(Kiosk 1) Uninsured Patients with Cancer Find a Bridge to Home: A Case Series

Case Diagnosis: Two uninsured patients with cancer, recent functional decline, and limited support at home are enrolled into a novel multidisciplinary program which provides more aggressive therapy, family training, and free DME resources to promote a safe discharge back home.

Case Description or Program Description: Appreciate the evolving impact of increasing numbers of unfunded individuals without access to inpatient rehabilitation services.
Increase awareness of factors that impact successful discharge to community from acute care hospitals.
Understand the role of physiatry and medical management considerations in a hybrid acute care-rehabilitation model.

Setting: Level 1 Trauma Center

Assessment/Results: Two patients with cancer are specifically addressed in this patient case series. Outcome measures included 6 minute walk test (6MWT), Berg Balance Scale (BBS), and the Activity Measure for Post-Acute Care (AMPAC) Mobility subset. Physiatry consultation assisted with treatment planning in acute care, including spasticity management, bowel/bladder program recommendations, and family education. Two hours of intensive PT/OT were provided five days per week. Both patients were able to be discharged to home, promoting the likelihood of continuing their cancer treatment goals of care.

Discussion (relevance): Patients lacking financial resources, including medical insurance and economic stability, experience unique challenges when hospitalized. These situations often lead to a prolonged length of stay beyond medical necessity and a significant financial burden to hospital systems. Post-acute care resources remain limited. This population needs creative solutions for safe transitions out of the hospital. Presenters will discuss innovative strategies developed within our hospital system and the local community to provide discharge solutions for similar underserved patients. Participants will learn strategies for adopting similar programs for services at their healthcare facilities.

Conclusions: For patients with cancer, a home disposition and improved functional status greatly increases the likelihood of receiving ongoing cancer treatment. The two patients addressed in this case series were successfully discharged home with plans of continuing treatment, which may not have otherwise been possible for them due to their limited financial resources and significant functional impairments. Programs like Bridge to Home ought to be considered at other acute care facilities when patients do not have access to post-acute care rehabilitation resources like inpatient rehabilitation hospitals due to funding.