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The selection of rehabilitation centers.

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The Selection of Rehabilitation Centers
HYSICIANS and their paramedical colleagues are becoming increasinglj
concerned about finding suitable rehabilitation facilities for their patients
The question is frequently asked “why are there so many different kinds
of places for rehabilitating the patient with disabilities?” The reason for
this question is the confusion that exists regarding the nature of the rather
wide variety of centers at which rehabilitation programs are being carried out.
It is a justifiable question when we recognize that there are at least nine different types of centers described by Redkey.’ These include ( a ) treatment
centers; ( b ) medical rehabilitaticn centers; ( c ) state vocational rehabilitation
centers; ( d ) sheltered shops; ( e ) single disability centers; ( f ) community-typ?
centers; ( g ) insurance co. centers; ( h ) workmen’s compensation centers and
( i ) speech and hearing centers.
The practitioner who is dealing primarily with patients suffering disabilities
as the aftermath of rheumatic disease is not likely to be equally interested in
all these various types of facilities. However, if he is to make the best use of
local facilities it would seem highly desirable that we have a clear understanding of what we can expect from the various types of centers we do use.
To this end, Redkey’s basic report “Rehabilitation Centers Today”2 has been
reviewed and treated in a somewhat different fashion from the original form
in order to compare certain aspects of one type of center with that of another.
Thus, the results may be helpful in aiding clinicians and others to understand
the particular values m each type of rehabilitation center services.
In his basic study: out of an estimated 100 centers, Redkey succeeded in
getting reports from 77 centers, of which 65 were ultimately used. The data
was obtained only through 1956. There are undoubtedly more centers today.
However, his data has been broken down into the several categories described
by him in his earlier report1 in order to see something of how these different
types of centers operate.
It was soon recognized that the majority of centers reporting (82.7per cent)
consisted of only three types, the treatment center, the medical rehabilitation
center and the community-type centers. Since these are the most universal
form currently in operation, the balance of this report will be limited to comparative data on just these three categories. These three categories of centers
are defined as Redkeyl has suggested. (Underlining is our own.)
The Treatment Center
These are usually very small . . most often have a narrow range of services. They
frequently begin with only physical therapy and occupational therapy services, do not
have a medical director and do work on the prescription of the referring physician only
From the Department of Medical Care, the National Foundation, New York, N . Y.
They tend t o limit their work to orthopedic cases. They are relatively inexpensive, limited
to outpatients and usually operated by nonprofit corporations established for the purpose . . . They frequently come into being becausc? physical medicine services in community hospitals are undeveloped
The Medical Rehabilitation Center
. . . of more reoent origin . . . an expression of the insreasing medical imr~ortrmceattrihzcted to the new medical specialty of physical medicine and rehabilitation. Because of
th-ir setting in a hospital or a medical school, they emphrisize very early introduction of
rehabilitation procedures in medical care. Some of them hsve developed unusually good
facilities for diagnosis and may engage in training programs. Their greatest contribution
has been im physical t%~~totation, . . thus far, as a class, been slow to serve extensively
the tuberculous, cardiacs, epileptics or the mentally retarded
. . . for
the most part
[they hace] only slowly introduced psychological and social smvices, o f t m not on n concentrated basis. Their contribution in the way of vocational services, with one or two
exceptiony, lzas been insignificant . . . Idtie to1 greater interest in the meclical side of
rehabilitation and their tendency t o think of rehabilitation as a medical specialty rather
than as a long process.
The Community Center
These are of several varieties; many have developed out of more limited treatment
centers, and most offer a fairly wide range of services. They are operated by nonprofit
corporations and are notable for flexibility in planning and increasing attentim to psychological, social and to some extent, vocational programs. They are often outpatient
centers, although a number have beds and others are adding them.
Keeping Redkey’s definitive statements in mind, let use examine briefly the
comparative data on some of the aspects of these three types of centers based
on the Redkey data.
A study of the findings strongly suggests that in most areas of service the
medical rehabilitation centers and the community rehabilitation centers offer
a great deal more service to the patient than the treatment center is likely to
have available. However, few if any of these types of centers offer adequate
psychiatric screening or therapy. It would seem logical, therefore, to deduce
that treatment centers should be reserved for those patients with minimal
needs for anything other than physical therapy, occupational therapy, psychological services and social work.
There is also strong evidence of a very heavy preponderance of physical
therapy and occupational therapy services in the treatment center while the
medical rehabilitation center is more likely to have its greatest professional
personnel assigned to the total medical care program. The discrepancies are
often emphasized further when one realizes that many of the treatment centers have no medical personnel, no nursing staff, no psychological services.
This is far less true of the medical rehabilitation centers and the community
rehabilitation centers.
All three types of centers carry heavv loadings of patients in the three major
areas of patient care, and the task is to select the type of center that is most
likely to render maximum service to the patient. One way one may arrive at
a decision regarding the selection of the most suitable type of center would
be to weigh the extent to which each type of center offers the broadest service program and the relative cost of such services per patient treated.
It is necessary to recognize that functionally these centers differ from one
another with reference to the type of patient that i s served in each. Treatment
centers serve outpatients predominantly. Only two of the nine treatment centers reported in the Redkey study served any inpatients whatever. Actually,
in the nine centers a grand total of 5317 patients were served in a year, only
7 per cent of whom were treated on an inpatient basis. The per patient cost
a5 based upon the total number of patients served and the estimated annual
budget reveals great variation with a range of $57.40 to $551.16,over-all cost
per patient. The mean expenditure per patient for this type of center was
$118.49.If we limit our attention to the treatment center serving outpatients
alcne, the average per patient cost is $169.93.
Medical rehabilitation centers, contrary to some opinion, serve nearly as
many outpatients as inpatients. Of the 22 centers in the study reviewed here,
three did not send in reports that covered their patient load and annual
operating budget. Of the remaining 19, only one served OP’s only, two
served inpatients only, and 16 served both types of patients. Of the 19,775
patients served, 56 per cent were in the outpatient service and 44 per cent
inpatients. The average cost per patient varied from a low of $37.62 up to
a high of $2,622.70in an institution serving inpatients only. The high for
institutions serving both types of patients was $2,592.89.The mean expenditure per patient was $319.24.
The community-operated rehabilitation centers totaled 20, three of which
did not have adequate reports of patient load or annual operating budget.
The overwhelming majority (95 per cent) of the patients were treated on
an outpatient basis. Four of the 17 centers do accept inpatients and in these
four centers the 0P:IP ratio is 2:l.The average cost per patient is $191.03
in centers carrying only OPs (13) and $363.59 in the four centers with combined OP-IP programs.
The vast majority of patients are served on an outpatient basis in all three
types of centers, with only the medical rehabilitation center serving any
sizeable proportion as inpatients. This would suggest that as matters exist at the
present time it would be most wise to utilize the medical rehabilitation center for all patients requiring maximal medical attention while undergoing
rehabilitation. The cost per patient will be high; nevertheless, for the amount
of service available it is less expensive than similar services offered by commmity-operated centers. On the other hand, patients who can profit from
outpatient care can be placed in the community-operated center at very
little increase in cost over that of the so-called “treatment center” with the
likelihood of more adequate services being offered.
While the data at present is both “skimpy” and not too reliable, the trend
indicated warrants the above assumption until further study establishes the
fact more reliably.
The acceptance of patients under 16 years of age has not received the
attention it warrants. This study reveals that 100 per cent of the treatment
centers accept patients under the age of 16 with these patients constituting
on the average 24 per cent of the patient load. About three-fourths of the
medical rehabilitation center with somewhat less than 18 per cent of their
total patient load constituted this category of patient. Eighty per cent of
community rehabilitation centers accept such children representing about
24 per cent of the total patient load.
It is clear that a much needed area of extension of rehabilitation center
services, especially to medical rehabilitation centers, is in the field of juvenile
rehabilitation. Proper development of such programs would lead not only
to improved care but to better medical, social and psychological outcomes
for the child and adolescent patient growing into adukhood.
1. Redkey, H.: Rehabilitation Centers in the
United States and Canada in ‘‘Prooeedings of the Institute on Rehabilitation Center Planning,” U. S. Departnient of Health, Education and Wel-
fare, 1959, pp. 33-48.
2. Redkey, H.: Rehabilitation Centers Today. Rehabilitation Service Series,
Government Printing Office, Washington, D. C., 1959.
Morton A. Seidenfeld, Ph.D., Assistant Chief, Division of Research and Demonstration Grants, Office of Vocational Rehabilitation, Department of Health, Education and Welfare,
Washington, D. C .
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selection, rehabilitation, center
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