Slow Stream Rehabilitation: A New Model of Post-Acute Care

To identify characteristics and outcomes of elderly patients admitted to a slow stream, low-intensity, and long-duration inpatient rehabilitation (SSR) program after an acute hospitalization because they were unable to tolerate traditional inpatient rehabilitation.

Single group pre-post study with assessments conducted on admission and discharge.

Baycrest's 30-bed SSR Unit in Toronto, Ontario, Canada.

A total of 104 patients older than 60 years admitted between September 2011 and December 2012.

Admission assessments included demographic data, Functional Independence Measure (FIM), and ability to ambulate. Discharge outcomes included change in motor and total FIM scores from admission to discharge, discharge residential status, and length of stay.

Mean age was 81.6 ± 8.4 years and 68.3% were women. Mean changes in motor and total FIM were 21.0 ± 12.2 (P < .001) and 22.6 ± 14.0 (P < .001), respectively. On admission, only 30.8% of patients were ambulatory even with mobility assistive devices, while on discharge, 68.3% of patients were ambulatory; 61.5% of patients returned to their preadmission living arrangement; 8.6% went from their own home to a retirement or relative's home. Only 16.3% were discharged to long-term nursing home care and 13.4% were transferred to an acute hospital. Mean length of SSR stay was 82.5 ± 26.4 days.

SSR programs can benefit elderly patients at risk for institutionalization after acute hospitalization by improving their functioning and mobility, and allowing them to return to the community.