Personal assistance: its effect on the long-term health of a rehabilitation hospital population.

Abstract

After discharge from a rehabilitation hospital, persons with severe disabilities may not be able to maintain health effectively without adequate personal assistance with activities of daily living. Techniques of qualitative analysis were used to assess interview results based on the observations of 41 physicians, physical therapists, occupational therapists, social workers, and nurses in five rehabilitation hospitals. A positive relationship was found between the adequacy of personal assistance and the ability of individuals disabled primarily by stroke, spinal cord injury, or traumatic brain injury to maintain good physical and mental health. The most commonly cited health problem was skin breakdown, followed by urinary tract infections, pulmonary infections, and contractures. Inadequate personal assistance also led to extended hospital stays, threats to safety, poor nutrition, and poor personal hygiene. Reliance on family alone for assistance was considered inadequate, common adverse effects including burnout, family role changes, and economic strain. Persons with the best health combined assistance by relatives and unrelated persons. Recommended is the establishment of a comprehensive system capable of coordinating service delivery from home health agencies, independent living centers, and rehabilitation hospitals.