A two-year study in intensive rehabilitation of 50 chronically ill indigent medical outpatients

Data concerning the rehabilitation of fifty chronically ill indigent medical outpatients are presented. The methods emphasized in the selection, evaluation, and care of these patients are enumerated. The keystone of this approach in rehabilitation is the determination of the residual functional capacity of each chronically ill individual. The development of an adequate understanding of this capacity by the patient, his family, and social agencies working with him permitted reasonable goals to be set for each patient in terms of remunerative employment. This rehabilitation study, accomplished through the efforts of two physicians working intensively with the patients over a prolonged period of time, demonstrates that the physician can do much in assisting his patient toward rehabilitation if he works intensively with the patient for a longer period of time than that required only for diagnosis and immediate therapy. Further, this study points up that rehabilitation can be done by the physician alone, without the intervention of a team of many paramedical specialists who may inavertently be working in an uncoordinated manner and actually to the detriment of the patient's success if there is a lack of communication among them. Fifteen of these fifty patients were able to return full-time competitive employment and seventeen additional patients were able to return to part-time employment and thereby reduce, partially, their dependence upon welfare. A comparison of these earnings in one year of the patients rehabilitated and the proportionate decrease in welfare assistance payments, with the total cost for the intensive work with each patient shows that such intensive rehabilitation efforts are a sound investment. The removal of fifteen patients and their families from any dependency upon public welfare assistance and the maintenance of this freedom from dependency over a subsequent two-year time has resulted in considerable savings in the taxpayers, both directly and indirectly.