By Elaine Widgett, senior director, inpatient rehabilitation and complex continuing care at Holland Bloorview Kids Rehabilitation Hospital         

Only four months into pandemic restrictions and deep uncertainty, families, staff and leaders at Toronto’s Holland Bloorview Kids Rehabilitation Hospital collectively relaunched one program that had been suspended – because it was too important for our young clients’ recovery.

The long-standing Weekend Pass initiative would send inpatients home and back to the hospital, a move contrary to the limited in-and-out privileges occurring at most health-care institutions. This bold move, in the early days of COVID, would prove to be the correct path to take.

In the spring of 2020, health-care organizations around the country enforced strict precautions to ensure the safety of on-site patients, staff and visitors. This was no different for us here at Canada’s largest children’s rehabilitation hospital.

There were, however, specific implications to certain specialties within the hospital, including the hospital's Brain Injury Rehabilitation Team (BIRT) and Specialized Orthopedic and Development Rehab (SODR) team. Not only was it necessary to restrict onsite caregivers and visitors, but both teams also had to manage without the Weekend Pass program on which it relied to guide successful rehabilitation journeys.

In the program, inpatient clients return home at week’s end to practice therapies, medications and other supports learned while admitted for rehab. At first, it was deemed too risky for clients to come and go. It didn’t take long, though, for the impact of these changes to come into sharp focus.

“Each child could have only two onsite caregivers, and the hardest part was that no siblings under 16 could come,” says Nicholas Joachimides, BIRT operations manager.

The emotional toll was particularly acute for some. One single-parent family lived a five-hour drive away from Holland Bloorview. The mother would stay at the child’s bedside while the father drove back and forth to see the sibling, now living with extended family.

“Families like these were forced to decide whether to finish rehab early in order to be discharged home, or stay and complete their care,” Nicholas says.

Beyond the increased isolation were the repercussions on the rehabilitation process itself. Staff could no longer ensure that new skills being learned would transfer home.

“Our therapists work on functional goals that are specific to individual families,” says Tess Bardikoff, BIRT social worker. “Practicing skills one-on-one with a therapist in our gym is not the same as practicing skills at home like navigating a staircase, toileting, bathing.”

This element is key to staff understanding where each child is at in their journey, and key to building confidence when discharged.

Working with families to reinstate the Weekend Pass

Holland Bloorview has always prioritized authentic and meaningful engagement of clients and their families. Listening to their needs despite a pandemic was no exception. In July 2020, staff and client families co-created a thoughtful approach that reinstated the Weekend Pass program – on the back of evidence-informed practices and a focus on client safety and family needs. 

Cheryl Peters, a family leader and mother to a Holland Bloorview client, sits on the hospital’s pandemic steering committee to provide the parent perspective on policies and pandemic recovery efforts. “It's so important for clients to be able to go home on weekends and get ready for life beyond the inpatient clinic. It's vital for their successful rehabilitation journey and for helping families regroup and get back to a new ‘normal’.”

The development of a comprehensive checklist signaling client readiness, while providing parent and caregiver education regarding safety protocols, were key to successfully reinstating this program.

A meaningful difference

With weekend passes back in play, BIRT and SODR staff saw immediate positive changes in demeanor among the children, who seemed more engaged in therapy.

“Parents would describe important developments, like their child being able to use their left hand again while playing with their sister,” Tess says. “These kids can make dramatic improvements when they are at home with their siblings – improvements that are great jumping off points when they return to us to continue their efforts.”

After the program returned, Nicholas says the conversations reverted back to what they needed to be – focused on rehab and client goals.

“In fact, we were able to accelerate both admissions and discharges, allowing kids to return home and restart their lives sooner.”

Relaunching the Weekend Pass program was successful because it was a decision made by all stakeholders, including front-line staff and the families they care for.

“The ability to flexibly institute a program amidst the regulations and uncertainty is a testament to trusting families, and to working with them both within our walls and beyond them,” Nicholas says.