Rehab for seniors: If the nursing home is not the last stop

Older people who come to a nursing home usually stay there. There is usually no way back home. The concept of “rehabilitative care” takes a different approach: a nursing home with a return ticket.

Doris Fisch fell, broke her vertebrae and had to undergo two operations. Because she was bedridden, she was placed in a nursing home. But she wanted to leave as soon as possible. “Because I didn’t like the facility I was in at all. And because I was just lying around in the corner,” says the 79-year-old, describing her situation at the time.

It’s been a year and a half now. When she heard about the Haus Ruhrgarten in Mülheim an der Ruhr, she took care of finding a place herself. Today Doris Fisch can walk again. And she has big goals: she would like to move home to her new apartment. Be as independent as possible.

Concept of “rehabilitative care”

Returning home in old age after a long time in a home – that is a very special approach that is followed in the Ruhrgarten building. It’s called “Rehabilitative Care”. Oskar Dierbach developed the concept of linking care and rehabilitation. He was a geriatric nurse and managed the nursing facility in Mülheim for many years until he retired last year.

“We have discovered what wealth it is when you focus on people and don’t think about keeping them, but about helping them back into life,” says Dierbach. The core questions are how people are doing today and what they need to feel better tomorrow.

There is a complex system behind it. Anyone receiving treatment in Haus Ruhrgarten has a large team around them: nurses, doctors, therapists, and pharmacists work hand in hand and exchange ideas. Together they then create an action plan. Each case is examined from all sides: Can medication be discontinued, can the person move, does it perhaps first need psychological care?

Many residents can go home again

According to Dierbach, 15 to 20 percent of the residents made it back home. In the years between 2017 and 2019 alone, 170 residents were released from inpatient care to their own homes. A good rate that speaks for the rehabilitative concept.

The AOK observes the concept of therapeutic-rehabilitative care very closely. “This reverses the current principle in care, which aligns remuneration with the level of care and does not provide any financial incentives to help people out of their need for care,” says Matthias Mohrmann, Deputy Chairman of the AOK Rhineland/Hamburg. In addition, fewer medicines would be needed, the number of hospital stays would be reduced and with it the treatment costs and more patients could return home.

Lack of legal basis

In practice, however, there is the problem that, in addition to outpatient and inpatient rehabilitation, there is still no legal basis for offering rehabilitation measures on site, i.e. in a nursing home or at home. Closing this loophole is the goal of a project by AOK Rheinland/Hamburg, which is scheduled to start in April.

Over a period of four years, the concept of therapeutic care will be implemented and scientifically supported in twelve other homes for inpatient care for the elderly in the AOK Rhineland/Hamburg catchment area. “The goal must be to break down the disciplinary boundaries between health and long-term care insurance and to transfer a holistic view of the person concerned to everyday nursing care,” says Mohrmann. However, the legislature must create the legal basis for this.

In any case, Doris Fisch is fighting to finally be able to live alone again – and she is getting closer to this goal bit by bit. At the moment she is still having a hard time getting up and walking across the room without help. “But if I can do that, I want to go home too,” she says. This perspective motivates her to continue training day after day.