Too often accessibility in medical facilities is either an afterthought, poorly executed from the beginning, or not even considered. This not only results in inadequate or unequal care for wheelchair users, but also discourages those in need of treatment from making an appointment in the first place. What is needed is a truly functional model of accessibility that begins with a caring, patient-centered viewpoint resulting in a blueprint for comprehensive access designed from the inside out.
Fortunately, that model — perhaps the only one of its kind — exists. Encompass HealthCare and Wound Medicine, an outpatient wound care facility in West Bloomfield, Mich., is a shining example of well-thought-out accessibility, staffed and run by people who really care about their patients. Founder and medical director Dr. Bruce Ruben explains what lies at the heart of his clinic: “Freedom is what I was really striving for with Encompass HealthCare,” he says. “I didn’t want there to be any barriers for patients to endure in order to obtain treatment. Quadriplegic and paraplegic patients have enough medical challenges in their lives. Access to the care in the first place shouldn’t be one of them.”
When you approach the clinic, the first thing you see is a long awning in front of the entrance — not unlike what you can find at upscale restaurants or first-class hotels — with plenty of space if you are waiting for a ride and want to stay out of the rain. But what makes a real impact on new patients is what they encounter when they pass through the automatic doors. The clinic has 48-inch-tall walls in the front treatment cubicles of the office that lengthen the lines of sight for wheelchair users.
According to Ruben, there is an important psychology behind the design. “Shorter walls are simply less intimidating for wheelchair users than being surrounded by four, full-size walls. They give the outer office an open and airy feeling. Wheelchair users feel more in control since they can see more of what’s going on around them.” Each treatment cubicle has its own height-adjustable recliner-style exam chair and necessary supplies. When more privacy is needed — for instance, when an ischial wound is the problem — traditional treatment rooms are nearby.
“The open design also provides a sense of community, particularly when we’re busy,” says Ruben.
“When you go inside, right away you notice it is very open, and the people are warm and friendly, more so than other medical facilities I’ve been to,” says Ron Elkin, 45, a T6 para who has had infusion therapy and flap surgery under Ruben’s care. He says the atmosphere is calm and relaxed. “You might be greeted by two certified therapy dogs that are Ruben’s personal dogs.”
And the infusion center is more than a sterile environment for treating infections. “This is the only doctor’s office I’ve ever been to where they offer to make you lunch!” says Elkin. “The lady who runs the infusion center has her own little café with a menu, and there is a nearby kitchenette. You go in for infusion therapy and she asks if she can make you something — coffee, a grilled cheese sandwich, protein shake, toast. Once she fixed me a ham sandwich. What makes this place so unique is the people really seem to care, and everything they have or do seems to flow out of that.”
Care by Design
The caring atmosphere is no accident. It comes directly from Ruben’s philosophy of patient-centered care. “You have to hire the right personalities to work together, and the training is every day,” says Ruben. “If I had to put it in just two words, they would be ‘passion’ and ‘compassion.’ To do what we do every day, seven days a week, passion and compassion have to be deep in your DNA. When a patient experiences that in you, all the psychological barriers come down. They know you care, that you’re on their side and that they’re not alone in their goal to heal their wound or to overcome an underlying condition preventing that wound from healing.”
For those who know him, Ruben’s philosophy is not merely academic. It comes naturally from a man who loves what he does. “This guy is a wonder guy,” says Thomas Durkee, a 72-year-old T11 incomplete para. “You go in his office and you feel like it’s a club. There is a definite camaraderie. And he knows what he is doing, treats you like a regular guy. I’ve been to a lot of different doctors. He has a chair you sit in and get weighed. Rehab doctors don’t even have this. The guy has poured himself into this thing to take care of people. He makes you feel great, does his job, and all his employees are nice.”
It may sound too good to be true, but the results the clinic gets are proof that the patient-centered model really works. Encompass HealthCare is gaining a reputation as a wound care clinic that succeeds where other treatment facilities give up. Kathy Best knows this all too well. She became severely depressed when no one seemed to be able, or even willing, to tackle a difficult wound. One doctor even told her that she would most likely have to go to a nursing home and would probably die there within five years.
Fortunately, she heard about Encompass HealthCare and went there. What happened next has been covered in greater detail in a previous story in New Mobility (“New Model for Wound Care,” April 2013). The short version is Dr. Ruben took her as a patient and restored her health and her sense of well-being. “Everything is fine with my health now,” she says. “All is fine, I’m shopping, driving, going out with girlfriends. I’m back to myself prior to how sick I was. Just two years ago I was way, way down in the dumps. I am so happy that I am so well. I stop people on the street and tell them I’m happy!”
Care When and Where It is Needed
You would think that results like this would mean long waits to get into the clinic, but the goal of the staff seems to be to get you in for evaluation and treatment as soon as possible, unlike many medical facilities or doctors’ offices where you must set an appointment weeks or even months in the future. This is where the concept of accessibility begins. When you need wound care, you need it now. Often the appointment at Encompass HealthCare happens the same day you call or the next day, which can mean the difference between having a minor infection spiral out of control — and maybe even lose a limb — or healing up a wound efficiently. And it is all done in an outpatient setting that keeps you out of the hospital.
Ora Smith is a Vietnam vet who became a diabetic as a result of being exposed to Agent Orange. He sometimes has to use a wheelchair. It was November 18, just before Thanksgiving, when he went to see Ruben, who suggested he start IV infusions to get rid of infection in his toe right away. He began having IV treatments at the clinic seven days per week immediately. “Do I have to come on Thanksgiving?” asked Smith.
“Well, the germs don’t know it’s Thanksgiving,” answered Dr. Ruben.