A Critical Next Step: How Neuro Transitional Centers Help Patients Move Forward

Select Medical, a leader in post-acute rehabilitation nationwide, is transforming recovery for individuals with brain and neurological injuries and illnesses. We are doing this by adding neuro transitional centers (NTCs) to our continuum of care. NTCs cover long-existing gaps in medical services – gaps that can leave patients unable to safely function at home or in the community and can result in being institutionalized.

Transitional rehabilitation at our NTCs serves as a vital bridge between hospital and home, offering patients the dedicated time and supportive environment they need to continue progressing in their recovery.

What is an NTC?

After an ICU or hospital stay, patients often transition to a critical illness recovery or inpatient rehabilitation hospital for continued medical care and therapy. Some then return home with outpatient support. Others need further care — that’s where NTCs come in.

NTCs provide intensive rehabilitation after injury or illness for patients who are medically stable but need to make further progress to return home safely and with the highest degree of independence possible. NTC patients live in a home-like setting and practice activities of daily living. NTCs aim to:

1. Help patients successfully return home and re-enter the community
2. Increase the number of patients who achieve lasting independence after discharge
3. Ensure family and caregiver readiness to support their loved one
4. Reduce disability and rehospitalization

Who benefits from an NTC?

NTCs focus on patients who have had a stroke, brain or spinal cord injury or live with other non-degenerative neurological conditions.

These individuals may have lingering physical, cognitive or behavioral limitations that can inhibit their ability to safely adjust to their home environment and daily living activities.

If a patient returns home too soon, they are more likely to be readmitted to the hospital or a skilled nursing facility. While nursing facilities can provide the care these patients need, they don’t offer the same intensive, focused rehabilitation that helps patients regain their independence.

Home-like environment

Select Medical’s NTC model is a nine- to 12-bed residential center that reflects the comforts of home. The small number of beds reflect the focus on individualized patient care. Each patient has a private suite with a bathroom and access to:

• Open kitchens to relearn tasks like cooking
• Laundry rooms to clean their clothes
• Computer lab to help return to functional activities
• Quiet room that provides a calming space
• Therapy gym and outdoor space
• Treatment areas with various levels of distraction to enhance focus skills

By immersing patients in an environment similar to their home, NTCs better prepare individuals for the transition back to everyday life. Most patients stay for approximately 100 days – according to the needs of the patient – allowing staff to concentrate on retraining patients in activities related to home, work and community.

Intensive rehabilitation

Upon admission, patients complete assessments, including a functional interest inventory, to help the care team understand their background, interests, and lifestyle. This insight enables the transdisciplinary team to set personalized, meaningful rehabilitation goals.

NTCs offer round-the-clock intensive rehabilitation with dedicated staff who are trained in several areas of rehabilitation. Our teams focus on coaching and guiding patients instead of completing tasks for them. We accomplish this through low staff to patient ratios, three patients to one staff member and patients typically participate in six hours of therapy daily.

During these sessions, patients work on activities of daily living skills -- the abilities they will need to live safely and independently. Patients are also given assignments outside of therapy sessions, that help them build on gains made during therapy.

Staff also accompany them on community field trips to places such as the grocery store, park, library or shopping mall up to three times a week. This community immersion allows patients to learn how to manage the same sort of stimulation they will face once they return home.

Caregiver participation

Like patients, caregivers also need preparation on how to best support and help their loved one have a successful transition home. Caregivers and family are encouraged to participate in therapy sessions where they can observe their loved one’s progress and how the staff supports them through activities, learning how they can assist their loved one at home. They can also discuss any challenges they may be anticipating and learn how to safely assist their loved one.

Providing support looks different for each patient since it depends on an individual’s strengths and weaknesses. Caregiver training throughout a patient’s NTC stay helps establish confidence and ease worries associated with a patient’s return home.

How are NTCs bridging the gap from hospital to home?

Individuals admitted to an NTC have had post-acute care following a stroke, neurological condition, spinal cord or brain injury. While they are ready to begin rehabilitation, they may still show moderate to severe impairment and low levels of overall independence. Select Medical has found that these patients can make further strides in recovery if given extended intensive care from experts in the field.

To shape each patient’s care plan, patients are evaluated for impairments and level of independence. This also provides a baseline to measure their progress. For brain injuries in particular, patients are assessed on the Mayo Portland Adaptive Inventory IV (MPAI-IV) Scale. This scale assesses a patient’s functional levels in three areas:

• Ability: Mobility, vision, communication, speech, concentration, memory and problem solving
• Adjustment: Anxiety, depression, irritability, pain, fatigue sensitivity, social interaction, and self-awareness
• Participation: Social contact, self-care, leisure activities, transportation to work/school and money management

These areas are essential to a patient’s ability to regain independence and return home safely. Progress is closely monitored through regular evaluations during their stay and again at discharge.

The following stats from Select Medical’s 2024 NTC patient outcomes show patient progress from admission to discharge:

• Most patients progressed improved from moderate-severe impairments at admission to mild-moderate impairments by discharge. More than 90% of patients discharged home
• 75% of patients can be independent and unsupervised for eight or more hours a day after rehabilitation at an NTC, reducing the need for caregiver assistance and the risk of rehospitalization.

An important part of reintegration into the community is the ability to work and participate in leisure activities. Select Medical’s 2024 NTC discharge data showed that 77% of patients could volunteer or work after returning home. This community integration ensures individuals live a fulfilling life while also pushing them to continuously work on their recovery.

For more information on Select Medical, its joint ventures and expansion plans for Neuro Transitional Centers, contact us.