environmental cha.nge is needed to enable patients to cope
.,.~
with the ne1.Y physical and· mental 1-lmi ta tions encountered.
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Rehabilit~tion servi~es
are. provided in several types of
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facilities, including hospitals, rehabili tatl,oi'l centers,
institutes, schools for specific
disabillti~s,
sheltered
workshops, vocationa:L training schools and even at home
wtth home health programs providing occupatiqnal there,py,
physical therapy, and speech therapy.
·These services
within institutions may be provided on an inpatient basis
or an outpatient schedule.
'rhe usual schedule . of th.er-
apies begins with the patient being institutionalized,
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pro~resses
to an
outp~tient
program and finally to a home
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health program.
In rehabilitation programs there have been numerous
professionals involved ln a teo.m approach to the physical
functionlng of. the patient.
fvlembers of these teams have
inc.luded physicians, nurses,· social workers, physical
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therapists, occupational therapists, recreationai
' therapists·, speech and hearing therapists, vocational
counselors; and additional .staff available as necessary,
including psychologists and psychia-trists.
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A follow-up study is an important part of the· treat-
ment on a unit su.ch as the rehabilitation center.
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When
a patient is involved with several therapies, and the
ho·spi talizatlon ls long· and- involved with numerous goals-,
the pa.-tlent should ccinti'nue to be followed by the center·
aft-er discharge to eva.lu:ate the effectiveness of his
rehabilitation program.and his return to community-and
family living.
A follow-up s·tudy also is necessary to
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determine if the
s~rvices
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of the center are achieving
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their desired results and whether or not the
benefi.ts by the services.
serves three purposes:
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p~tient
Therefore, a follow-up study
to monitor the
~atient
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in his
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net'i' environment, to determine accountability and eval-
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ua tl on, and to cle.terrnlne where educational input might
have an effect upon the services and/or patient.
There are many reasons why a follow-up study should
rehabili tation,-program.
to
determin~
These reasons include the need
whether services are
•
~chievin~
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: be conducted on patients discha.rged from an intensive
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their desired
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resu.l ts, and whether the patients- are utilizing referrals
· of exist1ng community resources advantageously.
'l'he data !
needed must come from t'he former patients or clients of
curr~nt
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programs who are now in a position to provide
C'
valuable feedback regarding the effectiveness of the
services and the use and ave.ile.bili ty of community health
resources to see what further help they might need.
All
of these outcomes have educational implications.
'l1 here are specific targets that should be used for
the evaluation efforts.- 'l'hose used in the Spain RehabilLj.
itation Center are most appropriate.
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1.
To what. extent .have the pre-conce1ved objectives ·1
of the staff been achieved (Program effective- . \
ness)?
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2.
Wh9.t exp~nd.i ture of ti.me, energy, and materials
were required to obtain these objectives
(costs)?
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Are they still in need of _services which are not
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· .. ···· ... , 4'
being provided-in their home communities'?
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·The National Council .on Rehabilitation
h~s
presented
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the follm-•ing definition of reha.bili.tation of the disabled:
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restoration of the
handl~8;pped
to the fullest
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physlcal·, mental, soc:lal, vocational, and eco~imic useful- I
115
ness ·of w·hich he is capable.
. Rehabilitation involves
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a combination of dl<cipllnes, techniques, and specialized
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facil·i ties to provide physi'cal restoration, psychological
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' adjustment, vocational.counselin(s. training, and pia.cementl
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The general philosophy_ of rehabilitation was well sum-
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marized in principles from the proceedings of a con-
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6
ference of psychologists in the field.
rl'hese
rna~y
be considered evaluation c'ri teria and
should be considered in establishing a rehabilitation
center_program.
1. Every 'human being has an inalienable value.and
is worthy of respect for his 01"111 sake.
2. Every person has members61p in society and
rehabilitation should cultivate his full acceptance.
3.
The assets of the person should be emphasized,
supported, and developed.
4.
B.eality factors should be stressed in helping
the person to cope with his environment.
5.
Comprehenslve treatment involves the "whole
person" because life-areas are interdependent ..
6. · '.rreatment should vary·· and· be flexible to deaJ.
with the special characteristics of each person.
7.
Each person should. assume as much initiative
and participation as possible in the rehabilitation
plan and its execution.
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8. Society ihould be respotisible through.all possible public and private agencies for the providing
of serv1ces and opportunities to t.hedisa.bled.
9.
Rehabilitation programs must be conducted with
interdisciplinary and interagency integration.
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.10. Hehabilitatlon is a continuous process.tha.t
applies as long as help is needed.
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11. Psychological and personal reactions· of the
indi vidttal are everpresent and, oft€m crucial.
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12. The rehabili tat·j_on process is complex and must .
be subject to constant reexamination - for each
individual and for the program as a ·whole.
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The purpose Of this study was to conduct a follow-up
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study on pati.ents dische.rged from tl;le Northridge ·Hospital
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Reha.bilit~tion
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Center to assess the·post-hospitalization
s te.tus of ·the patients in the 'physical, social ,l · psychologtcal, and vocational areas.
An
attempt
~<Tas
ma.de to
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assess the effectiveness of the systems of delivery of
health services, the multiple measures ·of- outcome to
determ111e meF.tsu:res of success of the progra1ns, .9.ncl
educational .implications.
This study was modeled after one conducted at the
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Spain Rehabilitation Center; Birmingham, Alabama
rl'his
st~udy
did not .formulate hypotheses. but. instead
focusecl on the follo't'ring questions:
1. \olhat i.s the pati€mt's physical, social, psycholor;ical, .and voca tiona.l sta·tus 11-ri th 12 months after
re~eiving inpatient servihes?
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2.
To what degree is the former patient satisfied
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th the services he lw.d received at the Rehabili ta- '
tion Center?
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J. Hhat is the extent of utilizati.on of community· 1
health resources and additional referrals desired?· . I
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What is the cost/benefit of the services?
5.
What is the relationship of rehabilitation
success/failure'to the medical and demographic
characteristics of the 1974 population?
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Definition of Terms:
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2.
ta.l Rehabilitation Serv_t_2._es.
Occupational Therapy, Physical Therapy, Speech
'Therapy, Social Services, Vocational Counseling,
Recreational Therapy, Nursing Services, and various
Physician Services •.
!~ortb.ri.dg_~-~£!_QJD21
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.Q~reb:roy~sc._ula:r:__ accident.
( CVA) Destruct:lon of brain _1
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substance resulting f~dm intracerebral bemorrhage,
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throm~osls, embolism, or vascular insufficiency.
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Q~r~br~}:_P~.:!:§.Y..!~
(C. P. ) This term describes the
c.ondi.tion of a heterogeneous group of patients whose
Central Nervous System has been damaged in utero, at
birth, or in early life. · 'l'he resulting physical and
menta.l defects may not be fully evident for several
years.
r,..
~~ltiple Sc\~~os~~~~-
Organic disease of the
central nervous system. 'l'remors appear during movement of the ltmbs and disappear at rest. Occasionally a static tremor of the head may be present.
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5.
.~HF..J_
6.
.E.'2J).m~U£.'!..
7.
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NHRC ._ 'I'hese initials are for Northridge Hospi tall
Foundation and Northridge Hospital Hehabilitation
·
Center.
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'l'his is the proces.s of contacting patients
after di. scharge to determine their status, needs and \
success.
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.9c_g_~J2..~t:Jonal 'l'herap;y.
( 0. •r. ) 'l'herapy invol v:tng the
exercise of the small muscles of the bqdy.
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]_:gysicf!;l. 'l'l~N.!__(P.T.l 'I'herapy given on the Hehabil~
itation Unit involving the exercise of the large
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.muscles of the body.
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9.
Forc~g__Ex:eJra ~_!on Volu~_iF. E. V_!_l
Amount of air
f)Xpelled from lungs after. normal expiration has
occ.urred.
10. Pulg'!QQ~Y Dis~a~~
respiratory system.
Illness involving the lungs ·and
11. Qf:[iq_ial:,_or
l)ubliq_:_s~ncies.
These agenc.ies are
Federally Funded, such as the Department of Health,
Education and Welfare, Children's Bureau, and
Rehabilit~tion Services Admini~tration.
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1.2..
,Yolunta.~;t_~__Qr non-pr?t:..LL§.Eencie~.
13.
li~al,th-rel§tted Q.!_g~ni?.~tion~.!.
These are legally
incorporated agencies as non-profit organizations on
the local. state, or national level and.which are
supported by funds solicited from the public. Examples are: American Cancer Society. American Diabetes
Association, and American Institute of Family
Relatl·ons.
· Welfare and social
agenc1es. These agencies.are not primarily devoted to
health, bu't they directly affect the health agencies
through th~ir control of resources, primarily patients
and money. Example: Department of Pttblic Social
Services.
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REVIE\~ OF THE LlTEH.NrUftE
In rev1ewing_ the literature there seemed to be very
fe~r
follmv-up studies conducted by rehabilita. tion centers,
e.l though the importance of such da. ta. has been recognized
as being nec·essa.ry, both by the patient and the rehabili-·
tation centers that are trying to improve care, services ·
and success.
It is this·
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succe·ss 11 that can be measur.ed
in ma.11y ways ..
The Spain Rehabilitation Center, Birmingham, Alabama,
4
study by ~ta:nley J. Smits
.
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l'ia.s done on the entire "1968
:lnpa ti ent hospital popula,tlon of that Center.
The final
version of the survey included sections dealing with
personal data, relevan-~ information from the hospital
records, the patient's evaluation. and h:l.s physical, social,
p_sychologica.l and vocation11l status at follow-up.
results i'rere summarized into five areas:
with services, (2) Effectiveness of
The
{ :l) Satisfaction
~ervices,
(3) Costs,
(4) Aftercare, and_ (5) Variables related to success.
'rhrough this study the Center learned how well it
......
was doing in 1.968 and the patient groups for whom their
services· needed. :i.mprovement ~
In addi ti·on, the survey
made the Center vi vldly a\'lare of the ne'ed. for follovi-up
9
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servic-es in the. community.
It was learned that health
care serv;i.ces for the severely disabled must be continued
in the home community.
'r~is
study also suggested the
need for a combination of vocational and recreational
experiences in· the home community with age being a major
determinant of 11'hlch of the two should rec.ei ve the
In another study,
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the psychological
physical dl sa.bili ty were deseri bed.
reaction~
to
'l1hi s suriTey under-
seared the fact that e. successful physical rehabili t,at.ion
progre.m ul tlmately ·depended on
!t
psycholog~cal
adaptatiol'J.s_.
1tms determined that if these adaptations did not occur,
the ultimate goa.ls of rehabilitation' could not occur.
If a patient needed psychotherapy, it may be. that he
V<rould not be ready for an intensive rehabilitation program until he reached a certain level of understanding
and adpeptance of himself.
This same study dealt with the intrinsic factors
affecting responses:
age, ·onset, prognosis, previous
personality, intelltgence, aptitude.and interest, and the
present 'degree of physical dependency.
It also covered
the externa) factors determining adjustment, ·which :ln- ·
eluded:
the psychologieal ewrironment, pt).ysical environ-
ment, economic con~itions. social expectations and eommunity resCA_urees.
The responses of patients to.dis-
abil1ty were varied.
Esther
Luc~le
patients as "people in trouble.' 11
Grown referred to
The person who goes to
11
a hospital for simple tests has a.loss of identity and
role activity, the loss.of home and familiar objects.
If admitted to a hospital, there is the additional loss
of friends and fa.mily except during visiting hours.
Also,
patients lose their strength and physical,endurance due
to hospitalization, diagnostic tests, and the dependent
role they are forced to adopt.
rrhe person "t'li th a chronic
dl sa bill t.y he.s all these losses to deal wl th, plus an
additional loss - the permanent loss of a function.
The patierit with a condition that will
cr~ate
a
permanent disability has a multlfaceted ad;justment a.hea.d.
While his basic problem is physical, his more imp6rtant
problems relate to his .future.· Financial needs, vocation...
al needs, housing requirements,·transportat.ion ava;ilablli t;y and psychosocial adjustm.ent. all
time or another.
·~a.l{e
precedence at one
Responses of health personnel are· impor-
tant and can be dlvided between personal responses and
therapeutic ·responses.
But finally,' ln order for .the
patient to develop self-esteem, he needs to
co-manager of his care.
b~come
a
.flatient participation can become
the key to vital psychological adjustment.
It may even
mot:ivate' early participation in plans for the future . .
Since motivation comes from within, it is the job of the
health professional to fincl ou:t; "rha t. interests will be
stimulatlng to the patient.
really like to .le.arn and do?
.
'
What is it that he would
~rhe
more· a plan is based: on
input from patients, the more helpful the.· health counsel-
12
i.ng will be.
In a study by Cornelia Hei.jn, !1. D., and Carl V.
8
Granger, M. D~ the causes o{ rehabilitation failure wer~
demonstrated.
l)epression may cause a patient to feel
that any -rehabilitationis po-intless and limit the
effectiveness of his· effort .. · Pati ants with dependent or
masochistic character traits may·similarly re.)ect rehabilitation
effo~ts b~6ause,
paradoxically, they.experience
illness or disability ltself as gratifying._ In some
situations, the gratifications
fro~
preclude successful i·ehabil:l tation.
secondary gain may
Approaches to man-
agement of such problems have been outlined by others.
For some patients the real losses are so great or.
else the absence of social supports is·such that they are
too ·overwhelmed to endure through the process of rehabil··
i tat:lon.
I·1aintaining hope may sometimes lead to the
avoidance of the topic of prognosis and liTi thout knowledge
of this, a patient may not have-experienced the disappointment of giving up aspects of his-prior adjustment.
-
Thus, he would not have been able to appropriatelj consider
other options still open in a now more restrictive world.
Newly disabled patients should not be expected to
become fully lnvol ved in all aspects of rehabili ta.tion.
.
.....
The patient may be poorly motivated until he has passed
through the phase of grief and mourning-and can come to
terms with permanent ctisabll:tty.
As the. mourning process
13
proceeds, one may observe a gradual shifting of interest;
8
tm;ards full involvement.'
Fublic health personnel tn various community studies
have disclosed the lack of coordination among agency
referrals.
This has cause'd problems for disabled people
discharged from institutions 'who should have numerous
cqmmunity agency referrals at their
N.
i1li.lson
disposal~
Robert
in a study of health action in twenty-one
cities has di.scussed "l'fhat vras identified as the chief
health concerns.
1'he most prominent issue appeared to
not :\.nvolve a specific disease entity, but rat;her the
coordination Of facilities to provide care for a variety
of
illnesse~.
The application of service to those
populations most in need of it often seemed haphazard and
irrational against a pattern of overlapping functions.
There was less than optimal use of extant capacities.
In a.ddi tion, there vJas a prolifera.tton of agencies for
9
preventive a.ncJ. therapeutic effort-s.
Study after study
I
revealed the necessity of coordinating these community
health services to
h~alth
th~
needs of the community for better
care services now a.nd in the future.
'rhe ner.,rly d.isabled patients who neecl community ser'-
vices should be allowed to participate in the decisions
as to 11hat programs are
n~eded
and what locations would
serve the most people.
Most health programs are designed
by professionals for the benefit of those with the health
needs. . Ed.ucational -progra.ms are ·.good in terms of per-
14
suading local cit:tzens to_do certain things in the interest
of better health.
But folldw-up surveys are always an
essential part of any health care agency providing good
servlces.
A more traditional approach is necessary
sometimes, for example, the studies done by sociologists,
which had delineating stages through which such action
progre.ms go.
Robert Wilson
9
related cmmnuni ty structure
to the community's efforts to deal with lts perceived
health problems while Smolensky and Haar viewed community
orr;r;ani·zation as a means toward solving community health
problems.
10
The Hiller-Form theory
of isst1.e outcome had been
summarized and tested successfully in Denver, Colorado,
by
Hansen. ·· The theory 11as based on tl:Je propos:i. tion that
the combined social force of three factors brought about
a community decision on a. general issue.
were:
'l'hese factors
1) 'rhe critically a.cti vated parts. of the insti-
tut:Lonal poi'Ter structure, which are aligned for or against
the 1 ssue propositi on: 2) rrhe power a.xra.ngement of the
community power complex, wl1ich may_ be unst:ru.c.tured. semistruetured, or unified on either side of the issue: and
3) 'l'op influential solidarity and activity.
.If t.he top
influentials were a
or a.utono-
sin~le,
exclusive,
~lite
mous pm·Jer, the outcome would be forecast by an analysis
of' their
st~nd
on the issue.
If the top influenti.als were
not the exclusive elite type, their degree of activity on
15
either side of the issue becomes a. relevant variable.
Barth and Johnson have given leads for developing
a typology of· social issues.
'l'hey have sought to pick
dimensions generic to all issues and to relate theoretically variations in each·dimension td· variations in
.
. li
patterns of influencing behavior .
.It is
justifi~ble
done ln the· area of
that more studies will need to be
foll~I'T-up
to determine the. needs Of
the patients involved e.nd more research to inventigate the
best posslble way of se.tting ·up the health care programs·
that are indicated as imperative to the return·of optimum
health of the pa.tients involved.
There have been studies done
~n
the individual dis-
eases that have been included in this study and several
1'rill be cited, but very few i:;tudies included more than one··
disease.
Chronically disabled people have a lot. of the
same basic needs in regard to community health services
and many could be provided v.nder the auspices of the
same program.
A one yetir follow-up study on the multidiscipline
treatment ef chronic pulmonary insufficiency was conducted
Gerald L. Baum, David Agel, E. H. Chester, G. Schey,
12
E. Aneteola, P. Buch, H. Bahler, and M. Wendt.
'l'hi s
by
study Nas supported by a 'grant from the Social and Rehabllltation Services, Department of Health, .Education Etnd
\velfare.
rrhe study explo.red the functional status of
the patients and deci.ded that of the many.disasters re-
16
sultlng from chronie obstru.e.tive lung d.is.ease, physical
disability is second only to cieath ·in importance to the
patient, his famtly, and his community.
Because of poor
\
understanding of etiologic factors and
th~ir
re~ationship
to u1t:tmate physical·impair:ment, corrective treatment of
the physiological abnormalitles had been ineffective.
Lung
transplantation offered no immediate hope to reverse the
disabl:tnP~
under1y1ng disease.·
Treatment efforts, there-
fore, Nere directed .toi'W.rds attempts to rehabilitate
chronic pulmonary insufficiency patients in addition to
their symptomatl c trea:tmel').t wl th the usual
12
procedures and medications.
ma.int.~.ining
S~veral
reports recently discussed the possibility of
combj_ning physical and pharmacological treatment programs
which ~ncluded an attempt to evaluate reemployment poten-
_tial on one hand and psychological characteristics on the
other.
In particula.r, Haas, Kimbel, Petty, and Bass
13
each
reported the success of rehabilitation programs from the
aspect of better mobil_:lza.tion of their patients.
of these i. t
appea.i~ed
In some
a.s if the work of breathing was
improved by the exercl se proe;:r.:a..ms while in others no
12
12
such findings l"Tere noted.
This report by Baum et al.
represented a stud_y. aimed at evaluating the effect of a
combined physical.
program on pat:tents
psychologic~l,
I'll th
and vocational treatment
dj_sabling chronic obstructive
17
'.I'1'renty-four patients· with chronic obstructive lv.ng
disease had entered into pnysical, psychological, and
vocational rehabilltatlon program.
Patients included in
the study were' unable to I'Wrk because of dyspnea,· had
objective evidence of airway obstruction, had no other
dise.bling disease., and an 'IQ of at least. 8) or above.
'l'he :
patients were interviewed by a psychiatrist and social
\
worker, were tested physiologically and
psychologi~ally,
treated intanslvely for four weeks, and then retested.
After this. the patients were folloWed in the outpatient
clinic at monthly intervals.
At the end of one year
physiological and psychological tests were redone, work
sta.t.us noted, e.nd·adjustment, both to life situation and
di se_bili ty. were evaluated.·
1:3
Of 23 patients t:mtered :i.nto a rehe_bili tation progre.m,
21 were followed to the qne-year point.
patients were
follow-up.
workin~
Ten of. the ·
full- or part-time at the one-year
Physiological evaluatlon sho-vred no change in
either pulmonary or. cardiac variables comparing one-year
with pre-program data except for a decrease in FEV.
Performance in one y·ear d.icl, not correlate
qf impairment at
th~ outs~t
Df the study.
'I'Ti
th the degree·
This perform-
e.nce did· seem to relate, however, to the psyc.hologi eal
factors of depression, anxiety, and body preoccupation.
Future reha.bili tation progra.ms should, they stated, be
coristructed so as to give major support to the
psyc&o~
18
logical factors of
occupat:ton.
depression~
anxiety, and body pre-
P'utu:re rehabilitationr)rop;rams should, they
stated, be constructed so as to give major support to the.
psychological aspects contributing to disabillty in patlents with chronic obstructive lung disease.
A
twelve-n~nth
survey was made in general practice
in an English town, to determine the incidence of incapacitating disease in patients oyer 65 iears old.
the 885 patients in this
~ge
group, were
thr~e
Among
times as
Fifty-Bix of the group (6.3 percent)
many women as men.
had diseases which rendered them totally incapacitated.
T~ey
were
c~red
for in their homes by interested
friends, or landladies.
lh
13endkov·rski, JVJ. D.
durtnp; 1966-·196'7.
relati~es,
This study wa.s conducted by B.
in Leigh-on-Sea, Essex, England
'l'he dise·ases causing incapacities in
this study were cerebral arteriosclerosis, ischaemia
heart disease, rheumatic diseases, b1indness, chroni.c
bronchitis _vrith emphysema, hemiplegia, anaemia, bronchial
asthma and pulmonary tuberculosis.
'I'hese diseases and
the'care of elderly patients in their homes were discussed.
Old patients seemed to get the best treatment in
their homes.
rrhey. know the familiar corners of the:lr
rooms. furniture
j
vi ei'TS from the wincl011Ts, and. thelr
:r1eighbors. · ·But it was lmportant that they have wllling
• .J
relatives or friends to load after them.
A family doctor
gave them adequate medical care ·w:tth the full cooperation
19
of ancillary services.
There were. increasing difficulties in finding residential accomodations for elderly patients with chronic
diseases.
Barbara H-obb's book, "Sans Everything 11 , focused·
pub1ic attention on the
incre1~sed
need for medical and
social services for elderly people and the need for night
sitting-in
.
.. 15 services for elderly patients with acute
d.isenses .Wylie has
cond~cted
m1merous studies regarding
cerebral vasculir accidents.
Among those are studies
and articles-published on age and long-term hospital
care folloHing a CVA, issues in measuring results of
action programs, factors influencing CVA patients to
seek
~ehabilitative
stroke patients to
care and gauging the response of
~ehabilitation.
In one study, age and
the_ rehabilltatj_on .care of stroke he conduc:ted a study
6ver a nine year period
16
on 1, 223 PEltients with cerebral
vascule.r acc.ldents w}1o had been admitted to Nontebello
State Hospital, a chronic disease institution.
The findings of this studt consistently reflected dn
ad.verse influence of rislng. age. on the response of CVfl
patlents to
r~habllttation.
The older patients (over 65)
were more disabled on admission, improved less often
......
v:rhi1e in the hospltal and died more often than the younger
patients.
However, the b~tter-response of the younger
patients did not reduce. their length of stay in the
hospital (21-23 weeks).
20
Wylie has stated that it l'IOuld be unfair, however,
for clinicians to reject
~or
old~r
rehabilitation all
patients beca.use _of these di sadv:antages, since the adjust';
ment analysis had shown 'one way (number o·f hospital-weeks
of care required to obtain a liv:tng and-improved patient)
in 'Nhlch priori ties can be· baianced for different age
gr_S>UPS.
figures
It would be premature, hol'l"ever, to apply these
~idely
until
larg~r
groups of patients are
studied in cllf:ferent rehabill tation centers.
~:
This can
be done quickly if it is agreed that scientific rather
than intu1 ttve e_;ulclolines for selecting patients deserve
urgent attention.
A
stucly or1 the life history of the stroke syndrome
1<ras ·conducted by iUchael B. Niller, M. :0., F. A.
c.
1?
P.
in which ie6overy pf funciion~ prognosis and mortality
rates were discussed, with i.ncluston of data from some of
the better reports in the literature.
The clinical life
history of the stroke syndrome and meaningful studies on
pron~osis
have been almost impossible to carry out
com~
pletely in general rnedical practice, in community hospitals,
or.ln specialized rehabilitation centers as currently
.-.constituted.
Hhen criteria ,for admission to health-care
faclll tles excluded pt:J.tlents 1.-ri th any degree of orp;anic
.
·brain s;y-nd;rome as being. "poor risks" or ha.ving
11
poor,
. rehabili tat ton potential," this obviously. resulted in ·
biasecl studies.
21
Since patients with cerebral infarcts and
organi~
brain syndrome comprise an important segment of the stroke
problem, their tnclusion in clinical studies dealing with
stroke
rehabilitati~n
and prognosis is mandatory.
All
facilities handling-this type of patient should be
brought into the mainstream of medical knowledge if
s~g­
nificant studies of the physical, psy6hiatric and social
problems of stroke
patien~s
are to be evaluated
properly~
This study concluded that a standardlzed nomencla· ture for the various syndromes of cerebral ischemia was
long overdue.
Osteoarthritls and rheumatoid arthrit:1..s of the hip
were each discussed with regard t.o clin1C13-l c·onsideratlons;
·radiograph:lc ·findings, and available'operative procedures
18
'
in Et study by Ja.ck Stevans, "!'1. D •.
For patients with
rheumatoid arthritis, se.lection is the more -important,
and difficulties arise from a lack of the same .extensive
background of clinical experience against which to review
a part:tcular patient's clinical state.
rrhe importance of
a team approach to the arthritic patient was emphasized,
with
particlpat~on
in. the team by a rheuymatologist or
internist, orthopedic surgeon,
_phy~ical
therapist, occu-
patlonal therapist·, soclal service worlwr and vocati,onal
rehabllitation counselor.
This survey also sho111ed that
th.ere is a pressing need for specialized teams in this
area of medlcirie.
22
In the Overs Study 19 three dtfferent approaches to
the social aspects of the strol\:e impairment l'Tere presented.'
'fhe first
Wf:l.S
primarily a. sociolop;i cal approach at an
abstract level and described
setting
societal and family
which the coping with
~ithin
occ1J.rred.
th~
~he
stroke- problem
On a11 the 1rariables seiected as possible areas.
for role changes the families were noticeably reluctant to
make any fundamental changes.
There did not seem to be
any greater degree of role changing in those 21 families
exposed to ''intensive'' counseling· than in the other fam·11tes .,
'I'his study did not conclude whether role changes
were indicative of adjtistment to a stroke.
However, it
concluded that family members must perceive-the way society
expects them to behave, before they can decide on their
appropriate roles.
To expect persons of advanced
education, and impaired physical and
ment~l
~ge,
low
functidning to
reallocate their. fam1ly roles in a manner directly con.
.
tradictory: to the norms Of· the SOC-iety in general is
presumptuous.
The seeond approach pre;sented selected data from a
four-year research·and. demonstration study (OVers andHealy. 1971) on the effectiven~ss of rehabilitation counselin~
pa~t
in helping families with stroke patients.
In this
family coping limits were discussed, the question of
probability bf value change in a stroke population, the
impact of psychological therapy on
st~oke
patients was -
reviewed and COJ1lmuni ty action was encouraged,
'rhey con-
23
eluded that it is unrealistic t6 expect a counsel6r to
effect ma.jor
ch~.:mges·
in the ·life style of families after
a catastrophe like a stroke, that if retirement income
is
adequate~
a period of two years is about the usual
lerw;th of time for personal adjustment to retirement to
be achieved and that most families indicated that by two
' y~ars after the stroke they had rea6hed some sort of an
equilibrium with their surroundings.
The third approach described concrete things the
counselor. could do to help, such as, establish a.n acti-vities program in the community, give documented information
about the nature of the strok,e clisabili ty, given information- about community resources, ad.vtse· pe.ttents about
·adaptive devices ih th~ home, give counselirig about
transportation posstbllities and encourage the use of
sub-professional personnel.
'l'he Joint Committee for Stroke Facilities c'onducted a
survey and ·lnclucied in their recommendations of the study
20
~roup wer~:
further research should be performed to
determine asymptomatic patients with treatable predisposing
factors~
pro~rams
of education should be designed
to ,helghten public awareness of the l{nown risk factors,for ·
education
......
concernin~
the urgency of ·recognizing
and treating significant symptoms ln asynrptom8-ticpatients
and that all pertinent deliverers of health care should
be coordin?ted in discharge planning arid follow-up of ·
the patient.
24
~~mmar;y:
~~1any
deficiencies in the care and. rehabilitation
of d.isabled. patients have been noted. in the literature.
Many of these deficiencies seem amenable to correction
by e.ducational efforts.
However, more funds must be
provided. for educational programs for the disabled, both
in the hospital and..in the community.
In addition, more
emphasis needs to be focused on preventative medicine
8.nd . men.sures.
More research is rieed.ed to determine why people of
different social classes have different patterns of
rehn.bilitatton utili.zation • . Along with thts is a.need to
heve a bet.ter understandinp; of the feeltngs of the disabled by health personnel who must deal with these feelings.
Continuing education programs could. assl st personnel in
developing skills of communication and insight into
o~e's
....
own react16ns to disability •
CHAP'rEH III
J:UTI?.2.f>B oL_E_tudy
'I'he purpose of this ·study ·Nas to ·conduct a follow-up
stutly on patlents discharged from the Northridge Hospital
Rehabilitation Center tb assess the post-hospitalization
status of the
p~tients
in the physical, social, psycho-
.
J.or;ical, and vocational areas, in an attempt to assess
.
the effectiveness of
th~
systems of delivery of health
servlces and to determine educational implications.
!?..§! s.2.£1-J2.t ~2!:1__9.-f_._§.§:~~-~
A
systematie sample was taken of all inpatients in
197'·t of the Northridge Hospital H.ehabilitation Center,
and 143 were selected to participate in
study.
Each patient
~ms
thi~
follow-up
contacted by phone to a.sk for
their cooperation in pa:rticipatine; in the survey and to
schedule the interview·.
Out
of ll.J-J sele.oted to partici-
pate it was possible to reach 104
men and fifty-one women.
The
p~tlents,
demo~raphic
fifty-three
statistics and
characteristics collected frbm this data are presented in
Table 2 •
The part:i.clpants also were divided into vari-ous
disease categories to assess the types and
25
percentag~s
26
treated in each categ6ry.
(See Table 1 .)
Data Collection
Each former pa.tient·:·was personally interviewed in
--order to elicit response to a 73 1 tern
(See
Appen~lx
A)
quest~. onnaire;
Existing records were used to obtain
-,
the basic demographic .:tnformatiori and medical history.
'l'he persontil tntervlew vlas chose-n ·beeause 1 t is an
accepted tool of social scientific survey research.
Each interview lasted approximately one hour, but varied
in tlme from 1-J-.5 minutes to one hour anci a half.
survey
lnstru~ent
The
included sectlonp dealing with personal
data, relevant information from the hospital records, the
patient's evaluation of the Rehabillta.tion Center's servfces, his status prior to the onset of d:isablllty, his
physical, soctal, psychological and vocational status at
f_ollot-J-up, arid his need and/or desire for community health
referrals to appropriate agencies.
ducted in patients' homes
wheneve~
Interviews were conpossible.
Inter~iews
Nere conducted tn the Hehabill tation Center for those '!-'Tho
Nere ·continuing to receive outpat,iE:mt services.
When
home interviews were not possible, dtie to distance or
unavailablli ty or tltne. then the interview 'Na.s conducted
by phone.
Interviews were
through April, 1975.
record. of observatfons
conduct~d
.from September. 1974,
The interviewer kept a narrative
8.S
well as comments made by the -
patient which were not 6overed by the survey form.
27
.TABLE
1
MEDICAL DIAGNOSES OF THE 1974 NORTHRIDGE
RDIABILITATION CENTER
1
CVA, Dominaht arid NonDominant Hemisphere
iNPA~lENTS
40
38.5%
23
22.1%
..
i2
Pulmonary, respiratory.
t3
Other:
Fractures, Polio,
Cerebral Palsy, post knee
surgery, multiple sclerosis,
and other surgery,arthritis 23
'
.4
5
·
22 .• 1%'
Brain damage, injur7 or
. surgery, craniotomy
9
9.0%
;Spinal cord injury, quadriparesis, traumatic, parapar':~s is, thoraco-lumba.r,
traumatic
7
7.0%
amputations
2
. 2.0%
Total·s
100.7%
28
TABLE 1.1
- COST OF HOSPITALIZATION iN tHE NORTHRIDGE
REHABILITATION GENTER
• Social Security Admini-stration ••
(59%)
33 P?-tients
jl
'
~ 1',•1 e d i _, r:c-11 • ,
tJ1
f·
II
fl
tl
••
t)
It
ft
f!l
fl' . •
8
"
'!I
oil
18
r>
Private insurance and other
olt
-
~
(1 L~. 3%)
8 patients
(27%)
15 patients
ll\d.L~:i,.!LPL~.§}<- ing ~-g2.5:D:.l...l..ll£2,...,.~.£J~l-Q.o ll__?...£....ill.n6un t:
Social Security Administr~tion
paid ···~···
$124,065.
Medi-Cal ••••• ·~~~·· •••• ;.o•••••••••••••••••
40,665.
' Private insurance· and other
.52,803.
• j
'
These fi~ures represent a sampling of 56 patients
costs of ho~pitalization from the original sample of 104
patients l.ntervie1.ved.
I
ii
I
29
TABLE 2
SELECTED DF.MOGRAPHIC CHARACTERISTICS
OF REHABILITATION PATIENTS AT NRC DUF(ING 1974
Charac.teris tics /Categories
Percent
No.
'
..._......_.
............. _. ___. __ ...-.
I.
~---·----·-----
......
-
---------------·
....~,_,..,.,..._.._~...-.------~----
/l..ge at Admission to NHRC
(a)
Not recordec1 .••••• ~ ••
(b)
Under 30 ••••••• ~ •••••••.••• ;
5
7
31-40 .·"·.,.
.6
( c:.)
'
i'<. 0
Ill
•
ft
4 .II
••
ff
It
8
••
"'II' •
II
~··
••
••
tr.
•
(d)
41·- 50
14
(e)
51·- 60
20.
(f)
61-70
25
(g)
71-·fW
22
(h)
81 and over
n
p
•
•
e •
~
8' P
•
~
~
~
•
•
•
4.8%
6.7%
.5.8%
13.5%
19.2%
2<'LO%
5
21.2%
4 .8%'
19
13.3%
Totals
H ea n :: .§J...~.:?.
.II.
Status at: Follm.rup in 1975
(a)
Out of state resident, or.unable to locBte • • • • • • • • • • • • •
(b)
Deceased
••••.•••••••••••• ~..
20
14.0%
(c)
Alive and participated •..•..
104
72.7%
1oo:o%
Totals
'III.
\.
......
l'.eadmissions t:o NHRC
(a)
r~ 011 e
(b.)
63
60.0%
One
28
26.9%
(c)
Tvm
11
10.6%
(d)
Three
2
1.9%
.•
fl
•
"
•
.,
••••
"
••
1'1
•
,.
It
It
Totals
ft
lit
•
,.
99
.t.~%
'
30
B;ach patient who expressed a desire for additional
community health referrals or had other questions needing
eri~wers
were referred b9ck to the Social Services Depart-
ment in Northridge
Hospital~
They were contacted indi-
vidu_ally by a social worker,
Whenever possible the patient was always interviewed.
Hqw-evrer, when the patient was 'foo ill,
or in another
hospital,- or unable to communicate, then the closest
fam:l 1y member was asked if Ehei felt they could answ.er
the questions regarding the Rehabilitation Center.
In
all but' one case, the family member was able to complete
the interview.
However. these answers
not includ_ed
~rere
in the statistics tabulated regarding rehabilitation
success.
Just the demographic information was used.
Included among the survey
item~
were ten Likert-
typE! items which were summed to provide an outcome
mee.su:re v'lhlch vms operationally defined as
11
rehabilttation
success."
These t'en
l.t
2.
J.
5.
4·.
6.
7.
8.
9.
10.
va:rial~1es
of success are:
Employment status
Physical functioning
Self-care
Ac ti vi t:t es outside home
Self-consciousness
Knortrledge e. bout condition
Social relationships
Partlc:l.pation ln family
Independent attitude
Affective outlook
These variables were selected to measure the patient's
physical, socie,l, psychol ogl cal, and vocational status,
31
and lt was felt to be superior to the narrow outcome
.
.
measures used in most attempts to quantify success.
The patients were further qualified by diagnosis,
and these ·vrere divided into six categories:
· CVA, Spinal
Cord injuries. brain damage and brain surgery, respiratory
and·pulmonary diseases, amputations and other.
Those
ln_cluded in the· other category included fractures of the
hip. polio'patients, cerebral palSy, and multiple
sclerosis patients.
{by
These diagno$es were ranked in
uercentages) order of occurrence and the number fall-
ing 1nto each categori.
(See table L )
Graphs and charts were used to indicate the success
area:.-:1 1
(S~e Table 3.') iricluding the operatlonal definition
of rehabll i tati orl success tables 'Ni th ten different
variables, (See Graph 1) rehabilitation succA~s fa;tor
lnterco~relations,
(See Table 4.) satisfactio~ with the
center's serylces at foll.ow-up,
(See 'rable 5.) and the
selected demographic characteristics •
.....
(See rrable 2, )
t
SUHVEY RESULTS AND INTEH:PHE1'A 1'I ONS
. The data Here analyzed to determine the d·egree of
success ili rehabilitation and what portlon of the changes
11as attributed to the program.
J.2__~~~g_£.§J2hl g_
S_ta t.L.s t )- c s
The tota.l nu:rnber of pa. ti ents considered for the
survey·was 143.
Of·thls, 20 (13.99%) were deceased, and
19·could not be contacted, (13.29%).
Thfis~
_the total
number of patients i.ncluded ln the survey was 104.
avera~e patient age was
This
'~.nas
61.5 years.
'l'he
(See Tabie 2. ).
eons.iderably h.igher than the average age of any
other study group listed in the review of the literature.
I+
lrr the Spain study t~e .average ~ge was 51.7 years.
This
factor should be considerad in determining criteria for
success.
Since pa tl ents j_n ·this a.ge group (_50% -are
a.bove 60 years of age) are almost in the "retired 11
category.. securing
~
job may not be considered as an
appropriate rehabilitative criterion
fo~
success.
(See
T0 ble 2. )
A separate·survey on
56 patients was conducted to
determine the average length of stay
vm.s determined to be 28. dEtys.
32.
pe~
patient.
This
'fhis figure was c·onslder,.,.
33
ably less thah most of the
~tud~es
ln the literature
review.
For example, the a 3rage total stay in the Spaln
4·
study was 60.8 days.
This may be attributed to the
fact that the highest number of any one disease in the
4
.
Spain study was 56 rheumatoid arthritis (22%) a chronic,
long term illness.
In this study, that disease fell into
(6%)
the lowest category by percentages.
Sixty-three patients had only one admission to the
N.H.R.C., and e. total of IH patients had to be re-admitted for one or more hospital:i.zattons.
(See Table 2.)
With the team· approach to pa·tient care in the
rehabilitation center there should be multiple objecti.ves
for the patients.
Host of the studies in the review of
the literature used a single measure of success and
ignored the need for multiple measures of outcome.
4
Spain Study
.
.
'The
used ten Likert-type scaled items which were
scored and totaled to provide a nume.rical lndex of
success which 'Vm,s broad in scope.
While the 10 goals may
not have applied .to all patlentsi they were judged in:the
4
- Spain Study, to provide • an unbaised cross- samp_le of
patient and staff ·objectives.
These same 10 items were
used ln thts study, and es.ch item 1-ras scaled from "1"
vlThtch lnd:tcated ''complete fa:i.lure" through to "5 11 which
lndj_cated "complete success.''
'l'he follm1ing ltems·, in
comblnati'on, consti tilted the operational definition of
rehabilitation success for the Northridge
Behabj_].j_tatton Center program of services:
Hospit~l
1.
\.IJhat is the employment status of the patient at
the present time?
·
2 •. Compared with 1'lhen the patient was a.dmi ttetl to
the NHRC, how ~ould he describe his present level
of physical functioning?
J.. How T/JTell can the pa. tient care for his personal
needs?
4.
How often does the patient engage in activities
outside the home at the present time?
5.
How does the patient feel about his disability
when he goes outside the home at the present time?
6.
How well does the
7.
How extensive are the social
patient?
B.
rro vrhat extent does the patient p>?.:Pticipate in·
family affairs?
9.
To what degr~e does the patient
independent?
:1.0.
~atlent
Understand his conditlonJ
relation~hips
~ant
o~
the
to be
Hh:::,.t is th'e patient's present affective outlook?
Interviewer scored each item by checking one of the
fiye scaled alternat:l.ves stated in the survey form.
results are sho"m in '-re.ble 3.
devj_nti.ons
sho~vr
'l'he
'I'he means and standard
that "success'·' as measured by these items
·1raried among the former patients.
Using "Y' as the de-
marcation between success.and failure. the total group of
patlents ·was successful. in on1y two areas, the highest
being Ln the area of
soci~l
relationships.
However, it
showed that the patients were unsuccessful in most areas
·-'
the least succ.ess belng shown _in the a:rea of employment
status.
(See Graph 1)'
This measure included·the patient's
phy~ical,
social,
3'5
TABLE 3
OPERATIONAL DEFINITION OF REHABILITATION SUCCESS
i\J10NG SELECTED VARIABLES FOR NRC PATIENTS
i 3)
1. • 3
Self Care
Activities Outside Home
2.5
1 •6
5)
Self-consciousness
3.0
l •6
6)
Know .ledge about Cohd it ion
2.1
1 .3
7)
Social Relationships
3.2
1. • 2
8)
P·A.rt ic 1. pat ion in family
2 J~
1 .4
9)
Independent i\1:titude
1 •5
1 .1
Affective Outlook
2.7
1 •0
:1 0)
Total PatiEmt:s In tervie'i-v·ed
·~
~·--lQ~
E:ach item ~vas scored by checking one of the five scal(~d
alternatives. stated. in the survey form.
The results are
..
11 Sucr.ess 11
' shown in Table 3.
as mea.sured by these items
1
varied among the former patients. Using "3.0 11 as the de·· I
mar~ation bet~een.su~cess ~nd ~ailu~e! ~he total group was J
on.Lny successful 1.n the follow~ng a1 eas.
l
1)
2)
Self-consciousness
Social Relationships
i
I
I
The patients
w~re
not successful in the follo\ving
AreaG:
1)
2)
3)
lj.)
5)
6)
7)
. 8)
Vocational
Activities Outside 'fhe Home
Physical Functioning
Affective Outlook
Self Care
Knowledge About Condition
Participation in Family
Independent Attitude
I
I
i
!
i
36
GEAPH 1
REHABILITATION RF.SULTS AT FOLLOHUP
'
·~ailure
Succes~
2
·1
3
'1
I. ,f
:
Employment Status
'
I
I
. ,,
7In7Im
i
I
f
I
!
I
t
I
I
I
I
I
I
I
t
t
5
I
f
I
I
i
I
I
.·
-(1..61)
P~wsical
,
I
t,
4
Functioning
llliilll~lllW7Z
<2 ·• o2)
I
-- -·~-··---- ... SUCCESS--------·~·- I
Selr Care
I
I
'
ZZZZZ7TllZ7llllllll <2 • 3 o)
Activities o~tside the Home
.2ll~lllTllllll7lllTllllZ
,
<2 • s 3 f
i
!
Dis~bility
Self-conscibusness about
ZZllZZ7lllTllllllLilllllUilll' .<2 • 9 7 )
Social Relationships
I
'plmZIIIItlliZIVmlllllllTt.Z c3 • 1 9)
!
-
Participation in Fa.mily i\ffa.'.rs
-z··z777Tzn7T7ll
..L 7. .. .. .L J. .LLLLJ_l.jL . ZZ. .J7
(2.39).
z·
! Independent Attitude
I
7Z7Illll ·
c-1. s >
Affective Outlook
7IILZZ1llZill1Zlll1[1711
.
<2 • r: 5 >
.
-------LACK OF SUCCESS--------
*
Mean
Fo~
All 104 Patients On Each Scale
37
' psychological. and vocational statuses.
The NHRC was somewhat unsuccessful in the areas of
vocational' adjustment and
self-car~
regarding the dis-
ability (.Table J); and eorrob9rated by the data and
LJ-
lnterpreta tions of the Spain· Rebabillte.tion Study.
Costs
----~~~
.·•
The average c:ost per day per patient was $1l..J..O. the
a"~reT91;8
eost per. patient stay was $3, 88'+, and the costs
were caid by ·various agenc:ies.
(See 'I'e.ble 1 .1)
There l'lere no private paying patients found in this
survey.
The cost of these services were probably pro-
hibitive for the individual to meet without some form of
insurance.
'rhere are other costs involved. in .having a eli sabili ty
and
J~.lJ.
patients ind-icated that they hF.td spent a
little
more than $500 ee.ch t_o m.ocUfy theil' places of residence
in order to accomodate their cortditions.
Several more
indicated they would. spend money to mat:e changes if they
could afforli lt.
Nore than 50-% ·v.rere paying out additional.
money monthly for extra costs ot
liv~ng
such
~s
transpor-
tatlon, nursing, care, oxygen, housekeep:ing services;
medications not covered by insurance, medical supplies,
equl-pment rentals, and furntture.
Hes:i..clences
Sixty percent oC the residences in the sample·were
:i.ndl vidue.l dwell tng 1ml-t.$, 20% were apartments or
38
·duplexes, 2. 8.% were slngle rooms;· ? . 7t; were .li.ving in
nursinp: homes ancl
5.8% in the homes of relEJtives •.
'
Sixty-t·vro
percent of the pe.tients were a.ble to
retu:rn to their homes without h9.vinrs to make any modificat:i.ons, 25% had to ma1m min~r mocliftcat.ions and 3.8% had
to make major modifications, while 3.8% had been-forced to
move.
Of the patients who had to modify their homes,
19.2% spent up to $500, 6.7% spent from $500 to $1,000.
19
and 12% spent above $1,·ooo. In the Overs Study
70%
of all patients inter'vievred had. made some household
changes.
Because of their
ha~d.icaps,
patients were ineligible
for most board. and. care homes in the area when.they were
1i sc harged,
It would be· beneficial to thes.e patients if
there were a board and
c~re
home available to people with
disabilities, both on a temporary and a nermanent basis.
Many patients need a transition peri6d to adjust to living .
'ltli..th the,ir disability. and learning to adapt to new social
relationships with new activities.
These former patients
would not feel so isolated and a.lone then, sinee many,
even though they return to their
prio~
and. family become socta.lly isolated.
living accomodations
l'iany patients stated·
that the only time they left their homes was once a month
to visit their doctor.
Education and Technical Tra:tning
-··-···--------·-·-··--·----·---·----------··--·-·--·-·--;}·
In answer· to the question, "He.ve ·you ever received
B.ny technical tra:i.ning? 11 , the follo·wing responses were
elici tecl. ·
1i. 5% indicated they had completed technlca.l
or trade school, none ·vrere currently engaged in such
training, 2% had initiated such training. but had not
completed it, 78;'£ he.d never had such training, and 5.7%
did not respond to the questiop..
This 1wuld i_ndicate· the
m9...j ori ty of the patients were unskilled prior to hospit-·
B.liz!:!..tion and· had 11 ttle formal training.
Because the average patient
a~e
was
61.5 there will
b$ fewer pa t1ents · seekin12; Jobs at di.scharge than Nhen the
average patient age is lower.
The average age of the
patients ln this study are almost 'at.retirement age and
many had not been working prior to admission since they
had a chronic disability.
alqng with psy6hol9gi6al
ti::> each pattent.
However, vocational counseling,
?oun~ellng
should be available
.If the pB.tient is not ready for these
services 1'1hlle hospi taJ.ized, it should be mad.e available
to him after di~chargc~ ~s en. outpaiient.
Under the
current Ivledlcare-fof'.ledi-Cal sy-stem, reslde:nts of this type
of board and care h01ue 1··wuld also be ellgi ble for nurstng
care, home health ai.rl prop:re.m, 0. 'l'., P. T., i3peech and
Social Servicei.
In a setting such as this, patients
would be encouraged to dispel feelings of .loneliness and
have the opportunity to drm~ strength from 'similarly
affected persons.
Groups.should be organized for the disabled, where
they can participate i-'Ti th others after di scha.rge. . A
4-0
TARLE
t~
REHARILITATION SUCCESS FACTOR INTERCORRELATIONS
. (N==lQ4)
,I
Success Variables
!
;
1
2'
3
4
. 5
6
7
8
·.19
~21
.22
10
9
"''.30
·'--..-........ - .. ~-----·-·- .. - ....--~-·---- ..· · - - - - - - - - - - · -... --~ ..,.,_..._p _ _ _ _ _ _ ~----------
~
.10
J
i
I
,.,_.
·k
2
.
.3t~
.38
.15
-.;,
,.(
3
.4t\
• t~ 6
i~
,..,
--lr
.26
• 26
,., .]1
.15
.5
,.,
.31
•lt
• 3l~
•. 22
·;'(
.45
'" .40
,., • 50
·(':~
.31
.1 0
.26
.18
'" .38 '"
.t~ 7
-;'(
n28
6-
7
.,·~
-1:
.28
.,.,
~·,
·h
• .3 0
·k
• 33
-;'('
'"
• {Q
CJ.-'
.37
.29
.3?
.33
.12
* .60
9
,.,
.~'t-5
• l~9 ·k·.36
R
.23
.,•r
.32
* .42
')'{
.t~I
,.. .38
10
Y.{l£J'a 9.1£:
-~9_c;L~.:
~
1 . - Employment Status.
2.
i3.
r.:,_.
5.
Physical Functioning
Self Care
Act iyi ties Outs ide Home
Self-consciousness
?
Knmvledge About
Condition
7. S6cial relationships
8 .. P~rticipation in
Family
9. Independent Attitude
10~
.Affective Outlook
6.
Any correlation above .25 is significant. (~ ~.05)
-Jc
S i.,gn if ican t
41
TABLE 5
SATISF/\CTI,ON \,HTll NHF SERVICES AT FOLLOvl-UP BY
.: 1.
!
To ivhat extent. Here th~se (your.-)
object~~es accomplished?
(a)
(b)
(c)
(d)
2.
&
4.
8
•
tt
"(\.
•
•
8
:. •
....
•
•
.•
71.2%
,"."
10.0%
.9%
Could these objectives have been
accomplLshed as wsll in another
,,,as 7
·(a)
(b)
(c)
(d)
3.
18.3%
c om p 1 e t e 1 y n • • • ~
Partly
~ ~~ ~. ~ ~".,.
~
Not at.all •• ~•••••••-'··~····
Don't know •• o••••••••• •••••
yes .... " ~ ~ -· e • "'
l\1 0 " •• " "' • tt ~ p ..
~
t:
~·
Don't know •••••••••••••••••
Not recorded,.~-~·· ••••••• ~~.
I!)
fl
...
p
{iiJ
fl
«'
"
•
"'
......
. . . · "'
.,
t'
ill'
"
,,
•
"
cf
.,
411
It
10
72
69.2%
10.0%
19
3
18.3%
2.9%
89
85.6'1~
4
3.8%
10.6%
Would you recommend the Northridge
P"ehabi.litation Center to a. fr.h:md
i,Jho needed treatment 7
(a)
(b)
(c)
~
~ ~
Yes
ll
,
f'~ 0
~
" "" ·• o .n •
..
,.
1')o
•
41
••
.,
fll
-~
..
f'l
•
«< "'" •
Pl
l!t
•
"
(I;_,. "'
o ""· "
f'
tt
Not ·recorded • . , ••••••••
s ,. , ·., ...
•
!I
•
~
c-
e ••• ,
11
The high degr~e of satisfaction on the part of the
197!l Northrid.[!,e Hospital Rehabilitation Center inpatients
Hitb the services they received is evident in this table.
The extremely high percentage who would recommend the
Northridge Hospital Rehabilitation Center to a friend v1l1.o
' needed treatment (85 .6%) places the \,]hole question of patient: ,satisfaction in l)(~rsp(~c:::tive.
hav~
1
I
I
I
I
I
I
II
l
I
I!
1
j
I
An'd 70% felt their objectives could not
been met !
in any otlwr \•.ray while 71% tel t they had partly· accomplish-)
eel t'heir . objective,<;, ancl 18% felt their objectives ha.d beeri
met cornplet~ly.
The small percentage.expressing dissati.s-:
facti6n with the services said they-should have received ad~
ditional medical help.(5%).
I
L~L
TABLE 6
SE:LECTETl SIGNIFICANT
CORRELATIONS
Correlation
toefficient
Significant
Vari.ables
t-·-·-----·-·-----------·~-~--·-..;.
_______.,_____. __~---. --.--....;_,--.~------~---·--1
8,9
;.1.~9
6' g.
.:. L17
6,8
I
J~f·
3' {~
5
3,9
&4 5
3,8
•• 4/l
2, t.,.
:• L1
I
0
4 2
7' 10
'. 4 1
8' 10
0
The
probabili~ies
Participation in famtly Independent Attitude
I
Activities Outside Home l'
Social Relationships·
I
Knowledge About Condition Independent Attitude
Knowledge about condition Partici~ation ~n Family .
Self Care - Activities 01...1tside
Home
Se l.f Car·e
Independent
Attitude
Participation in ·
Self Care
Family·
Physical Functioning Activities Outside Horne
Social Relationships Affective Outlook
Participation in Family Affective Ot~tlook
are less of these happening by·
chance alone above the .2.5 level- at..~:( :.05 •
.....
I
43
program of this type is located at the Stroke Resocializatioh Program at Northridge Hospital.
In this group
the patients meet once a 1'Teelt and participate in activities
they have planned and coordinated or they
vi~it,
play
card~,
pool and socialize.
The follm-ving significantly· correlated variables
.were selected for detailed commenhs (See Tabie ?.):
_!'a tt~.!l__t_s
~n_owl ecig_~- D:_'bo~ut, __ conc'!:_t_:tt_on~--~nd p~-~~-tt ci_Q_a ti_Q._!]._
f§lll)J:-}L_g_Lf13::1::!.~·
i.Q
( .LI-'7) · This .significant correlation
indicates that the role of the family must be
tak~n
into
consld.eration Wheh dealing Nith the long term care of the
disabled.
If patJ.ent lmmvledge is low, then participation
ln f,grnily affairs will. be low.
'
include the family in the
Efforts must be made to
tr~atment
plan.
The Spain
/+-
Study
came to the same conclusions.
Health education
programs set up ln the hospital and commun:i. ty· for patients
shouJ.d not only
.Lncl1.Jde~
but· j.nsist, that family me.mbers
attend as part of the total education of the patient in
regard to hls.hea.lth care plan and Jearnlng to live with
his cUsabiJ.ity. ,.
1.!:!9-.!:'?.PBnd~l.'!L.?-~.t..:t.~-- anq. se:h_[::._2ar~.
Heijp· this dem6nstrates that persons
(. 45)
J\ccord.lng to
~ttltudes,
beliefs
and values are important in fostering self-esteem and egostren~thening,
'rhus
the
and deal with.the patients emotional level.
p~::ttient
v.r'ho w:i.ll feel ver;v ihd.ependent in self-
care will also be involved in the social activities of the
.i
TABLE 7
DISTRIBUTION OF
USE OF' COl'\HUNlTY HEALTH SERVICES
BY PATIENTS 1\.FTEP~ DISCHARGE FROM THE NRC
NED I CAL
!.~ .5
10
85
8
R5
ECON01'1J. C
7
81
VOCATIONAL
4
89
EDUCATIONAL
.1
90
SOC.IAL
' These anmvers
your
dischar~e
'\-•Tere
elicited to ·tlie question,
u1nce
from Nwrthridge Hospital Rehabilitation
Center, have you received, or are
'services in any ·of the above
I
IIC'•
-
yo~ p~esently
categortE~s ?·".
receiving
The total
\
number of responses in the yes column indicated t+2 yes
I
-respon_ses using community resources, but a further check
ievealed these 42 retponses
involved only 22 people.
Thus,
iapproxirnately .20'1o \vere utilizing available community health
rPsources.
fe.m:lly and the family should 1)e encouraged. to be supportive
of this attitude and ~trive for additional independence.
Group therapy sessions have been suggested for disabled
7 .
patlents in a rehabilitatton ce,;nter.
'I'he family should
be able to participate in thls group or perhaps ·have a.
sep~rate
atrist
group just for family members.
should.~e
Also a psychi-
made available to the family throughout
afte~
discharge •
.!LB.Q.?.9=- af_fec~:!:_ve_f:?_~tloSJJs_was -~Q_:rr~la_te_d with
particiE_~-
the patient 1 s hospitalization and even
1toll.__ 1:_1~~_fe.mtJx:..:.@-ctJ v_L!:_~-~-i! (. 41), e-nd this relationship
..
takes into consideratlon the problems of everyday living,
the enforced_ early :retirement and the extra longevi t.y
that ls afforded the patient.
In the survey by Overs,
19
one of the most lmportant factors in having a good
affective outlo6k is age and family relations_.
vislon
~f
The
pro~
family support and encouragement during a
cUsabling ·illness wlll. alloN· for e. better personal
adjustment on the part of the patient.
These v:.:::trlables. are ·dependent upon each other in
encouraging the values that are need.ed for a successful
rehablli ta tion program, mainta.inilip:; self- respect indepence with the
fam~ly
According to 1tlyl:ie
e.nd outside relationships.
good ·inst.cr,ht helps change attitudes
and ·achieve personal growth and increase actlvities.
~£h ~-}:. 2.!:.~___2_[__~ h~--f~mi l:.Y_t_~-~I:!.~:.._ad_j_
us t~~n t .....QL.~h~<i~abl ~9:
!!~-s .!?_~_e~:_~j._e;!!.?:f_:l.:_S:~l~1~.1X_~o i~ r~lat ed...!~~:,!.!!. __s ~J::.f. :.. ~are §1.:!14 wl~!1
]~!]:Q_~~~g.g~---·§-~-~~~t --~-~g_q"i ~J..9E~
(. 45)
The family must
facilitate the
p~tient's ~ehnbilitation
or they
~ill
not
allo1-v him ·to become as tndependent as possible and the
importance of aftercare services is
Study
19
~hewn
in the Overs
to provide social relationships and increased
activities away from home:.and is directly .rel.9:ted to
,
h8.v:i.ng independ.ent atti tl.J.des e.nd good social relation-
~~led_g~~...§..~_S?_ut __l?:..~ndJ::_:tLf2!l_~_?.:§____§jJ5Qift_~an~.lY..--correl_?.:.i_:_ed
§:_:ttJ- t]~d~,
w:Ltb~ __ i __!:!deJ~en~,~:Q_t___
.( . .49) which lndicates the
patient 1 s need for receiving
~ood,
reliable, accurate
information ln termin<;>l6gy he .can understancl. Rei jn 1 s
8
survey det~rmined that the rehabilitation staff should
talre every precaution to develop trust and confidence in
the patient and help him to acquire }{noi'rledge and understanding of causative factors which inflUence his present
state of health,
Health care personnel should be educating
the patient so as to help him understand the meaning of
his di8.gnosi s or suTgi cal procedure and helpi.ng him plan
activities which will promote and prevent occurrence of
harmYul
sequelae~
However, thiB should not be on a hit
or miss basis, but rather an established or planned program of education for the patients
and specific personnel
in charge of the education program.
'rhe staff should also encourage the understanding
......
of the importance of follow-up health care and participating Hith family .in home care planning and decision. mal-ting;~
!lm9J:lllt Q_f __i:_!}vg_l Y..~A!~nt __tx~.-~:.ti y_i tt.~~~-ou·~slde
~he__ll_~:rg-~
~£-'?:S · ~~gp:U'_i C§-.~1tl,y____co_rr~l~t:es1 __1!1 th_ self- car~ ( . 46) a.nd
indicates, according to Wylie, an intense need to reconfirm and
fami.ly..
reoragniz~
role
relation~hips
wlth spouse and
Also, patients need to be given a chance to
·success in
exp~rience
lea~ning
to cope with their dis-
ab_ility.
A_g,y i x_t.tie ~OL!is i.:_Q. e _t
l}_~_.ll_om~-~~.§..,_al so__:? i
gni f i
c~u1~1r
~o~r~_:!:_~ted_wi ttL._§_gcia.l._J:,el_~.t.i.S?..r.!.~h~p_~ .(.50) which can
19
according to Overs
.
. indicate a dependence upon the need
for the patients to lea.rn to cope with their feelings,
fear, anger, denial, irritability, anxiety, depression,
fine.neial \'lorries, frustration. concerns and emotional
problems to obtaln understanding ·from the family and.
:frlends and restructure tt1eir s'elf-image.
Families must
sometimes reshuffle the roles within their family structure.
If successful, then the patient with good social relation'
.
.
shlps wlll have many outside activities.
In this area
the families are US1J.a1ly encourag:i.ng independence rather
remain j_n his sick dependent
than having the patient
role.
19
In the Ove.rs Study.
the sign:l.flca.nce of various
social activities in the rehabll1tation of disabled
patients was established •
......
~-~"..tJ...2.l£!?:.!J._<:?_:r:!_h0_J:am1_1l'__~-:-~ti vi tt~2.._.!:~_._hi &hll.. co:;:-
!'~·~._a ~~~~-~!~!_!:?:_~_f fee t1.:Y.:.~-..9~:!_;lo_~}~ (. 'll) and J~~.rJi c=':_:ea 't:i o~
48
'I'hls sho:r,rs
there ·is n clefini te relationship to ha>Ting a
good self-concept with his perception of the role he can
perform and what othe1~s in the environment expect him to
be able to conform to.
His attitude will depend on how
-vtell he can ,judge what his eapabili ties are and will
depend upon how well he will do in group settings.
Overs
19
~ubjects
were. found to diffei,in success of
rehabilitation aecordtng to the extent to which they.
vi_e..,~ed.
t·hemselves a.s disabled.
If others· expected the
patient to contribute to the proper.functioning of family
.activities, then he
~as
theoretical assumption
must
111ake
more likely to
oi
imp~ove.
A major
Overs' project was that families
decisions about patient ce.re ancl safety, and
these dectslons can lead to maladjnstment if the different
family members have
differ~nt
perceptiorts ·of the exterit
of the pa tl ent 1 S· ablli ty to participate· ln fa.mily acti vit:Les.
l'Iany of these·
correl~:~.t].ons
found to be sig.niflca:nt
·in this study.were also significant in several other
stucUes reviewed in the 11 terature.
with previous
.
..~
resu~ts
is significant •
This corrobore.tion
(See 'I'able f3)
TABLE 8
)
REHABILlT/\.T ION SUCCESS VARIABLES FRON THE NRC P1\T iENTS
.RELATED TO VARIABLES IN PRIOR.STUDIES
.
i
!. Y9£i~:1~.1.§_____9.9.XK.§1il..:t1.21J__GQID!I!£!.~-~-E'.
..,..Bf!lat :i,;p_g_ To__Ot.heL.V ~ri£1?.1~~
.
.
I
I
This is exp~cted to be low due to t~e
'Statu~
1.61
average pat1ents age, 61~5 years, as
_
·
~om~ared to .the Spain Study ~ean o~J
. -------~.:_ ____ ·~--~----------·--·-·- ·- ______]._~12...~..here_ _t!} .§...J.!Y...~.r.~z,g_ .Y?.~_§,_9-J.~-!l
EmpLoyment
I
I
Ph=ysical
Functioning
This is low probably due to high
1
average patient age and the greates~
percentage <?f disease was in the_ CVAj
category \-vhn:h leaves_ the most d1.sa-j
bility, where~as the Spain Study wa~
s';lcces s ful ( 3. 38) and the 1.1i~her~t
!
...:............... __________~---·-····-·--------~--9.1&~:;1§.~<;_§j;:.§.gQ.:t;L.Y~a §....l!.Lthr 1 t.l-2-·-----~
Self Care
~------· ...... ____
2.02
2..30
·
This i.s low probably due to the factl
h
1
•
1. .f. unct1.on1ng
•
•
. an d a·~
ff' ec~·;'
t.at
p.1ys1ca
----···------·------·----·~----J~_i.y_g___ ~!J.2.9J5.._gi;-_e:......9L§ SLJlD.§.ll C,:~_Q§. s l'::1.1...!J
.
I
prohably due to age., diagnosis !
and lack of independent attitude an~
2.53·
-good affective outlook, The Spain
Study
show~d -succes in all-these
.
.
•
{+
.
.
I
~----·-"· ....... ------------·-·-·---~--.:... ... .S!J.:~?:§ .~......... _________________·""-------------i
Activities
Outside the.
Home
Lm-1,
!
Self-consciousness
, About Disability
3.0·
-·---- ---- ...
Indicat~B patient's acceptance of
j
a\.;rareness of disability. · Each pa- i
tient is seen bv a social worker fo~
-~-~-----.......... ___... ~.---·.... ----~ f :~;t~~~~n-~~1_~~:.~~~~--;~~ ~;;~-~~~ !9j
I
LoH ~ probably due to the lack of· act-j
equate. educa t i<?n, information and
1
·----·------------·-·-·-..·""·__:<;?._,.Q______·_.."___.£..QI~1l!l!!DJJ~Y-~f'SV 1.£.§.§_!'_~f.~££flL~-'------ _.._~
Knowledge About
Condit ipn
i
Indicates successful relationships. !
This was also true in the ·Spain
:
Sttidy; and probably due to the inte~sive recreational therapy program a~d
·----------·-·~--·_;··~------_:.----·~--f_O..f..J.aJ~§..§.!:Yj.g_~L§Ya !,l_~.Q i 1 t Y...!.~ . ----·j
Participation in
Low clue to family's response to con~
Family Affairs 2.3
dition and patients level of physicaJ.
-···--·-·--·-----~·-·-··-· __________.__J.:vn.~ t Joll.t!!g~--~-------------------_____
Independent
· Lmv dtH.~ to patients p.ercept ion of hJ]s
Attitude·
1
$5
limitations attitudes and
values.
I
----·-----------·-·-- ............_____ . ____ ~----....-----····-----··-·.!----~-----·---~-----·----!
Affective
Expected to be low when physical furicOutlook
2.65
tioni.n.g and indeperidence are low
l
Social
Rc"~la t
3~2
ionsh ips
:_j
1
1
.
CHAPTER V
HIPLICA'l'IONS FOB. COi'!fv!UNI'I'Y HEALTH EDUCNriON
Conclusions
1\ list of community resources should always be
made s.vailable to each pat:ient and family because a:t1'
effective -public information program Will direct attention
to the risk factors lnvol v-eci >r:i:th Tre.ri ous
explain the
preventati~e
j_J.lne~h<es,
actions that might be takep,
provide accurate information on the nature of each illness
e,nd 1 ts management.
eli ssemlna te acc.urate i:nforma ti on
_,.
.
~
about the ce.re and fe.cill tles e.vailable in the community,
e.nd stfmuJ.e.te acceptance of th,e clisabled_ person by the
family and
by
the community.
Communl ty resources vary from area. to area, but in
the So.n Fernando Valley there are numerous agencies
s.vsJ.lable to
peonle.
ar~s1st
aged, handics.pped., poor and lonely
Very fe·w ( 22) patients in this study respo:nded
e.fflr;native1y to the use of any of the resources available
in this a.rea.,..
(See Table 6. )
'rhe pe.ttents either were
not aware that specific agencies-such as Easter Seals,
Canc~r Society.
Rebounder and Fish existed or did not
know- hoN to use them.
In many eases they had heard about
the,vari6us agencies ·through 'the so6ial worker or the
voce.tj_ onal cm:mselor, but did not in:i. t1ate contact with
them for the follo·Hing reasons:
50
g~neralized
fee.r; a laclr
51
cost~
of transportation, fear of financial
th~y
thought
no one cared~ they felt people ·f.'rould make fun of them; the'
family disuaded patient from calling, they were too tired.
they 'tATere unwilling to accept help from anyone; or they
didn 1 t want scimet,hing for nothing._
11
One_ patient said,
'l'hey 'd call me if they were interested.
11
ta.J~k
feel help was need eel,_ were e.fraid to
Some didn 1 t
to stra\).gers,
or only wanted to see people they knew before their
ctlse.bilj_ty, etc.
Accordit1g t.o the report Of the lTo'lnt Committee :for
20
stroke should be attacked at both
Stroke Facilities.
the preventJ ve and· _treatme:nt levels.
must be
weJl~-informed abo1.:~t
'l'hus; the. commun].ty ,
the nature of the disease and
its prevention and. eare, as well a.s· the resources uhi.ch
are or should be ayatlable.
This means education -
educati.on. 11'ot only to transmtt information and. to teach
skills f6r dealing with the many problems. but also to
effect atti ti..ldlnal c.hanp;es.
1'he educa,t:i.onal techniques
and content will differ for various
The goals for health
eclucat~on
~roups.
intervention·are to
' dJ.ssemtnate information about and to chang-e e.tti tudes and
behnv1 or towG.rd stroke preven t:i.on and ca.re.
modes
~f
Since llar:)i tua,l
reacting to health and health practices become
deeply inr;ratned. i.md resl st change. programs must be
planned
with this diff'leulty in mlncL
,
Educa,tional tech-
,nlques need t.o be ta:i.lorecl for varlous ethnic, cultllral,
52
social, J.an,c;:;ua.ge, and a.ge groups,
Some people may per-
ceive the recommended changes in a ttl tudes· and beha.vior
Thu~,
as a threat to their ethnic identity.
their help
should be sought early in the planning sta.ges.
To be
effective;.public education needs to be cogent and
retnforced over time..
data on stroke, on
p~e~ention,
risk
'l'he programs need to include baste
e~ch
f~ctors
disease. the
pos~ibilities
for
and their contrdl .• early signs
of stroke, the care of stroke patients, associated disnhilitles, 9.nd the avaJ.labilit:y of fa.cili ties to manage
all
sta~es
of the illness.
eluded for the families
Insurance
~olicies
and~.
Information
need~
to be
in~
their roles.
should ,include preventative
proRraMs as well as better coverage .for rehabilitation.
• Hany policies today do not cover this type of expense and
there are no berl.efi·ts even for P. T. or 0. T.
.Nany patients
in the survey-(15%), stated that they left the Rehabilita.tion Center due to lack of additional insurance benefits
·and not beee.use they felt they: had reached their· goals.
Other comments by pattents· were that there could have been
,more staff available and better use of available staff.
Nurses shouldn 1t
have to be doing clerical· work and other
non--m.1rslng FJ.dministrative: funetions.
Hedlca:t·e and Hedi-Cal should make funds ava.ilab1e
to provide· home health aides for all patients recently
dl scharged from a.n acute hospl tal, especially a. rehabll t-
53
tation .center, so. that they me.y be properly followed and
cHred for at home for a temporary period.
I1any patients
expressed a desire for this (lW) • . This ·would be les.s
expense than the cost of. a nursing home for·. the same
.period of
~fme
and most patients prefer to be.at home
a.mong family, frlencls and·· familta:r surrotmclings.
this initial period of
adjustment~
After
a home 'health care
team membe.r should visit each patient at least once .a
month to re-evaluate and re-assess the situation.
A
follow~up
interview should be conducted on every
patient ·Within six months of discharge.
A
·similar
questionnaire 'Sh01lld be developed for relatives and/or
family members of patients to determine their attitudes.
since many family members g.re asked to make decislons
regardi.ng patient· c9.re and. safety 8.nd they will need to
have a real;lstic expectation of the extent of the patient's
disability as well as ability.
During t.l1ese home visits the family members should
be
~ssisted
in developing realistic expectations 1n order
to prec.lude rejection of .the p;ains of the rehabilltation
therapies no matter hoN .small they may seem to be.
.
'rhey·
\
should also be given
~dequate
information about illness
and eommuni t;y resources ancl help d.evelop a.ddi tlonal
'
.
..~
lacking
resourc~s •
Trainin~
proRrams need to be set up for staff ·to
educate them in the principles of eac.h disease and its
rehabilitation care.
The staff should also be encouraged
54
to explor·e, dev-elop, e.nd implement expax:tded roles so· ths. t
>
they
their
m~y
be challenged by the
in providing
a~ilities
oppor~unity
of utilizing
care.
Health care
b~tter
professional practices should be
e~tended
to include
appropriate education so tlae.t competence. may be· established.
'
Early
and intensive rehabilitation treatment should
be readily available to,everyone, since it increases the
chances of surviv-al and recov-ery, and in many·cases,
hastens the pa.tlent 1 s return to usefulness.·
Public educatlon should be
of identifyj.ng
~isk
incr~ased
ln the area
factors ln all diseases requiring
extensiv-e reha.bilite.tlon.
Hany patients in the stl.rv-ey
di.d not use communi. t;r resources that i'>Ie:re avai.lable e:ven
when they knew about themL
'
transpprtation,
lack of a
Such factors as lack of
famil~ me~ber
or friend to
accompany them, and le.cl{ of self-conficenee, contributed to
the failure to use the communi.ty resources •.
Almost all of the
patient~
in nursing homes expressed
a desire for a follow-up vislt.from the r~habilitation
c.enter for cont;j_nued evalu:at:ton.
They cUd not feel that
the nursinp: homes "rere encour;aglng independence a.nd they
felt abandoned.
Recommendations
.~
The resources available for the disabled need to be
determlned and
a c.urrent 1istlng should be l\:ept.
Con-
tirmt::\tlon of support for on-going epidemiological studies
. 55
should be enc_ouraged.
Additional programs for education
should be established both for patients and staff with
more structure and based on objectives; such on-going
programs should be evaluated in terms of these objectives
and goals.
Additional social services should be ma9.e available
to the patients after discharge since so many indicated
problems in the areas of r6le changes, sexual
emotional problemsj
probl~ms·of
dependency,
dysfunction~
and-the.
fear of families· in taking patients home from the hospital.
More re-soci~lization grou~s should be established
similar to the one·currently sponsored for stroke patients
b~
Northridge
Hospit~l.
This program, however, is
staffed by volunteers, and is oriJy for stroke or ~raifi
damaged patients.
Additional groups such as the stroke re-s6cialization
programs should be established for all ·disabilities
so the handicapped have a place to go wheFe they can meet
people with similar problems and lend each other emotional
support.
Health authorities should id-ontify and eva.Juate
the adequacy of strategically placied rehabilitation centers.
If such recommendations are followed, the ·chances
are greater that better health care would be provided to
a11 patients •. with better ttse of community health agenc1es,
a greater un(\erstanding of each specific -illness would be
.,..•
56
·obtain~d
by patient, familles an.d staff.
The possi hil-
itles would be increased thnt there would be
mo1.~.e
coordin-
ation of services e.nd follo-vr .. up for a greater chance of.
returning the. handicapped patient ·to ~the community as
e. useful contri butim; member.
57
FOOTNOTES
l
Brieland, D.,· Costin, L., 'Atherton, c., .Q9_:t1:.:t:empQ_:ra.:r;y:
-~oc1_a.l ___i4or~. tl!cGrav~-Hill Book Go.,. N. Y., 1975.
2 "Chronic Conditions and Limitations of Aetivity and
t'lobillty in the United States," July 1965-June 1967,
Vital and.Health Statistics Data fro~ the National
Health Survey, ser. 10, no. 61, U. S. Department of
Health. Education and Welfare.
H.lchar~J
3
P:resiclentia1 Documents:
no. 39, p. 1197.
4
Smits, Stanley i., Ph-.D., "Spain 11erl8.bi1itation Study,
Satisfnetion for the Severely Disabled, 11 Jo'urnal of '
.tJ.eJ:laptl.ita.tJ_ol};. July-Att,o;ust, 1973.'
-------·-----·
5
National Council on Rehabilitation, Symposium on the
Process of Rehabilitation, Cleveland. Ohio, 1944,
p.
6.
.
Nixon, 1973, Vol. 9,
.
6
vh:-:i~ht·,
'7
l{rysen, H. H., IL D., F'.A.C.P., -Handbook
of Phvsical
.......
___________
Medicine and R~h~bilitation, W. B. Saunders Co,,
Ph iTa d. e fphl ~~-iifis y c·Eo i 0 g i cal F8. c tors Af fee ti ng
Disability,'' pp. 15--23.
8.
Hei.jn, Cornelias, I•l. D. and Granger, ·Carl, H. D.,
"Understanding Hoti vatlonEtl Pntterns--.B~arly Identi..,.
fic.stion Aids Heha.billtatlon, '' Journal Of Rehabili-_t~·~--tC?_r:!, November-December, 1. 974~---pp,--;:n;-:-29-.----------- ·
9
Hilson, Robert N.,
Beatrice A, (ed.J, Psychology arid Rehabi,J_itatio:ri,
l\merlcan Psyehological Association, Hashington, D. C. i
1959, -pp. 26-28.
-------~··
1970, p. 2--A •
--~
.~o~tc.?_l}_~~'lr.!2::.~Y.J:D-ob~,
(,(-------~-
Oc.tober 11,
.
lO
lilil1er, Del bert and F'orm .• Will lam. _l:nr;l!~StJ::ial_ 8?.,9_1q.J.:..2KY:t
l'if. Y., 19_5:3, He.rper Brothers, p. 27tL
·
11
F'reem8.n, H. , Levlne, S. , · Reeder, L. , Hai1dbook of
. tl~~_§:.f_§-2~1.91 og_~, · .Prentice- Hall,· Inc-:-·:N:--;L-; 19 '7 2.
·" .
p.'
12
,~;23.
-
Be.um· et a.L:
"f·1uitidlsclp1ine treatment of chronic.
pulmoriary, insuffici~ncy; functional sbatus at 1
year foJlcn'l'-up,." ~!.Il._li~Y.._3-e§J2...J2i~ 105:993-994, 1972.
58
13
Haas, A. Ce.rdon H. ; 11 Rebabili tation in chronic
obstructive pulmonary disease:
A five year study
of 252 male patients," _!i~d~_Q];.,inic L~T!! 53: 59·6, 1969.
Bendkowski, B., N, D., 1'1.H.C.G.P., P' .• A.G.S., '"Ince.pacitating Diseases in the Elderly:
A survey in General
Practice'' 1966--1967, Journal of the American Geria.:tri£~-'-So_Q_i_~.IT· Vol. _f()-;1\Io-. 12 t 19b8. -----
15
Robb, B.: ~ans_Ev~r_;yj;_b_!_ng_:_~ c~_?~to
Thomas Nelson & Son, 19~7.
·
16.
ltJylie, Charles f11urray, N. D., Dr. P. ·B., 11 Age a.nd the
Rehab1.lltatlve Care of Stroke,"· Journal of .the American
Q.~-r:t§:..t..£1 c §_e_oc_~~-tY, ·Vol.
~ns~.
London~
16, Ho. q:-·~-".AP'rf1T%EL-----·------.
17. !'Iiller, H. B., f'L D., F./LG.P., "L:i.fe History of the
Stroke .Syndrome," Journal of the-American Geriatrics
19 68 , Vol:-T;-;---No~-5:·-----------~-----------
_§g_~J~iY.:,
· · 18
Steyens, Jacl{, {vi. D. , "The Role of Surgery ·in •r:rea tment of Arthritis of the Hip," Journal of the Ameri_~:?.?-n_Q~..r.1~~~~r\_2.§___~Q9i§~t_y p 1968. 1/oi-.-Tb"~- No~~.---·---
' 19
Overs, Hobert 8.nd Healy, John B., 11 Stoke Patients:
'.L'heir Spouses, F'arn:llies and the Community," Nedica.l
_?:nc!__!:~;y:_cl:!.9_;_~_g_e_t.~~L.A~:Re c_t_§!____9 f _l~i sa 1?.11 i tx.
-----------
20
~gJ:p.t___~_om_Ig;l,:tt~e for ---~troJ.~~- .. Fac i_liJ~i.l?..§., January. February, ,19?lJ., Heprinted by U.s. Department of
Health, Education, and Hel:fare, Health Resources
Ad.mi ni s t:rati on,,
59
Bernard, .J. Ph.D., Thompson, L.F.; R.N., M.S., Sos;iol.Q,&Y
!:i~J:1L~-~.3}l£LJ~he i~=- I' ?.!;;.;h.gp_t; §_Jn~l}.- ~Qsif'J..D_..§..Q_Si.f::.:tY., c •v .
Mosby Co., 1970
Freeman, Hm·lard E.; Levine, Sol>,. Rt1eder, L.G., Handbook
H~c1Js.e.l S.Q£.j,g):ggy. · Prent icl~-Hall, N. J. · 19 7 2
J
1
o~
Golcliamond, Israel, 11 A Diary of Self-J1odification, 11
I!D?..£h.9.l.9.gy__:}' oQQY , f'1o v ember , l. 9 7 3
i Kalt1g;er,
.
1
George, Ph.D, and Unkovic, Charles H., Ph.D,
!
I
i
I
I
I·
.P_§.Y.£1:~.91.Qgy__ atJ.9'"'..?o~]:o~_ggy, C. V. Mosby Co,, Saint Louis, j·
1969.
, Klenk, R. and· Ryan, R., T~J§...Y1-.fi£1;:1£!:L..2U2..<;";J~L Wgf·t, 19 70.
Hacls',..Jorth Publishing Co~, .Inc., Be~mont, California
f'ara.d, Ho"'1ard ..J., .Cris i~- Inj;:_~.rY.~DIJ:..Q[!_;__"' ___$..§Jec.:!§.9 R~§.s:1_}.11£§.,
Family Service Associatiorr of America, 1965.
Pc=trsons, Ta'.cott and Fox, Renee, 1'Illftess, Therapy and The
Hod ern Urban L\merican Family. 11 Ihe I::.?mil.Y>Edited by i.
Norman Bell and .Ezra Vogel. ·Illinois:
Free Press, 196q.
I
11
l
Shellhase, Leslie and Shellhase, Fern, Role of the Family
j
·in Rehabili.tation.• 11 §~2.£l.?.~..:c~.§..Q~or..:}s., il53 ( Novem~)er,
· 19 7 2): 54t+ ... st,.9
!'
I
·
1
Sneden, La',,71:-ence E:.,Ph.D., Poyg.£.tYJ..:......_LL.f.§Y..£.!f_Q.§...QCie1
!
6n?JJ.Y£.i.~, l'lcCutchan Publishing Co., Berkeley, Californi~,
1970.
I
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.~
'!
60
.APPENDIX A
FOLLOW-UP S'l"'tJDY
.fr~_- Sl~J.:Y..~;!;.nf_~;rma ti on
L
Demogra.phlc Data:
·
N9.me:
2,
I . D . ~l: ---·--··-·-·---·----------
3.
Address·: ·
city ; -'--·~--·---------~-_:: _ __ _county:_._·------------·-·-
sta t:e: ----·-------~·-·-·---~Zl:P Code:------·----------
.II.
L~ •
Telephone # = ......:.....'____, _____
· ...:..__ 5.
6.
Sex: ___________ ?.
Date of Blrth:
Raee: -----------8.
Har1 tal Status:
Hosnltal Hecord.:
Chart #:
10.
Date Admitted:
11.
Age \\Then Your Condi tlon Began_~---------·-------~
12.
1:~ge VI' hen Admit ted Here:-------·--------
13.
Adm1: t tlnp:; Servl ce: ------------------------··------
1Lr.
Heferral Source ( Incl:J,.1de doct·or' s name):-~----
. l5.
Diagnosis e.t Discharge:_ . _____________________________
Co d. e
16.
No.
i¥. _____________.____. . ...,_,.__
of E,e-Aclmlssio:ns: _______ 1.?.
'I'otal
# Days
as Inpa. t i en t : ________:.._......,.....--
18. ·Total cost of Hospttaliza.tion: ___ ~-----------·
19.
Costs Pe.id by:-----------------------··-------'----·------·-
61
20.
I.
. Date of Last Discharge_________________ _
Setttng:
21.
23.
Date of· Intervie'w: ________ 22. Place:_·______ _
_Respondent:-------·------~--
If not pa tienl;,
a.
Hela.tionship to patient: ___·---------~---·. --.-
b.
Reason for respondi:mt other than patlent:
-·-
--------··---------------~----·--···-------·
II.
·-'----
Satisfaction with Services:
24.
Why, in patient's view, was he admitted to
N.H;H.C.; what were the objectives as seen by
him?
To what extent were these objectl ve's ace omplished?
1.
2.
3.
lJ-.
.5.
25.
Completely
Almost completely
Somer,.rha t
Very 1 i tt1e
Not at all
Could these objectives have been accomplished
e.s -vrell i.n another way: ,
1.
2.
J.
Yes
No
Don 1 t know
Ho'uld. you recommend the· N.H.R.C. to a :friend
.
.....
who 'needed treatment9
1. Yes
2 •. No
3. Don' t know
6'2
III,
Gommu.ni ty Health Services:
Since Jrour discharge from N.lL R. C. have you rec.eived
or are you presently recelving services in any of
\.
the-categories listed beloM?
If you have needed any
of them but.have been unable to obtain them, please
tell me as· we go through the list.
Service Area
---·-·-----....-·-27.
l'1edi cal
28.
Bocla).
29. ·Psychological
30.
Economic
31.
Vocational
32 •
Eth:tea. t 1_ onal
--------·---------·-·--
(Inquire further regar.dJ.nr; any unobtainable ser-
vices to. see if
·~-<re
can. arrange for help that. is
currently nE;!eded ~ )_____________________
· ----------------·-···--·
Pl.
Voce.tional.Status:
-33.
What is the patient's currertt statu~ with the
State.Vocationaf Hehabi1itation Agency?
1.
2.
Never activated
'L
Active
_s.
Reactivated
Unemployed
h.
Employed
34.- What is the employment status of the patient at
the present time?
1.
2..
3.
tJ:i:1empl oyed
In training status;· retired.
Homemaker; part-time employment up to 20
hours per week; volunteer activities of
consistent nature
63
Li-.
5.
35.
Part-time employment of between 20 and 35
hours per week
'Employed full-· time
If unemployed, 1'rhy?
Age _
Medical problems
.3. Layoff from job, temporary
4, Lack of avai'lahle jobs
5. ·Other: (Describe)__________________ _
1.
2.
36.
- ....-·-----,.·-·---·~-------·-·-·----·-·.:.--·-~---··-----lf employed now. how d1d you get your ;job?
1.
2.
J.
4.
5.
6.
V.
Former -employer
Self, friend, relative
State Employment A~ency
Private employment agency
Vocational Rebabi1itation Counselor·
Other: (Describe) ________________________________
Life Sty1e Varlables:
37.
What
1•
2.
).
4.
56.
7.
38.
~s
the·hi~hest
leve1 job youlve ever held?
Higher executive largB prop., major prof.
Business Manager middle prop;, lesser prof.
J\dmlni stra t1 ve .personnel, small bustness,
mln<'Jr prof.
Clerical and sa1es, little business,
technlclan
Skilled manual employee, small farmer
Machine operator, semi~skilled employee,
tena.nt farmer
Unskilled employee, sharecropper, unemployed
Have you ev-er recei vecl fl.ny technl cal or trade
school training?
L
2.
J.
4.
39,
Has completed technica1 or trade school
tra-ining
r:resently enge.,a;ed ln such training
Initiated such trainln~. did not complete
Has never had such training
.
·
How much educatlon have you had?
1.
, 2.
J.
Graduate pr6fessional tralnin~
College gr8.duate
Partie.1 college traJ.ni.ng
4.
5.
6.
7.
40.
High school grad~ate
Partial high school training
Junior high (7-9)
Less than 7 year~ of training.
Type of residerice?
1.
2.
' 3.
~_,_.
5.
'6.
. 7.
Single family dwelling
Apartment or duplex
Room
Nu:rsing_home
In home of relative
Other-institution
Other: (Describe )------------------------..
..
. ..-~-·---~----..:.-----~- ... ---~-·.-------:---~~ -~------ -~--·
~~-1.
--.----
Has there been a change o1· modiflcation in your
residence beGause-of your impairment?
1.
2.
3.
·4.
5.
1~-2.
No change
_
Minor modifications
MajDr modifications
Forced to move
Moved ~nd modified
Has there been a change or modification in your
residence beco.use of your equipment?
1.
2.
3.
4- ,.
5.
No change
Minor modifications
haJor modifications
Forced to move.
Moved and modified
11-3. , .Are sta.i.rs a problem to you?
1.
2.
3.
4~
Yes
No
Slight
Need an elevator
4h. . Estiir)B.t;ed: cost. overall,- of modifice.ti on in
residence:
1.
2.
3.
4.
5.
No modification
Up_ to ~~500
$500 to $1~000 ·
$1,000 to $5.000
$5,000 and above
65
45.
Do yau
have.extr~
costs of living now because
of Jour i.mpairtnent e.g.
transportation, house-
keeper .• nursing ca:re, oxygen, medi'ca tion, etc.
If yes, please estimate·the .extra costs on a
monthly basis.:
1.
2.
3.
4.
S.
46.
j.
4.
5.
no 11 to .#L~J.
Patient is not·a member of a family group
Pe.tient and spouse onJy.
Member of· family of J-4
Member .of family of 5-6
Membei of family of 7 or more
Primary· source of fami1y 1ncome:
L
2,
J.
4.
5.
VI.
11
Size ot family:
1.
2.
L~7.
l'Jone. Le. answer is
Up to $5'0
$50 to . ~~100
$100 to $200
Over $200 per month
Ea:rni ngs by pe.tient
Eernlng by .other fam11y members
Compensation fOr disability
Regular retirement benefits
,
Other compensation (unemployment, VA, sick
leave, etc.)
48.
!'Iontl1l~y
11-9.
Honthly compensation for disability: $-----~­
earnlngs by pe.tient:
~; _________
Physical, Soclal, Family Functioning Levels:
SO~
Compared to bef,o:t;e you ~rere admitted to the
N.H.F.R.C·., how Hou:ld you describe your present
. level of
functioning?
imp~ovement·
1.
Great
2"
Saine i1npT·ove1nent
·3,
4.
,5.
51•
~hysicaL
No change
Some deterioration
Gre(;tt deter,ioratton'
How -v.re11 c.an you ce.re for your personal needs?
1.
2.
.3.
4.
5.
52.
Attends to all personal needs
Needs only minimal help
Partla,.l -self- care; feeds and dresses self
some
Needs help for a majority of personal care
activities
·
Nearly total, or total, dependence
HoN often do· you e.n~age .tn 'acti v:l. t:i.es outside
the home at·the present time?
1,
2.
3.
4.
5.
53.
'
'hLtce or more we~kly
Once weelcly
,Once monthly
Less than once a month
Never, or almost never
The actual limitations of
mi
impairment are
such tha.t:
1.
2.
3.
4.
5.
54.
It has not chang~d my former schedul~ of
going out
.
It has made going out somewhat more difficult, but I still go
It is much more d.ifficult but I ·go· anyway
It is so difficult for me that I rarely
go out anymore
I cannot go out at all anymore
How ofteri.did you engage in activities outside
of the home before yobr condition?
1.
;;:~,
J.
4.
5.
·5·5.
\~hat
Twice or more ·weekly
Once weekly
Once monthly
Less than once a month
Never 6r almost never
kinds of activities do you enga.ge ln ·
around the house. and would you describe these
as light. moderate or heQvy?
1•
2,
3.
56.
Housevrork
Yard wor1{
Hobhtes
Have these ehHn~:;ed slnce your stay in N.H.R.C.?
1, About th~ s~m~·
67
2.
J.
4.
·57.
Hm,r far do }rou 1'Jalk regularly?
1.
2.
3.
l.f,,
58.
More vigorbus
Less vi~orou~
Appreciably less
Less than 1 blo6k
1 block
2-J blocks
Appreciably 111ore
HoN do you fee.l about your impairment 11t1en you
go outside the home?
I
2.
I am always aware of it.
~.
s~
It bothers me somewhat
It really bothers me a lot
I bothers me so ffi'UCh that I rarely go out
Hm-1
well do you und.ersta.nd you:r condition?
1.
2.
I knNT quite a bit, but would lil<e to
J,
h.
n1ore
I know enough about it
I knmr something abou.t it
I know almost nothing about it
J.
59.
5.
60.
am hardly rn-ra.re of . 1 t
l,
I.know or understand
~ompletely
kno~r
it.J'hat equipment do you have and 1N·ho prescribed
it?
1,
' 2.
J,
4·.
61.
I~w
Respirator
Oxygen suppo:rt syst.em
Halkers,' or other a.ssistive devices
Other-------.... -..-.~--·-·-·---~----------~·-----~----often do you use the equipment prescribed
by N.H.R..C.?
·1.
2.
3.
......
?
6 "-'•
As prescribed
Less often
f!lore often
·---·-··-~--- x day
___________,x day
day
_________ )C
Do ybu understand aDd follow the training program prescribed for· you by. N.H.H.C.?
1.
2.
Understand and follm'r
Understand a.nd.don'·t fo1low
'68
-3.
Don't understand and follow
Don't understand and don't foilow·
''fant more "information
h.
5.
6J.
Do you smoke?
Less than ~- pack/day
~- -. 1 paclt/day
1 - -2 paclrs/day
Hore than 2 pacJ:s/day
1.
2.
J.
LL
64.
If so, how much?
If yes to #63, are you aware of the Smoke
Counseling Cllni cs? ------------·
65.
Would you attend such a clinic?
66.
Ffa,.J"e you even smoke(i?
If so, 1-i"hen did you qui't
.and how much did you smoke?
~ ·paclr,/ da.y
~ ·- 1 pack/day
Less :t:han
1•
2.-
J.
1 -· 2 packs/day
I',Iore than 2 packs/day
1~.
67.
The patient 1 s family lets hlm~ or herj do:
Prrictically everything that he can d~ for
himself
·Most things that he can do for him~elf
Some things that he ean do f.or hi-mself
Few things that he can do for himself
Practically nothing that he c~n rlo for him-,
self
1.
2.
J.
4.
5.
68.
The soc:lal relationships .of,the patient can
be described as:
· Extensl ve friendships
2. FFequent friendships
J, Some· friendships
L
I
+.
5.
69.
.
.
Fell friendships
Isole. ted except for tm.mediate family
Tho family's relationship may be described·as:
• .J
1.
2.
3.
4.
5.
Consistently positive
Usually positive
About half positive, half negative
Usual].y negative
Consistently negative
,.
69
70.
How actively helpful is the family of your
reha bl 1 i ta.tt on?
l.
2~
J.
4.
5.
71.
Highly contributory
Usually helpful
SbDetimes helpful
Often harmful
Highly detrimental
Patient's participa.tion ln family affai:i·s may
be descri.hed as:
H:Lghly pa.rtictpatory
Qui. te active
J, . Somewhat active
h. Quite passive
5. ·'Totally passive
1.
·2.
?i.
The. patient wahts to be:
l..
2.
J.
4,
5.
?3.
independ·e:nt as poss,i ble
Quite independent~
Half Jndependent. half dependent
Qul te ·dependent
Completely cared for .a.nd depend_e.nt '
As
Your present emotional 0utlook is:
1,
2.
·J.
LJ..
5.
Consistently positive.
Usually posi ti·~_~;e
Vacillates between.positive and negative
Usua.lly pessimistic and depressed
Consistently pessimistic and depressed