Charlotte Smith, MDCharlotte Smith, MD


Charlotte Smith, MD
Rehabilitation Medical Director, SETON Family of Hospitals

Many positive changes in technology and innovation of science have been injected into the experience of health care over the last decade. Dr. Smith cautioned that the good has also brought challenges like less time, less communication, less trust, and more opportunities for things to go wrong.

In addition, family issues have become a barrier to taking care of the rehabilitation patient. Dr. Smith has experienced that the family has less capacity to be caretakers because of the changes in family structure. Dual income couples, more singles, geographic distance between family members has increased, and definition of family has changed: these factors make it harder for family members to be effective caretakers and create stress.

As a result, caretaker depression is a real concern, which is why caretakers tend to neglect their own health care needs (1/3 of all caretakers are in fair to poor health). Health issues are compounded by relational issues between the caretaker and patient and Dr. Smith suggests that they impact both equally. Finally, Dr. Smith points out that financial issues create immense amounts of stress. In 2009, medical bankruptcy was up 400%.

Meanwhile, facilities are dealing with increased costs leading to tighter controls and resulting on overwhelming demands for provider services and time. "Time is how we show people we love them," according to Dr. Smith, and the increased demands on provider time leads to families feeling like health care providers are out of touch with the patient. Smith says there are other factors like fragmentation of care, lack of expertise and knowledge in complex care and comfort measures, and cultural differences, which can often exist in the care team and be compounded by differences in expectations with the patient.

Dr. Smith said that clear communication is the best way to overcome these issues and that health care providers need to focus on delivering the right information at the right time and in a way the patient and family understand.

"They don't care what we know until they know that we care," according to Dr. Smith.

Smith says teamwork is the key to delivering this and the team needs to:

  • Share information
  • Coordinate care
  • Message consistently
  • Have agreement in the treatment plan
  • Provide excellent education and training before discharge
  • Ensure post discharge support from someone (inside or outside the normal care team

In Dr. Smith's experience providing patient care conferences is a excellent strategy to communicate with the patient and family early in the care and meet the needs of the family and the care team. Multi-disciplinary team conferences will allow the care team to coordinate and ensure consistency in messaging. Dr. Smith shared that the concept of the Accountable Care Organization (ACO) means facilities will be incentivized to coordinate care. Additionally, the post-discharge support for patients will be provided by the patient navigators; this dedicated resource will prove that the care team is interested in not only healing but recovery.

Finally, Dr. Smith says that in the long term acute care hospital (LTACH) the longer length of stay creates a greater opportunity to build relationships with patients and families. It also means that there must be more work in care coordination and providing a consistent experience over the longer time. What can we do to ensure a more consistent experience in our hospital and across our company?

Psychosocial Support and Impact on Family During Rehabilitation