Rehabilitation centers nationwide are finding that a piece of the real world can help improve clinical outcomes, attract new staff and help promote their facilities.
The real-life rehabilitation program Easy Street Environments is intended to "teach patients needing therapy how to deal with physical challenges when they leave the hospital," said Reginald Ballantyne, president of Phoenix-based PMH Health Resources, which owns Easy Street.
The project originated in 1985 at PMH's Phoenix Memorial Hospital when an occupational therapist wanted more realistic-and less clinical-settings for rehabilitation patients. It began with some basics, such as a telephone booth, and soon expanded into a neighborhood-
like setting featuring simulated automobiles, stores and a movie theater.
Two years later, PMH hired Scottsdale, Ariz.-based HSM Group to market Easy Street Environments to rehabilitation facilities and hospitals outside Phoenix.
In July 1987, DCH Rehab Pavilion in Tuscaloosa, Ala., was the first institution after PMH to have Easy Street installed.
There are now 64 Easy Street settings in North America. Every facility is approached as a custom design, said Anne-Marie Nelson, vice president of the HSM Group. Working with an average area of 1,400 to 1,500 square feet, Easy Street's construction company, Habitat, collaborates with the clinical staff to choose "modules," or areas of activity, to meet the facility's needs, she said. Fourteen modules are available, ranging from a laundry room to a restaurant.
Scott Hopman, vice president of Tempe, Ariz.-based Habitat, said some of the most common modules are markets and cars. Adult living environments, such as bedrooms, help patients make the transition back to home life. Habitat, which also works for Marriott Corp. and Walt Disney Co., constructs futuristic, Disney World-like settings.
True to life. In an effort to maintain realism, the centers include sound effects and natural lighting to simulate day and night. Plastic aqua-weights are injected into fruits in the marketplace to give them real weight when patients pick them up, said Mr. Hopman.
Once hospitals or rehabilitation centers are able to clear space for the modules they have chosen, Habitat begins construction. The Boulder, Colo.-based Mapleton Center for Rehabilitation spent a year negotiating with its administration and another year planning its 3,500-square-foot facility, which is equipped with all 14 modules, said Colleen Grady-Yuskewich, director of occupational therapy.
The average cost of installing Easy Street is about $250,000, but the cost varies depending on the number of modules and the size of the space, said HSM's Ms. Nelson. However, some hospitals have found they can recoup part of the cost through fund raising.
Cambridge, Mass.-based Youville Hospital and Rehabilitation Center spent $500,000 to install a 14-module Easy Street. Combining its therapy center with the new environment, Youville was able to update its program and improve the aesthetic appeal of its traditional facility. "I was astounded at the excellence of the process," said Martha Bertrand, director of the Saint Marguerite D'Youville Foundation.
Youville found the marriage between traditional rehabilitation and the Easy Street program to be clinically effective as well. According to Medical Administrator Melvyn Hecht, M.D., 68% of patients in the rehabilitation program use Easy Street. They spend about 5% to 10% of their time on Easy Street and the rest in traditional rehabilitation. A patient spends about half an hour on Easy Street per session, Dr. Hecht said.
Old meets new. Kevin DeBraal, director of physical therapy at Crown Point, Ind.-based St. Anthony Medical Center, sees Easy Street as a tool that can be integrated in traditional therapy.
As part of a community re-entrance program, St. Anthony's patients are taken from the medical center into town to practice their skills, a process that is sometimes embarrassing for patients in early stages of their rehabilitation, Mr. DeBraal said. Now, patients can practice their skills on Easy Street.
At Mid Michigan Regional Medical Center in Midland, patients ranging from acute care to mental health make use of Easy Street, said Pam Gifford, coordinator of the medical center's rehabilitation program. Easy Street is even used by the center's speech therapists, who conduct activities in hotel or restaurant modules, surroundings seen as less threatening than an office.
Staying focused. Much of Easy Street's clinical success is attributed to the motivation and incentive it gives patients in therapy. Instead of lifting weights to recover from a shoulder injury, a patient may be asked to go to the Easy Street grocery store and lift certain items off the shelves. "They see the reason for the exercise. It keeps them focused," Mr. DeBraal said.
Beyond its clinical benefits, Easy Street also has proved to be an effective marketing and business tool, giving some rehabilitation centers a competitive edge. While medical centers may initially be deterred by Easy Street's cost, most are able to raise funds for the project outside of their capital budgets, Ms. Nelson said.
Fun fund raising. "This was one of the more fun and easy fund-raisers we've done," said Mapleton's Ms. Grady-Yuskewich. By placing the names of donors on bricks (for $100), stars (for $500) and signs (for $1,000), along with taking contributions from individuals and businesses, Mapleton Center for Rehabilitation raised $325,000, the complete cost of its Easy Street facility.
"People are really drawn to it. We've had squeals of delight when people come to see it," said Youville's Ms. Bertrand. She credits corporate visibility for bringing in enough sponsors to underwrite half the $500,000 price tag. Youville Hospital also received $50,000 in free advertising from the Boston Globe. "They were impressed that the facility can make such a difference," she said.
At Wichita, Kan.-based St. Joseph Medical Center, the restaurant module was transformed into a Pizza Hut in return for a $25,000 donation. Hospital employees also contributed through payroll deductions, said Phil Murray, rehabilitation manager at the facility.
Recruiting tool. Several hospitals also noted the advantage of Easy Street in attracting rehabilitation staff. "It has been a very exciting recruiting tool," said Youville's Dr. Hecht, noting the challenge of finding therapists in today's market.
While Easy Street alone may not always draw new therapists, it can reflect a medical center's serious interest in innovative rehabilitation. "When all rehabilitation programs look the same, Easy Street shows there is a commitment to rehab at that facility," said Ms. Gifford of Mid Michigan.
Easy Street also provides managed-care groups with tangible results to evaluate. "With today's emphasis on functional outcomes, Easy Street allows a realistic measure of clinical progress," said PMH's Mr. Ballantyne. A therapist could determine the necessary duration of a patient's stay by observing how much the person can do in a real-world setting.
Dr. Hecht said Youville was able to negotiate additional HMO contracts after the groups toured the facility.
While it may be difficult to measure Easy Street's effects on decreasing the length of hospitalization, some directors believe it does help speed patient discharge. "It saves start-up time to get people back out into the community," said Laurie Labarca, St. Joseph's director of rehabilitation. Easy Street provides a more secure environment for patients to attempt daily tasks. This helps those who may be less willing to leave the hospital, and more likely to prolong their stay, to move back into the community. The type of social skills and abilities Easy Street fosters also help to deter post-discharge problems such as depression, Ms. Labarca said.
Staying on top. Easy Street has even helped some medical centers stay ahead in their field. When St. Joseph Medical Center first opened in Wichita, there was no competition in the area of rehabilitation. Several years later, two centers joined the race for rehabilitation patients. Much to their surprise, St. Joseph did not experience any loss. "We have maintained our market share extremely well. We actually have grown," said Mr. Murray.
While many factors played into the center's success, Mr. Murray acknowledges that Easy Street did help the center maintain an edge.
Some hospitals also have found Easy Street an effective means to increase awareness of physical disabilities within the community. At Mid Michigan, business leaders taking part in the "Leadership Midland" conference were taken through Easy Street in order to understand the obstacles faced by injured or disabled workers, said Ms. Gifford.
At La Grange (Ill.) Memorial Health Systems, grade-school children are taken on tours through Easy Street to learn about therapy.
Because of the relative newness of Easy Street, rehabilitation facilities are still learning how to best utilize it.
Youville has set up a team to evaluate its therapy program. "We want to reassure patients they get the rehab they expect by learning how to maximize its effectiveness," said Dr. Hecht.
HSM has designed a patient opinion monitor, an automated push-button survey to measure patient satisfaction. The marketer also held a forum last February for owners to discuss new utilization techniques.
The latest addition to the Easy Street project is a smaller version called "First Place." With five modules in 600 square feet, First Place costs around $150,000 and is a more realistic option for facilities with less space and a smaller budget.
As for the future, HSM plans to extend its market from solely acute-care to long-term-care facilities. Like the integration process taking place in healthcare, Easy Street also hopes to provide one multipurpose setting for various types of therapy, rehabilitation and medical care.