The mission of Burke Rehabilitation’s inpatient rehabilitation program is to provide the most comprehensive, patient centered and effective rehabilitation to maximize recovery from physical, cognitive and psychological impairments caused by conditions such as but not limited to: traumatic or acquired spinal cord dysfunction and neurological dysfunction, traumatic and acquired brain injuries, stroke, chronic and acute lung disease, cardiac dysfunction, amputation, and orthopedic dysfunction. The interdisciplinary teams on each program work collaboratively with patients and family/care givers to facilitate achievement of the best possible physical and mental recovery. Intensive rehabilitation is provided in a safe, secure and structured environment to allow the individual to reach his/her full potential and return to an active, productive lifestyle.
The rehabilitation team consists of the patient, his or her family and/or caregivers, and medical, nursing and other rehabilitation personnel who, by virtue of their education, training, and experience, are qualified to work with this patient population. The medical and rehabilitation professionals on the team are responsible for assessing the patient’s medical, behavioral and rehabilitation needs, establishing individualized goals in consultation with the individual and/or family/caregiver, designing and implementing a treatment program, assessing its outcome, communicating with the team and preparing the individual and family for the next phase in the rehabilitation process.
Scope of Services:
- Providing rehabilitation through an interdisciplinary approach that emphasizes communication, collaboration and cooperation.
- Maximize recovery from physical and psychological impairments resulting from one’s diagnosis.
- Maximizing one’s functional independence through functional retraining while focusing on the individual’s capabilities. This including training in compensatory strategies and use of devices.
- Providing the highest quality of patient focused rehabilitation
- Removing or lessening restrictions to participation in life situations to the extent possible.
- Preparing the individual, family and/or caregiver to make the transition to the next stage of the rehabilitation process.
Within the scope of the Brain Injury Program, patient evaluation and care planning are designed around the World Health Organization definitions. The model assesses levels of dysfunction which stem from the patients’ admitting diagnosis regarding impairments, activity limitations and participation restrictions.
Impairments: Weakening, damage, or deterioration of function within a specific component of the neurological system, as a result of injury or disease.
Examples: Decreases in strength, active range of motion, passive range of motion, cognition, impulse control, balance, and / or activity tolerance along with increases in pain.
Activity Limitations: The inability to perform a specific task as a consequence of the aforementioned impairments.
Examples: Difficulty with ambulation, stair negotiation, reading, eating or self-care.
Participation Restrictions: The cumulative effect of impairments and activity limitations on the ability of a person to participate in life roles.
Examples: Inability to perform duties as a parent, caregiver, employee or participant in social and leisure activities.
Cultural and religious needs are respected for each patient by the entire team. Accommodations to the patient’s schedule, dietary needs and requests, and the provision of appropriate equipment are provided to enhance the patient’s experience and support full participation in the rehabilitation program. All staff members participate in annual cultural diversity and sensitivity training. Patients’ preferences are shared throughout the team to ensure that patients receive individualized care.
Every potential patient who may benefit from our care is discussed with the screening staff, physician, and/or program director. The rehabilitation potential for every patient is evaluated prior to admission.
Admission Criteria for all inpatient programs includes the following:
- There is a reasonable expectation of measurable improvement that will be of practical value to the patient within a predictable and reasonable period of time.
- The patient must require and receive at least three hours a day of physical and/or occupational therapy, (or other skilled modalities including speech-language pathology, prosthetic or orthotic services), at least five times per week. (The patient must require at least two therapy modalities each day.)
- The patient’s plan of care is developed and managed by a coordinated multidisciplinary team including a physician, rehabilitation nurse, social worker, and a therapist.
- The rehabilitation is provided in an inpatient rehabilitation facility rather than a less intensive setting due to the following conditions:
- The patient requires 24-hour a day access to a registered nurse with specialized training in rehabilitation.
- The patient requires frequent evaluation by the rehabilitation physician to asses for changes in physical or medical status, and to direct the rehabilitation team.
- The rehabilitation services require such an intensity and frequency as to make it impractical for the patient to receive such services in a less intense alternative setting.
- Prognosis-Patient is expected to demonstrate the potential, from a medical standpoint as well as a rehabilitation standpoint, to improve functionally through exposure to the acute rehabilitation environment.
Referrals to Burke are usually made by physicians, social workers, discharge planners or case managers. A reasonable medical and functional profile must be provided and appropriate sections of the medical record from the acute care process are included. A rehabilitation nurse may also perform a detailed evaluation at the referring institution. Recommendations are then made to the appropriate member of the medical staff who renders a final decision with regard to admission.
- The Amputee Program serves patient populations from adolescence through geriatric.
- Diagnoses of patients served include Above Knee Amputations (bilateral and unilateral)
- Below Knee Amputations (bilateral and unilateral)
- Toe Amputations
Brain Injury Program:
Candidates for admission include patients who have suffered a traumatic or non-traumatic brain injury. Individuals with a brain injury who would not be appropriate for admission include:
- Patients who are in a coma or vegetative state
- Patients who require ventilator support
- Patients requiring dialysis
Patients who present with chronic and/or acute lung or heart disease; patients a diagnosis of general medical debility.
Diagnoses for admission include but are not limited to:
- COPD: emphysema, bronchitis, asthma, bronchiectasis
- Idiopathic Pulmonary Fibrosis
- Restrictive Lung Diseases
- Post-operative Thoracotomy: s/p Pneumonectomy, Lobectomy or wedge resection.
- Status Post Lung Volume Reduction Surgery
- Congestive Heart Failure
- Status Post Coronary Artery Bypass Graft
- Status Post Valve Replacement (mitral, aortic)
- Medical debility
- S/P lung transplant
- S/P heart transplant
- S/P renal transplant
- S/P Left Ventricular Assist Device placement
Patients who are not appropriate for admission include:
- Patients who require 24-hour mechanical ventilation
- Patients with unstable cardiac disease
Patients with physician-diagnosed diseases such as multiple sclerosis, Parkinson’s disease, Guillian-Barre syndrome, myasthenia gravis, etc. may be candidates for admission for rehabilitation if:
- Patients have residual deficits such as weakness, incoordination, spasticity, dysphasia, dysarthria, sensory loss, perceptual problems, bowel and bladder problems resulting in functional limitations restriction life roles
- Patients with chronic diseases where there has been incomplete or no rehabilitation in the past.
- Recent episode of the chronic disease which has lowered functional capacity.
- There are medical issues needing periodic reevaluation and other persistent neurological deficits which may require reevaluation and/or treatment by an interdisciplinary team.
Candidates for admission include the following:
- The Orthopedic Program serves patient populations from adolescence through geriatric. Diagnoses of patients served include:
- Unilateral and Bilateral Total Joint Arthroplasty,
- Uni-compartmental Knee Replacement and Hip Resurfacing,
- Lower Extremity Fracture with or without Fixation,
- Multiple Trauma
- Spinal Surgery
Diagnoses for admission include, but are not limited to:
- Traumatic spinal cord injury
- Non-traumatic spinal cord injury such as aneurysm dissection with spinal cord infarction
- Transverse myelitis of any etiology
- Spinal tumors
- Disease processes effecting the central and/or peripheral nervous system.
Additionally, the following is a brief, but not inclusive, list of admission criteria:
- The patient is not in danger to him/herself or other patients on the unit.
- Individuals presenting with chronic spinal cord injury with recent changes in medical or functional status requiring reevaluation or treatment by an interdisciplinary team.
Candidates for admission include the following:
- Primary diagnosis of stroke, subarachnoid hemorrhage, intracerebral hemorrhage, subdural hematoma and resection of meningioma
Additionally, the following is a brief but not inclusive list of admission criteria:
- Prior to onset of diagnosis, patient was independent in ambulation and activities of daily living
- Onset of stroke is within 6 weeks of screening
- Patient is not receiving Haldol, Mellaril or any anti-psychotic medication. Ant-depressant therapy is accepted. Patient is not a suicidal risk.
- Will accept patients with feeding tubes, IV antibiotics and oxygen.
- Patients who have had removal of benign/malignant brain tumors, who are currently not undergoing chemotherapy or radiation therapy.
- Patients who have residual weakness, incoordination, spasticity, dysphagia, dysarthria, sensory loss or perceptual problems.
- Patient demonstrates ability to interact with nursing staff and therapists.
Patients not appropriate for admission include:
- Patient receiving Haldol, Mellaril or any anti-psychotic medication. Ant-depressant therapy is accepted.
- Patient is a potential suicide risk.
The discharge planning process begins when the patient is first admitted to the program. The social worker/case manager leads the planning process, coordinating information from all members of the interdisciplinary team, the patient, and the caregivers/family. Based on the individual’s functional status, family support, pre-morbid living situation and level of function, and available resources (i.e. health insurance), the team makes recommendations for the most appropriate and suitable discharge plan for the patient. At the team or family’s request, a formal meeting with the team and patient/family is scheduled to discuss appropriate options. A safe discharge is a primary consideration when options are considered.
Patients are discharged from the inpatient rehabilitation programs, when any of the following occur:
- The patient has achieved maximal levels of functional improvement, or has gained the ability to independently direct his or her own care.
- The patient demonstrates ambulation/mobility, self-care and cognitive skills that meet the patient’s needs and allow for a safe discharge to that patient’s next stage in the rehabilitation process.
- The patient shows no functional improvement despite alteration of treatment techniques.
- The patient is discharged to an acute care hospital for medical reasons
- The patient is unable to participate in treatment due to medical, psychological, or cognitive reasons.
Recommendations for discharge may include:
- Home with home care services
- Home with outpatient services
- Sub-acute rehabilitation services
- Long term care services
- Hospice level care
The social worker/case manager assumes a leadership role in planning and preparing for the individual’s discharge from the inpatient program. This planning and preparation begins when the individual is admitted to the inpatient program, continues during the inpatient stay and culminates when the team determines that the individual is ready to move to the next step in the rehabilitation process. A formal meeting with the family or caregiver(s) and the rehabilitation team is scheduled when appropriate and communication with the family or caregiver(s) occurs throughout the duration of the individual’s stay at Burke. The social worker/case manager is also responsible for communicating with the school for adolescents when necessary to address the patient’s educational needs. Neuropsychology performs neuro-psychological testing to facilitate return to school or academic supports.
At the time of discharge, the patient is provided with a summary of all recommendation for continued care and follow-up services including, but not limited to therapy services, assistance required, medical appointments, summary of applications for transportation or parking permits, etc.
In 2019, the inpatient programs discharged 2,894 patients. Discharged patients went to the following environments:
- 67% (1,953) of the patients returned home to the community.
- 20% (579) of the patients continued therapy at a subacute rehabilitation facility.
- 12% (530) of the patients returned to the acute care hospital.
- 0% of the patients entered a long term care facility.
The age range of the patients treated in the inpatient programs in 2019 was 14 to 101. The average age of the patients was 70.
Three adolescent patients were treated on the inpatient program in 2018 and 2019.
In order to ascertain the long-term outcome for the individual, Burke contracts with a company to conduct follow-up interviews via phone at 3-months post-discharge.
Three months post-discharge from Burke in 2019, the patients experienced the following outcomes:
- Percent of patients living in the community: 91%
- Percent of patients who were overall satisfied with community participation, quality of life and goal attainment 3 months after discharge from Burke: 84%
- Percent of patients that reported being the "same or better" 3 months after discharge from Burke: 90%
In-Patient Rehabilitation Team Description
The philosophy of the inpatient programs is that the program’s mission can best be accomplished by providing rehabilitative care through an interdisciplinary team approach.
The team consists of the following:
- The patient
- Patient’s family and/or caregiver(s)
- Rehabilitation Nursing
- Speech and Language Therapy
- Occupational Therapy
- Physical Therapy
- Recreation Therapy
- Social Work/Case Management
- Respiratory Therapy
Additional services available to meet the needs of each individual patient include:
- Medical consultations (Podiatry, Urology, Plastics, ENT, Dermatology, etc.)
- Spiritual Services
- Orthotic/Prosthetic Services
- Laboratory Services
- Complimentary Therapy
- Wheelchair seating/positioning
- Peer support
From admission through the discharge planning process, team members work collaboratively with each other, the patient and the family and/or caregiver(s) to ensure that the specific needs of each individual are addressed. Patient and family and/or caregiver involvement and participation is strongly encouraged throughout the entire rehabilitation process.
Based on the results of the initial assessment, goals are determined with the individual and/or family, and a treatment plan is implemented. The individual’s progress is discussed formally once per week at team conference/medical rounds. Team consultation and collaboration occur throughout the treatment program. In addition to speaking directly with members of the team regarding the patient’s medical condition, progress, functional status, participation in therapy, achievement of established goals, family members and/or caregivers are strongly encouraged to attend and participate in treatment sessions and patient care as appropriate.
The Burke Inpatient Rehabilitation Programs Offer:
As the leader of the interdisciplinary team, the physicians are responsible for directing the medical care of the individual and monitoring the overall team process and outcome. At Burke, a physician is available 24 hours a day, seven days a week. The medical staff create a plan of medical care to address the primary medical/physiological needs and changes associated with various diagnoses.
The Burke Rehabilitation Hospital has long recognized that coping with a life changing illness or injury is difficult for patients and families. Burke’s clinical neuropsychologist, Dr. Julieanne Shulman, Psy.D., a specialist in the evaluation and treatment of brain-behavior relationships, works with patients to monitor recovery progress and develop treatment goals and objectives. Dr. Shulman assists in communicating with the team as well as psychiatry as needed to ensure the needs of individuals with pre-morbid behavioral health needs and/or history of substance use are being met after injury and during their inpatient stay.
Occupational therapists assist patients in becoming as independent as possible with daily activities, including dressing, bathing, personal hygiene, feeding, getting around in the home and community, pursuing household, work related or leisure activities, and all other activities that occupy one’s day. Following a thorough and comprehensive evaluation, the occupational therapist design an individualized treatment program tailored to address each patient’s individual needs.
Occupational therapists are responsible for teaching patients the skills necessary for wheelchair mobility as well as determining the appropriate equipment for each patient (e.g. wheelchair, bathroom equipment, adaptive equipment, assistive technology). In addition, occupational therapists evaluate visual skills, perception skills, and cognitive skills related to functional activities. Occupational therapists complete home evaluation assessments, community skills evaluations, and wheelchair seating recommendations during the length of stay to help facilitate a home discharge as appropriate. Education for vocational training and driving are available.
The Occupational Therapy team assists patients and family members and/or caregivers in learning how to do familiar tasks in a new way, and help to make the transition to home and into the community as smooth as possible.
Physical therapists assist patients in becoming as functionally independent and maximize recovery following trauma or illness. Physical therapy may consist of muscle strengthening, endurance training, breathing retraining and pulmonary hygiene interventions, improving flexibility, balance training, and functional mobility skills training. Functional mobility skills training includes getting in and out of bed, transferring to and from a wheelchair, mat, and bed, walking and going up and down stairs (as appropriate). Following a thorough and comprehensive evaluation, the physical therapist designs an individualized treatment program tailored to address each patient’s individual needs.
Speech-language pathologists evaluate and treat adults with communication disorders, such as speech, language, voice and cognitive difficulties, and swallowing disorders. Patients are evaluated by a speech-language pathologist when it is recommended by the team. Following a thorough and comprehensive evaluation, the speech-language pathologist determines appropriate therapeutic interventions, and work with patients to help regain communication skills as well as assisting patients with swallowing disorders to safely drink liquids and eat foods.
Rehabilitation nursing is a specialty of professional nursing and is available at Burke Rehabilitation Hospital 24 hours a day, seven days a week. Nurses at Burke function as care coordinators as they work with patients, family members and/or caregivers and as part of the rehabilitation team to solve problems and promote each patient’s maximum independence. The nursing team consists of a nurse manager, registered nurses, rehabilitation technicians, nursing assistants, and nursing attendants. Throughout a patient’s stay, the nursing team provides education to the patient, family and/or caregiver, administer medications and assist with personal care needs.
Social Work/Case Management
The social worker/case manager assumes a leadership role in planning and preparing for the individual’s discharge from the inpatient program. Social workers/case managers help patients and family members deal with social, financial, and emotional aspects of the patient’s condition. This planning and preparation begins when the individual is admitted to the inpatient program, continues during the inpatient stay and culminates when the team determines that the individual is ready to move to the next step in the rehabilitation process. The social worker/case manager is also responsible for arranging for individual tutoring for adolescents when necessary to address the patient’s educational needs. In addition, social workers assist individuals in completing documentation (i.e. employment, insurance, and transportation) that may be necessary for long-term support in the community as well as providing education for hiring personal care assistants as needed post discharge. Social workers organize formal meetings with the family or caregiver(s) when appropriate and communicate with the family or caregiver(s) throughout the duration of the individual’s stay at Burke. In addition, social workers/case managers serve as hospital liaisons with the patient’s insurance case manager.
Recreation therapists use a wide range of interventions to help patients make improvements in the physical, cognitive, emotional, social, and leisure areas of their lives. They assist patients develop skills, knowledge and behaviors for daily living and community involvement. Recreation therapists work with the patient to incorporate specific interests into therapy to achieve optimal outcomes that transfer to real life situations. Research supports the concept that people with satisfying lifestyles will be happier and healthier.
Recreation therapy interventions for patients include individualized therapy sessions, humor therapy, relaxation therapy, adapted leisure and sports activities, and complementary therapy. Computers, games, crafts, adapted sports, and other activities are incorporated. Leisure education and leisure resources are offered, in addition to entertainment and social programs.
A registered dietitian visits patients in need of assistance in understanding their dietary modifications or other nutritional concerns in order to provide patients and family members with the knowledge and skills to make informed choices about healthful diets.
Hospital chaplains representing the Jewish, Catholic, and Protestant faiths are available to visit patients and families. Chaplains offer spiritual services and provide for various religious needs. Patients may arrange for visits from clergy from other religious traditions. Holiday services for various faiths are held.
The chaplains respect each patient’s personal beliefs and individual ideas. The goal of the Spiritual Services Department is to help renew each patient’s sense of hope and offer a spiritual home away from home.
Use of Technology
- RTI FES Bike (RT300, 200)
- Bioness H200
- Bioness L300+ and L300Go
- Rex Robot
- Zero G Lite
- Restorative Therapies Xcite
- Saebo- glove, MAS, myotrac and micro stim
- Tecla Shield
- Rifton Tram Lift
The inpatient programs are actively involved in performance improvement initiatives. As part of the hospital’s strategic plan, the goals of collecting and analyzing data on a continuous basis include:
- Improve operational efficiency in caring for patients with diagnoses consistent with the program.
- Establish an optimal model for patient centered, cost effective, interdisciplinary rehabilitation care of the patient.
- Develop a data collection system to document and provide information to monitor and evaluate the clinical effectiveness of the program;
- Utilize outcome information to establish standardization of care and evaluation guidelines.
Outcomes that will be measured will address effectiveness, efficiency, access and satisfaction. They include:
- Discharge disposition
- Achievement of GG Scores for mobility and self-care tasks
- Compliance with the “Three Hour Rule”
- Percent of patients screened versus patients admitted
- Patient satisfaction
- Length of stay
- Acute care transfers
Additional outcomes measured include:
Patient and Family/Caregiver
Ongoing education of the rehabilitation patient and the family and/or caregiver is essential in order to maximize recovery from the physical, cognitive and psychological impairments caused by the rehabilitation diagnosis and effectively prepare the individual and family and/or caregiver for the transition to home or the next stage in the rehabilitation process.
Individuals admitted to the inpatient programs will receive ongoing education from each discipline throughout his/her stay in order to maximize achievement of each individual’s goals. Coping, resources, and the need for lifelong follow up to deal with changing needs are provided.
Family members and/or caregivers are encouraged to attend and participate in treatment sessions and patient care activities as appropriate. Providing education and training for the family and/or caregivers is an essential component of the patient’s rehabilitation stay and provides an opportunity to successfully transition the patient to the next phase of rehabilitation.
Resources continue to be available post discharge including a variety of monthly support group held at Burke and ongoing recreation, leisure, and education programs are offered at Burke for individuals to participate in.
In house education via in services provided by Burke staff, research staff, as well as outside speakers, including vendors, is provided to team members.
Team members are supported in attending professional conferences, continuing education courses and seminars throughout the year. Clinical learning workshops that address current trends in the treatment of diagnoses/impairments specific to the programs are provided regularly.
The program’s goal is to provide evidence-based, state of the art treatment. All staff education initiatives and opportunities will attempt to support this goal. Opportunities are available for education for advanced degrees and clinical specialty certifications.
Participation in research initiatives and presentations of poster/platform presentations at seminars and conferences is encouraged and embraced by team members.
Education of the healthcare professional community in the area of spinal cord injury, BI, Cardiopulmonary, Orthopedic/amputee and Stroke is a priority to team members. The Burke team provide numerous educational opportunities every year by offering observations for future students in the field of healthcare, serving as clinical instructors at academic institutions, and hosting student internships for physical therapy, occupational therapy, speech therapy, and social work/case management. Team members have provided in-service training to other institutions with emphasis on the treatment and care for individuals post spinal cord injury or other neurologic diseases, Cardiopulmonary Dysfunction, Stroke, etc. to improve the care that individuals receive across the spectrum of healthcare.
All appropriate information will be maintained in each patient’s Electronic Medical Record (EMR) for the duration of the patient’s stay. All other documents will be maintained in the patient’s medical chart. At discharge, these documents will be scanned to be included as part of the patient’s EMR.
Each discipline will be responsible for completing all appropriate documentation and abiding by timeframes established by the hospital.
Discipline specific documentation requirements include:
Pre-admission screening information
- Admission screens
- Initial evaluations
- Daily charting
- Discharge evaluations
- Equipment request/justification forms
Patient Financial Services/Fees
Burke’s patient account representatives can answer any questions about insurance coverage, expenses and hospital charges. Once a patient has been medically accepted to a Burke program and insurance benefits have been verified, a patient can be admitted to Burke. Upon discharge, a bill for physicians’ and hospital services will be sent to the patient or the patient’s insurance carrier. If there are other fees that are not covered by an insurance company for items such as medications and supplies, a bill will be sent to the responsible party for direct payment to the hospital. In order to understand what, if any, services are not covered by the patient’s insurance carrier, the Burke Business Office can be contacted for additional information. An inpatient representative may be reached at (914) 597-2329.
If the patient does not have health insurance, or has limited coverage, Burke may be able to help. Burke staff is trained to assist patients in identifying options for paying their medical bills. Burke provides financial aid to patients based on their income, assets and needs. If necessary, Burke will assist the patient, family member, etc. with applying for Medicaid or help to arrange a manageable payment plan. Burke will work with the patient, family member, etc. to determine if the patient is eligible for any of the following payment programs and will help with the completion of the application process:
- Government sponsored programs like Medicaid
- Hospital-Sponsored Financial Assistance
- State Assistance Programs
- Charity Care
- No Interest Payment Plans
Insurance and Managed Care
Burke Rehabilitation Hospital is currently contracted with numerous health care organizations. A partial list is below:
- Blue Cross Pathway
- CIGNA HealthCare
- ConnectiCare, Inc.
- EmblemHealth (HIP/GHI)
- Empire Blue Cross/Blue Shield
- First Health
- Health Republic
- Hudson Health Plan/MVP
- Local 1199
- Magna Care
- Multiplan Multiplan/PHCS
- United Healthcare
Insurance carriers offer multiple insurance plans with differing coverage levels. It is important to check whether Burke’s rehabilitation programs and services are included in the patient’s insurance plan’s covered medical benefits. Also, it is common for insurance plans to carry deductible and co-insurance obligations which are the financial responsibility of the patient. Financial representatives from Burke are available to assist in determining whether our rehabilitation services are covered by the patient’s insurance plan and in calculating the patient’s personal financial obligations as a result of the deductible and co-insurance terms of the insurance plan. The Financial Assistance Office can be contacted at (914) 597-2329 between the hours of 9:00 AM and 4:00 PM, Monday through Friday.
Hospitals are required by law to make available information about their standard charges for the items and services they provide. Burke’s standard charges are:
Service Description Standard Gross Charge
Inpatient Semi Private Room & Board $1,900 per day
During the inpatient stay at Burke, in addition to being charged a daily room & board rate, the patient will also be charged for physician services received, along with any physical, occupational, or speech therapy and pharmacy prescriptions ordered by the physician. These additional charges vary according to treatment plans associated with a patient’s diagnosis. Charges for all inpatient services at Burke will be included on one all-inclusive bill generated by Burke. The patient will not be billed separately by any third party provider.
For inpatient services, financial representatives from Burke are available to assist in determining gross charges for the patient’s particular diagnosis between the hours of 9:00 AM and 4:00 pm, Monday through Friday. For questions concerning inpatient services, the Financial Assistance Office can be contacted at (914) 597-2329.