Patients who return home are provided a binder detailing their exercises and other rehabilitation routines. That information can be used as a blueprint for continued recovery.
The planning process also incorporates coordinating medical needs, often with ANMC, and the complex role of transportation to ensure that patients, their medical equipment and their aides all arrive at roughly the same time.
“For rural Alaskans, we rely 100% on local airlines and very small aircraft for transportation of our patients to outlying areas,” says Amy. “There is no car or boat that can get a patient to Savoonga (680 miles from Anchorage) or Bethel (398 miles).”
“It’s common for rural Alaskans to utilize a four-wheeler or snow machine to get to their home in the smaller outlying villages,” she says.
There are also a number of cultural realities that the rehabilitation staff and case managers encounter. With more than 20 dialects associated with the Indigenous populations of Alaska, there can often be a language barrier.
Cultural differences can also inform how the care provider and care recipient perceive their goals.
“Our goal in rehab is to teach the individual to be as independent with their own function as possible, because we know that this is best for their long-term health [and] recovery, and in order to prevent them from having health regressions,” says Ellen.
The family-centric values of many cultures can often result in a communal approach to healthcare. Caregivers have seen the benefits of communities who care for their families as an act of service.
“Each person relies on the others’ skills, and the wealth is shared by the community,” says Ellen. “Therefore, if someone has a stroke, they can still be fed, housed and cared for.”
“We have to determine with the patient and family what the goal is for them and plan our care based on their goals while ensuring that they understand the rationale behind our goal to allow the person to be as independent as possible,” she explains. “For example, feeding their loved one can constitute honor and respect, but feeding someone may actually impair their ability to recover the function of their arm after a stroke.”
Further, the Alaska Regional staff connects patients and families with telemedicine therapy providers when those services are available. “We utilize telemedicine to provide remote training sessions to caregivers,” says Ellen. “Our therapists have created safe simulations of hunting, fishing and berry picking to help the patient feel that the therapeutic activities they are performing have meaning in terms of their real-life needs.”