David Estrada, paralyzed from the chest down in a motorcycle accident 18 years ago, remembers well his miserable three months in a rehabilitation hospital room he shared with three other patients.
That experience inspired him to help others with disabilities, which is why Estrada stopped short as he rolled his wheelchair through the new Spaulding Rehabilitation Hospital in Charlestown during its construction last winter. He’d heard there was a panoramic water view from the hospital’s third-floor gymnasium, but he was not seeing it. The sills blocked the view of anyone in a wheelchair.
“I said to the construction guys, ‘You must be serious about wanting people to focus on their therapy in the gym, because I can’t see out the window,’ ” said Estrada, director of the Greater Boston Chapter of the National Spinal Cord Injury Association. Estrada’s observation prompted the lowering of the sills. Price tag for the redo: $300,000.
Every nook of the new Spaulding, on the tip of the old Charlestown Navy Yard, was designed to eliminate barriers, starting with sensors that open doors with the nod of a head. The facility is emblematic of the transformation rehabilitation medicine has undergone.
A profession that once healed frail tuberculosis patients and battle-scarred World War II soldiers has evolved into a high-tech field that treats the most challenging of traumatic brain and spinal cord injuries.
Among those expected to get care at the new Spaulding are some of the people injured in last week’s Boston Marathon bombing, including 14 patients with amputations, who will face daunting months of rehabilitation to relearn many of the most basic activities of daily life.
“We are bringing rehab medicine out of the basement,” said David Storto, president of Spaulding Rehabilitation Network.
Scheduled to open Saturday, the $225 million, nine-story hospital will replace Spaulding’s 42-year-old facility on the Charles River in Boston. The worn, 10-story facility was fashioned out of a former nursing home with infrastructure that is now largely obsolete. Bathrooms in patient rooms are not large enough for a person in a wheelchair, forcing patients to either wait for help or wheel down the hall to the few accessible bathrooms on each floor.
Compare that with the new facility: U-shaped cutouts at reception desks and nurses stations allow wheelchair users to pull straight up and face the person behind the desk at eye level, instead of having to sit sideways. Sink basins are tilted to minimize splashing on wheelchair users. There are few shiny metal surfaces, to reduce glare for those who depend on lip reading.
And carpets are sunk into the floor so the nap is level with the surrounding space. “If you are on wheels, this is unheard of,” Betsy Pillsbury, the disability resource coordinator for Partners HeathCare, the parent company of Spaulding, said of the smooth nap. “Otherwise, it’s like pushing wheels through sand, it’s so hard.”
Rehab hospitals are being reborn in other cities as well. The Rehabilitation Institute of Chicago is replacing its 39-year-old hospital with a $450 million facility twice its size that will feature substantially more room to incorporate research in rehab therapy. In Massachusetts, three of the five hospitals that have received state permission since 2000 to construct replacement buildings are rehabilitation facilities.
“When [many of] these hospitals were built in the ’60s and ’70s, they had lots of double-occupancy rooms and in some places triple rooms, and they also did not have all of the mechanized equipment that we have now,” said Dr. Alberto Esquenazi, president of the American Academy of Physical Medicine and Rehabilitation, and chief medical officer at MossRehab in Pennsylvania.
State of the art for rehab hospitals now includes private rooms, largely to improve infection control and to accommodate modern equipment, Esquenazi said.
The renaissance comes at a crossroads for the industry. The aging populace has increasing need for rehabilitation services, particularly for stroke care, and in the past that drove many hospitals to expand their rehab offerings.
“The rehab area has become a very big segment of health care spending, particularly for people in Medicare,” said Stuart Altman, an economist and Brandeis University professor of national health policy.
But the federal Medicare program has tightened restrictions on the length of time patients can spend in rehabilitation facilities and is considering other payment reductions. That squeeze has led to the closing of roughly 200 rehabilitation units within hospitals nationwide since 2006, said Marsha Lommel, chair of the American Medical Rehabilitation Providers Association .
Spaulding and other rehab hospitals have responded to this changing landscape by building their new facilities with fewer beds, more technology, and more space to treat people on an outpatient basis, which is less expensive.
Storto, Spaulding’s president, estimates that 90 percent of those treated in the new building’s therapy pools will be outpatients. The hospital expects that the number of annual outpatient therapy visits, currently about 20,000, will grow, while its approximately 2,400 annual inpatient admissions will remain about the same in the new building.
Spaulding’s new home on the waterfront reflects its nautical surroundings, from an ocean-colored, floor-to-ceiling tile sculpture in the lobby, to a harbor walk that wraps around the sleek glass and recycled-aluminum building. The path will be open to the public and includes access points for casting fishing lines and even places for people to clean their catch.
Rooms have sophisticated ceiling-mounted lift systems to move severely disabled patients from their beds to the bathroom and shower. The building also includes more elbow space for the hospital’s motion analysis and robotic laboratories, where researchers analyze patients’ gait and create devices to help those who have suffered strokes, brain injuries, or other debilitating illnesses walk again.
Pillsbury, who uses a wheelchair because of a spinal cord injury, said she worked closely with the project’s architects, Perkins + Will, to help them design a building sensitive to the needs of disabled patients. The architects spent a day in the old hospital entirely in wheelchairs, she said, to help them understand the perspective and challenges.
And yet, everyone missed the too-high gym windows until Estrada pointed out the problem, underscoring for Spaulding’s leaders the value of continually soliciting feedback from the disabled community.
Storto said hospital leaders exhaustively considered other options before deciding on a brand new facility, such as renovating and expanding the hospital’s current site on Nashua Street, or moving into another building. But the other choices were nearly as expensive and logistically impractical, involving, for example, temporarily displacing patients.
Building a new Spaulding was a labor of patience and fortitude. Storto said hospital leaders started researching their options in 1998 and decided to go with a new building in 2004, But by the time Partners executives gave the go-ahead, they ran headlong into the recession in 2008, which put funding for the project on hold for a couple more years.
When shovels finally broke ground in 2010, it was first for a yearlong, $23 million cleanup of PCBs, lead, fuel oils, and other contaminants left behind by the Navy.
If all goes according to schedule, moving day on Saturday will be carried out with military-like precision, planned by one of Spaulding’s occupational therapists who, as a major in the Army Reserve, helped move medical bases during several tours of Iraq.
Kevin Love said he has backup plans to his backup plans, with contingencies in the event of rain, snow, power outages, computer failures, phone failures, traffic backups, and then some. “We live in a world where stuff happens,” Love said.
At 5:45 a.m., the first group of five patients from Spaulding’s Nashua Street hospital will be moved from the sixth-floor stroke rehab unit to the lobby, checked out, loaded into ambulances or a van, depending on each one’s mobility, and driven the 1.8-mile route to the new Charlestown site. There, each will be wheeled in, checked in, and taken to his or her bed, with the same staffer assigned to a patient from bedside to bedside.
Groups of five patients will be moved out of the old Spaulding every 15 minutes until all of the roughly 132 patients are in new beds in Charlestown no later than 3 p.m. The move will require 200 staffers, Love said.
The Nashua Street facility will remain with Partners, likely to be used for administrative space.
Estrada, who is also a spokesman for the Boston Police Department, said the new Spaulding is a hospital he couldn’t have imagined 18 years ago during his rehab. He has toured it four times in the past year, and is excited that the association will have a satellite office there.
The third-floor gym, one of his favorite features, “is going to be a place that I think will feel communal. It’s welcoming,” said Estrada. “We have come a long way in 18 years in awareness.”
Correction: An earlier version of this story gave an incorrect name for the Rehabilitation Institute of Chicago. The story has been updated with the correct name.