by Jeff Berliner, DO
Featured in the September-October 2020 Colorado Medicine Colorado Medicine.
The onset of the COVID-19 pandemic changed many practices in an instant, and Rehabilitation Services Volunteer Project (RSVP) is no exception. Co-founders Bill Niehaus, MD, Christina Draganich, DO, and I opened the 501(c)(3) nonprofit clinic in 2017 to provide uninsured individuals with disabilities in our Colorado community access to rehabilitation services. Along with 200 other volunteers, we donate our time and skills to provide care for patients with spinal cord injury, brain injury, stroke and amputation.
The vision of RSVP is to build a community in which people with disabilities lead lives of maximum independence, inclusion, and meaning. Recognizing that rehabilitation can contribute to this outcome, our mission is to provide outpatient services – physical therapy, occupational therapy, speech therapy, nursing care, social work and case management, wound care and physician care – and medical equipment to people who lack access to these services.
Since opening three years ago, RSVP has provided care in clinic space donated in-kind by Craig Hospital in Englewood. When Craig stopped all outpatient services in March as a response to COVID-19 they also closed the RSVP clinic to this at-risk patient population. We created a virtual clinic platform on Zoom and provided iPads to our patients to use for the week of the clinic and then return. The clinic also provided monetary support for patients at risk of losing their housing and to help with food insecurity. However, we eventually felt that our patients required in-person services and that our virtual platform was not fulfilling all of our patients’ needs.
It was at that point that we decided we would create a COVID team that would go into patients’ homes to provide services for those who had suffered catastrophic injury.
There are many situations in rehabilitation that require an in-person approach as opposed to services rendered online. For example, you can’t fit someone for a wheelchair or fix a wheelchair virtually. However, personal protective equipment (PPE) was scarce.
We were very fortunate to be able to order PPE in May through the Colorado Medical Society (CMS) to provide in-home care safely.
As of Aug. 24, 2020, Craig Hospital decided that we could once again provide 50 percent of our services in person, or five visits per clinic, which we are thrilled about. We will prioritize seeing patients with the most needs in-clinic and continue to see some patients virtually, especially for follow-up visits. Access to PPE will be more critical than ever with our return to in-person clinic services and we plan to use the remaining PPE from CMS during this time.
Before the opportunity to order PPE I had not interacted much with CMS. I have been a member since I moved to Colorado six years ago, but before COVID-19 I had attended just one in-person program. As the pandemic ramped up, I participated in the virtual Town Halls and was able to place the PPE order when my volunteer team and patients needed it most. I am grateful to CMS for the resources they provided during the public health emergency and look forward to continuing my membership and work with CMS. CMS should continue to advocate for individuals with lack of access to health care and encourage physicians and other organizations to do the same. It is the belief of RSVP that providing health care to the uninsured is noble, but that the medical community must not overlook the circumstances of economic injustice that made our clinic necessary.
We have all seen the high unemployment rate and related high number of patients who have lost their health insurance coverage.
I encourage all physicians to keep in mind those who are struggling and consider the social determinants of health when providing health care.
Too often health care professionals provide medical care without understanding the psychosocial ramifications that societal events may have on a person and community. A patient might be on our clinic schedule but does she have transportation to come in that day? We might write another patient a prescription but does he have the ability to pay to fill it? We can’t leave the people who are on the periphery of the health care community, who really need care, in the wilderness of medicine. We are called to help.
Rehabilitation Services Volunteer Partnership is available for referrals, and accepts volunteers and donations at our website, www.coloradorsvpclinic.org.