Spaulding Cape Cod's Direct Admission Program Fills Gap in Care

The Direct Admission Program (DAP) at Spaulding Rehabilitation Hospital Cape Cod is an innovative approach to two critical needs:  helping at-risk seniors remain in their homes, and reducing preventable hospital readmissions. 

Spaulding Cape Cod’s DAP allows patients who meet certain criteria access to advanced inpatient rehabilitation from home, from the emergency room, and from skilled nursing facilities – without the prior three-day hospital stay required by Medicare. DAP is designed to help those who are in a medical and/or functional decline due to a known cause or diagnosis but who are not sick enough to qualify for acute hospitalization nor admission to a nursing home. 

“With DAP we can intervene with medical and rehabilitation care at what is often a critical juncture,” says David M. Lowell, MD, Chief Medical Officer at SCC. “Our goal is to stabilize and improve the patient’s medical condition and strengthen the patient so that he or she can continue to live safely at home – before a serious or catastrophic event occurs.”

Often the patient’s functional decline is complicated by issues with anti-coagulation, high blood pressure or diabetes medications, urinary tract infections, and swallowing problems. “These patients need the close medical oversight and nursing care that we provide in the rehab hospital setting,” explains Dr. Lowell. 

Persons admitted to DAP must meet Medicare’s requirements for medical necessity in a rehabilitation hospital, including: the expectation for measurable progress towards practical, functional goals; a need for nursing care and frequent physician visits; and the patient must be able and willing to engage in intensive rehabilitation, usually three hours a day. 

“We can begin therapy at the bedside and spread it out over the day for patients who are very weak or sick,” says Daina Juhansoo, DPT, Director of Inpatient Rehabilitation. Therapy focuses on skills that help the patient function safely at home, such as walking, balance, transfers, toileting and swallowing. “For example, building strength, flexibility and balance reduces the risk for falls, one of the biggest triggers for disability among seniors,” says Daina. Falls are also a common reason a patient may be readmitted to the acute care hospital. 

Education is a critical aspect of DAP. “Our nurses educate on the proper use of medications, on managing diabetes, high blood pressure and other diseases,” says Martha Hunter, BSN, MBA, SCC Nursing Director.  They also teach the family to recognize early signs of problems so that issues can be addressed promptly to avoid a crisis. 

Today, DAP is playing an increasingly important role in the continuum of care. “The patient who goes through intensive rehab and whose medical needs are carefully managed is less likely to land back in the hospital due to something preventable,” says Dr. Lowell. DAP has also helped address caregiver burnout. While the patient is at SCC, the care partner can connect with community resources and arrange for home modifications to make a safer environment. 

 “Though necessary at times, hospitalization is stressful, expensive and disruptive to families,” says Anne Walker, Director of Admissions and Referral Relations for SCC. “If we can get the patient stronger without an acute hospitalization, that benefits the patient and our health care system.” She further notes that DAP promotes collaboration among hospitals, primary care physicians, home care agencies and others, working against a siloed approach to care.    

SCC nurse liaisons screen patients for DAP. A home evaluation or visit to an SCC physician can be arranged when necessary. For more information about Spaulding’s Direct Admission Program, please call Admissions at 508-833-4200 or visit www.spauldingrehab.org – search Direct Admission Program.

DAP Can Help Patients With:
- Parkinson’s disease, movement disorders
- Recent stroke with decline in function
- Gait disorders due to a known cause
- Recurring falls due to a known cause
- Brain or spinal cord injury with a need for training in specific skills
- Spasticity
- Multiple Sclerosis
- Others considered on case-by-case basis