Why the Future of Rehabilitation is Outpatient

A rehabilitation can be carried out “full-time outpatient” or “inpatient”. There may be individual factors that speak more in favor of inpatient or outpatient treatment – but in principle, both are equivalent alternatives. So why is a predominantly outpatient concept practical?

This article has been published first on the Valenus Group Blog and subsequently been translated from German to English. The rehabilitation concepts described in this article apply mainly to Germany.

The Inpatient Rehabilitation

In-patient rehab is the rehab that most people have in mind at the first thought. The inpatient rehab clinics are mostly located away from home in the regions where it is nice. The patient can choose between rehab clinics on the North Sea or Baltic Sea, in the Harz Mountains, in the Black Forest and many other idyllic health resorts. However, a rehabilitation, even if it is carried out in the most beautiful regions of Germany, is not a wellness holiday. The focus is still on restoring health.

In certain cases, in-patient rehabilitation can be more sensible than an out-patient option. For example, some supra-regional inpatient clinics have specialized in rare diseases and can therefore offer higher quality and better chances of success. If intensive medical and nursing care is necessary, in-patient rehabilitation may be necessary, because the red emergency button is there.

The Outpatient Rehabilitation

Outpatient rehabilitation is also a rehabilitation close to home. The German Pension Insurance Fund currently understands outpatient rehabilitation to be “all-day outpatient” rehabilitation, i.e. treatments are carried out from morning to evening on working days. In order for outpatient rehabilitation to be permitted by the German Pension Insurance, the facility must be close to the patient’s home, i.e. it must be possible to reach the facility by public transport within a reasonable travel time. At the same time, this requires that there must be sufficient mobility to enable the patient to manage the journeys from home to the clinic and back.

If a patient’s condition generally lends itself to both inpatient and outpatient rehabilitation, which type of treatment makes the most sense today?

Advantages of Outpatient Rehabilitation

Advantages of outpatient rehabilitation
If the health impairments are not so severe that continuous medical or nursing care is required and the patient can reach the outpatient clinic independently within a reasonable travel time, then outpatient treatment offers some advantages over inpatient rehabilitation.

The decisive advantage of outpatient rehabilitation is its integration into everyday life and the living environment. The patient stays in the clinic only during the time of therapy and treatment and therefore the “all-day outpatient” rehabilitation of the German Pension Insurance reminds of a schedule at school. In a time window of about four to eight hours different treatments take place in the outpatient clinic. The treatment plan is individually adapted and aligned to the patient and his or her complaints.

The fact that the treatment and therapy takes place close to the patient’s home results in the following decisive advantages compared to in-patient rehabilitation:

• The proximity of the place of residence and the apartment helps with the reintegration into the domestic and professional everyday life
• The patient remains in his familiar social environment and only comes to the rehab facility for therapy and treatment so that existing social contacts can be maintained and domestic duties can be performed to a limited extent
• Employees can return to their jobs faster and better prepared, for example by accompanying discussions on returning to work with colleagues or superiors
• Doctors and therapists can easily exchange information with the patient’s relatives to provide information and avoid conflicts
• The patient stays in the outpatient clinic only during the day during the treatment and can sleep in his own bed
• The integration of individual everyday experiences such as not having to go to the toilet at home, driving a car or using public transport can be discussed and tackled in a training course close to everyday life
• What you learn in rehabilitation can be immediately applied and implemented in your private and, if necessary, professional environment
• The proximity to the treating acute clinic enables the medical care of the operating or treating physician in addition to the care of the rehabilitation doctor
• Physicians in private practice in the immediate vicinity can easily be included
• Even after a completed rehab, the treating rehab doctors and therapists can still be there for the patient and with services such as intensive post-rehab care (IRENA), rehab sports or health training to consolidate the therapeutic success in the long term in familiar surroundings

Outpatient Rehabilitation as a Future Concept

The principle of “outpatient before inpatient” has become established in almost all areas of the German health care system. The situation in the medical rehabilitation field is different at the present time, with an inpatient treatment model predominating here.

As already mentioned, inpatient rehabilitation clinics are often located where it is nice and not where they are actually needed. You can find in-patient rehabilitation clinics in the middle of the Black Forest, at the North and Baltic Sea or in Mecklenburg-Western Pomerania. A meaningful and sufficient outpatient concept for the population does not exist. In 2018, 81% of all rehabilitation services were inpatient only 15% of all services of the German Pension Insurance were outpatient (2000: 3%), although there are numerous arguments in favor of outpatient rehabilitation care for the majority of patients. At the same time, treatment at the outpatient facility is equivalent to treatment at the inpatient clinics. Hubert Seiter, former Chairman of the Management Board of DRV Baden-Württemberg, also explains that the number of therapy units in outpatient facilities is already higher in 2010 than in inpatient clinics

Outpatient means Flexibility

New outpatient concepts can score points above all in terms of flexibility. While an in-patient rehabilitation takes the patient out of everyday life for about 3 weeks and then releases him/her again, out-patient concepts can respond to the actual living conditions over a longer period of time (e.g. 6 weeks).

Not every patient needs three weeks of rehab in a row, where necessary a longer treatment may be necessary. Outpatient rehabilitation concepts also allow for therapy while working. A patient who is treated for his knee or back problems in an outpatient facility from 08.00 to 12.00 hours could attend business appointments in the office in the afternoon. A single mother can adjust the outpatient rehabilitation according to her circumstances and still be there for the children in the morning and evening.

Life-oriented rehabilitation also takes into account the living environment, including the family, possible everyday stress or the world of work, which activates the self-help potential more strongly and role conflicts of the affected person can often only be tackled in an outpatient setting.

An outpatient concept can be designed flexibly:

• the therapy frequency can be determined individually
• the range of therapies can be adapted individually and according to needs
• rehab can also take place on a part-time basis
• the treatment and therapy can be structured and planned in a complex way over several weeks or even months
• real everyday stresses and strains can be tested and trained as required
• an interdisciplinary treatment approach can take place on site, i.e. the involvement and close cooperation of doctors, psychologists, physiotherapists, nutritionists and nurses
• Outpatient rehabilitation is flexible and adapts to people’s living conditions – not the other way around – that is the future.

Resume

In almost all areas, the motto outpatient before inpatient applies, but despite all the arguments, over 80% (2018) of rehabilitation services will still take place on an inpatient basis and thus far from the patient’s home. At the same time, demographic developments are leading to a significant increase in the demand for physical medicine and rehabilitation. A large amount of bureaucracy on the part of the funding bodies as well as a lack of innovative strength on the part of existing inpatient rehabilitation providers and possibly fixed real estate locations are currently preventing outpatient concepts that make real sense for patients

All in all, urban and residential rehabilitation concepts offer a great opportunity to improve people’s health care. Scientific studies show that there are no significant differences in the effectiveness of both forms of care. There are many arguments not only in favor of the outpatient version for the patient, but a predominantly outpatient concept in future will also reduce the costs for the funding organizations enormously – outpatient rehabilitation is up to 30% cheaper than inpatient rehabilitation and efficiency will be increasing considerably in future with increasing occupancy rates and larger, professionally managed outpatient health centers.