Steelers Nation Welcomes Forbes!

Forbes Center for Rehabilitation and Healthcare was excited to be a part of the Steelers Training Camp Day on August 6, 2015. A few of the communities’ residents who are Steelers Football Fans had an amazing time watching their favorite NFL players. Forbes Center for Rehabilitation and Healthcare was proud to share in this experience with their resident fans and become a part of “Steelers Nation” for the day!

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Case Study: Forbes Center for Rehabilitation & Healthcare (June 2015)

Patient Age 68
Admission Date: May 13, 2015
Admitted From: UPMC Shadyside
Discharge Date: June 10, 2015
Discharged To: Home
Length of Stay: 28 Days

She is a 68 y/o woman with renal failure (on dialysis), insulin requiring diabetes, recent pneumonia, congestive heart failure and adult respiratory distress syndrome. She required a prolonged stay at a hospital intensive care unit on a breathing machine. Eventually she was taken off the ventilator and the breathing tube was removed. She came to Forbes with a persistent feeding tube, however – which had been inserted through her nose and lodged in her stomach. She was weak, sick and had difficulty swallowing; managing her own oral secretions and simply breathing was a challenge. Nevertheless she needed this tube for nutrition, hydration and maintaining a calorie balance necessary to accommodate her insulin schedule. She also required it to finesse delicate fluid management in a patient with end stage renal failure who also has congestive heart disease.

Forbes provided intelligent, persistent and professional care for this sick and fragile individual. Speech worked with her every day to help her regain her ability to communicate and eat. When her feeding tube accidentally came out of her nose, clinical staff wisely realized that replacing it would hamper progress in physical therapy, breathing, swallowing and speaking. The tube, though, was still needed to continue nutrition and prevent dangerously low blood sugars that could result from her diabetic regimen. Forbes arranged to place the tube directly into the stomach at the level of the abdomen (thereby avoiding the nose face and throat). This served all requirements – it afforded cautious feeding and hydration while allowing the mouth and throat to recover. Her swallowing and speech trouble resolved completely. Removing the tube from the nose also resulted in less inhibited interactions with family and peers while allowing greater participation in physical therapy.

She walked out of Forbes bright – with clear speech and confident strides. She was completely independent in her ability to care for herself and eat normally.

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Case Study: Forbes Center for Rehabilitation & Healthcare (May 2015)

Admission Date: January 16, 2015
Admitted From: Allegheny General Hospital
Discharge Date: February 20, 2015
Discharged To: Home
Length of Stay: 45 Days
Reason for Stay: Liver Issues

Introduction: Patients with end stage liver disease can be challenging to manage in any healthcare setting. This case illustrates how CareRite Forbes took compassionate and effective care of a patient with complicated liver issues.

Vignette: Mrs. B was a 60 year old nurse with pulmonary hypertension, congestive heart failure and end stage liver disease. Nutrition is transported from the intestines to the liver by a large vein called the portal vein. The liver acts as a primary filter detoxifying poisons but also capturing and packaging raw nutrition. When the liver hardens due to cirrhosis (as was the case here) it blocks flow from the portal vein. Pressure in the portal vein builds up and the blood there tries to find a way back to the main circulation by veins in the stomach and esophagus. These veins then become very fragile and bleed. Mrs. B’s esophagus veins bled. Her doctors at the hospital used a tips procedure to connect the portal vein circulation with the normal (central) vein circulation in order to decompress the bleeding veins. Tips means that a catheter is placed in the main vein which is then used to poke a hole in the liver to the portal side, allowing flow that bypasses the liver itself. This in turn led to an unintended overflow into the main venous circulation and a condition we call pulmonary hypertension. The pulmonary hypertension was so severe that the tips procedure had to be reversed. Her course was complicated by respiratory failure requiring placement of a tracheostomy, dependence on a ventilator as well as a feeding tube from the nose to the stomach. Mrs. B came to Forbes Center with advanced liver failure, problems with her portal circulation and respiratory failure. Her liver failure manifested as fluid overload, loss of an ability to clot (bruising) as well as an inability to process the toxins of digestion (ammonia) resulting in extreme lethargy and confusion. Added to this was her tenuous dependence on tubes to provide respiratory support (ventilator machine connected to a trache tube in her throat) and a tube to supply nutrition and hydration (nasal – gastric tube.) Pulmonary hypertension made it difficult to balance fluids as too little hydration and the blood pressure would collapse and a bit more hydration and she would swell further and have greater difficulty breathing.

Course:
• Mrs. B was steadily weaned from the ventilator and then had her trache tube removed from her neck.

• While delirious Mrs. B pulled out her nasal feeding tube repeatedly, but nursing staff patiently replaced this important lifeline each time.

• Delirium was controlled by adjusting specific anti-ammonia medications (lactulose.) As lactulose restored Mrs. B’s mental faculties it allowed powerful antipsychotics to be gradually eliminated. This in turn improved her ability to participate in physical therapy and be restored to her old self. As her thinking improved so did swallowing and the feeding tube was removed.

• Severe anemia, inability to clot and fluid overloaded were carefully managed throughout.

Conclusion:
At the time of discharge Mrs. B had regained her personality, her mental focus and her physical strength. She was able to converse normally and also walk about, unassisted – completely free of breathing tube, ventilator and feeding tube. At no point did Mrs. B require rehospitalization. Complex nursing, medical, respiratory, speech and physical therapy management were done entirely at Forbes.

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ReNEWal Night Hosted By Forbes

Forbes Center for Rehabilitation and Healthcare hosted an elegant evening of relaxation, fun and ReNEWal at the Fairmont Hotel with the surrounding communities’ social workers, physicians and case managers on Friday, June 5th. It was a fantastic event and great success!

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Forbes Celebrates National Nursing Home Week 2015

Spirit week at Forbes was really special! The staff and residents felt a change in the air. It was so much fun handing out gifts to show our appreciation to staff and residents alike. The atmosphere was one of love and comradery. The Administrator and Director of Concierge Services were also onsite in order to ensure that the overnight staff also received their gift bags. Spirit week 2015 truly was an experience to cherish and remember.

Click below for a snapshot of National Nursing Home Week 2015 throughout our CareRite Network. ReNEWal Happens Here!

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Case Study: Forbes Center for Rehabilitation & Healthcare (March 2015)

Patients Age: 63
Admission Date: 2/16/15
Admitted From: Allegheny General Hospital
Discharge Date: 3/17/15
Discharged To: Home
Reason for Stay: Chronic Respiratory Failure

Patient was admitted to Forbes Rehab with Chronic Respiratory Failure. Upon admission she was a tracheotomy patient on a ventilator who was unable to ambulate without assistance and needed frequent breaks in even the most simplistic of tasks. She engaged in Occupational, Physical, and Speech Therapies multiple times a day for 3 1/2 weeks in attempt to allow her to perform ADLs and thus showed tremendous improvement. Due to the tireless efforts of the nursing and rehab staff; she was transferred off of the ventilator unit and into a regular room not requiring any assistive breathing machinery. Her uplifting attitude was a positive experience for all that interacted with her. At the end of her stay she was able to ambulate on her own as well as conduct ADLs. She was discharged home in stable condition.

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Valentine’s Day at Forbes

Valentine’s Day was a fun day for all! We enjoyed a party with music and a show! Happiness and love were in the air and good times were shared by all.

Forbes Veteran’s Day Program

Forbes celebrated Veterans day with our residents and special honorees with a celebration that included assistance from the activities department. We started our program with the song “God Bless America,” with James playing the piano. Everyone was singing along. After the Pledge of Allegiance, the Chaplain from the American Legion post 577 said an opening prayer thanking our Vets, which was followed by the former Commander of the same post reading about the history of Veterans day. We sang patriotic songs in between, recognized and honored our Vets with a certificate, card, and flag thanking them for their service. We followed up with a moment of silent prayer with a bell ringing for those that were lost, and a reading from Scripture. We ended the program with a patriotic song, and afterward we all enjoyed some refreshments and socializing. On Thursday at our Catholic mass, Father Joe continued the Veterans day theme dedicating the mass to our Vets.

Shared by LeeAnn Tozzi

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Case Study: Forbes Center (October 2014)

Case Study

Community Name: Forbes Rehabilitation and Healthcare
Concierge Director: LeeAnn Tozzi
Patients Age: 60
Admission Date: 9/27/14
Admitted From: West Penn Hospital
Discharge Date: 10/28/14
Discharged To: Home
Length of Stay: 32 Days
Reason for Stay: Hernia surgery
How did this patient hear about Forbes Center?
Patient’s Mother-In-Law was a guest at Forbes earlier this year

Please share your patient’s positive experience including highlights, obstacles overcome and information critical to this being a successful patient experience.

Details of Experience:

Patient arrived at Forbes in the early morning hours and was welcomed by the Nursing staff and made comfortable in his room for rehabilitation following double abdominal,srotum hernia surgery.Patient had drainage tube across abdomin due which caused discomfort and pain.The rehabilitation team got to work. OT began exercising the upper body , stretching and strenghtening the biceps and triceps. Physical Therapy worked on getting the patient more mobile by leg strenghtening exercises and walking. Patient struggled at first, but perservered due the staff who were patient and understanding. The staples and drainage tube continued to make the skin feel pulled and uncomfortable. The patients wife and Mother-In-Law visited daily which helped lift his spirits bringing him special treats from home. Patient was finally able to visit his Surgeon for a post operative appointment. The Doctor removed the staples and drainage tube which brought immediate relief. The patient, recovering fully, was able to be discharged to home with follow up Nursing, PT, and OT. The patient is thankful to all the staff at Forbes who aided in his recovery.

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Case Study: Forbes Center (Sept 2014)

Case Study
Community Name: Forbes Center for Rehabilitation and Healthcare
Patient’s Age: 75
Discharged To:Home
Length of Stay: 2 Months
Reason for Stay: Skilled Nursing
How did this patient hear about Forbes Center?
From Daughter who is an ICU Nurse at a local hospital

Details of Experience:
Patient rehabilitation process began actually six months ago when patient came into Forbes for skilled nursing and therapeutic therapy for general dehabilitation at the end of March in 2014. Her stay would not be long as she was transferred to a local hospital due to a new diagnosis of volvulis(strangled gut), which required surgery, along with a peg tube and trach/vent being put in. She spent the next 35 days hospitalized, recovering slowly and in a more weakened state. She left one hospital to move on to another for additional care. In June, she suffered another set back and needed to have a pacemaker evaluation. The Doctors decided she was in need of an implant and so she continued her stay at the hospital following surgery to recover. In July, she was stable enough to return to Forbes Rehabilitation and Healthcare. When she returned to Forbes her prognosis was poor. Not only was she a trach/vent patient, she had surgery wounds along with a bedsore on her backside coccyx from the hospital. She required a feeding tube for daily nutrition, was unable to speak, and was in an overall state of depression. Our wonderful respiratory team took over and began the weaning process from the ventilator and then the trach. The team worked tirelessly and with great care along with the nursing team Our multi interdisciplinary team, PT, OT, and Speech Therapy began rehabilitation.
Physical and Occupational therapy worked in tandem in rebuilding the patients upper and lower body muscles so she could regain strength. Speech Therapy worked with the patient on swallowing exercises and speech so that her trach tube could eventually be capped. Speech therapy continued until finally the patient was able to speak and move to a regular diet with supplemental tube feedings only.
Throughout the entire process, her husband encouraged and supported the work and care that helped make his wife stronger. Her husband, along with the team at Forbes, participated passionately in her daily rehabilitation, resulting in a positive outcome.
The patient has overcome many obstacles, and her own self determination to get better, has been an integral part in her recovery. Due to the commitment of our team and our rehabilitation efforts, the patient was able to return to her home and continue with out-patient therapy, with a solid foundation to build upon.

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