In Israel, Adapting Rehabilitation to the Reality of Coronavirus

When Corona came, the first feeling I had was guilt. 

As a geriatric nurse practitioner, with much-needed clinical skills, I felt that sitting behind my computer at JDC, developing and managing rehabilitation centers somehow wasn’t right. Surely, I was needed at the coal face, in the acute care hospitals, or nursing homes. With horror stories flooding in from Italy I was certain all health care professionals would soon be called into help.

Instead, I was home with my husband, David — a high school principal who began running his school online from our lounge room — and my four children, aged 10-19. My 19-year-old son, Itai, a soldier in his first year of nursing studies through the army (The apple does not fall far from the tree!), had, much to his disdain, been sent home from university to study 40 hours a week online and was sleeping and studying on the couch in my home office. 

We quickly fell into a routine of working from morning to night. We discovered working from home meant there were no real office hours — you could start at 6am and still be going at midnight, because no one ever came to clean or turn off the lights, and because the kitchen and the laundry were only meters away. Between Zoom and Teams meetings, I cooked with my son and daughter, had family dinners every night (something that once only happened on Shabbat), built 3D puzzles, played many games of cricket, and had family games nights.  

On Friday evenings, we went out onto our front porch and sang Kabbalat Shabbat with our many neighbors, some of whom we had never met. My children who all play musical instruments, continued to play daily and receive lessons from their music teachers via WhatsApp video. I cooked and shopped for elderly in need and my sons did the deliveries all over Jerusalem. I continued teaching my gerontology course via Zoom and volunteered in the evenings on a Corona hotline. Itai volunteered for MDA on the ambulance and taking Corona tests. His highlight was delivering a baby in the back of the ambulance. Pesach came and went, and we spent our first ever Pesach, on our own, at home.

Though I was at home, I was also facing one of the most tumultuous times of my career. In horror I watched as all six of the Misgav rehabilitation centers I had poured heart and soul into over my two years at JDC were forced to close one by one. I was under no illusions — not all would be able to reopen. It was clear that the 90 or so active clients who were in the middle of the rehabilitation process would have their rehabilitation halted. Tele-rehabilitation was always in our plan for the Misgav rehabilitation centers, and we had a small pilot running in one of our centers, but we always faced so much resistance. Realizing it was the only route, my team at JDC-Eshel and I set out to get our clients online. 

Amazingly, in the face of Corona, all the barriers to tele-rehabilitation fell away.

Amazingly, in the face of Corona, all the barriers fell away, the Ministry of Health agreed and health care professionals who were skeptical agreed to give it a try — it was better than nothing. Processes that would have taken months were achieved in days, programs written and approved, funding found, providers chosen, contracts written and signed. Within three weeks the first of our patients were receiving a full rehabilitation program online, including medical, nursing, physiotherapy, occupational therapy, social work, speech pathology and psychology.  

Unfortunately, we have not managed to get all our clients online. Haredi Jews and Arab Israelis from the villages in the North did not have access to the technology required, other elderly clients were unable to use the technology or just didn’t want to, and we were also unable to take clients who lived alone as there were too many safety concerns. On the bright side, we were able to continue to rehabilitate a third of our clients, who reported in interviews that, for them, there was little difference in receiving the therapy online instead of in the center, that they had continued to improve, and that in these challenging times the tele-rehab had been a lifeline. We also interviewed the professionals who provided the therapy, who were thrilled with the results — a new possibility for therapy had been opened to them, skepticism removed. Though they did not feel it fully replaced hands-on therapy, they did feel that it had its place and would be an additional tool for providing ongoing rehabilitation care.

A door has opened and at JDC Eshel we are not going to let it close. We are in the process of rebuilding our Misgav model to provide rehabilitation care not just in our centers, but at home and online as well. We are currently training all our Misgav teams in the provision of online therapy. Where in the past in Israel, rehabilitation was provided in the hospital, at home, or in the community, clients will now have the option to combine their treatment setting and receive their therapy in all three, over the same time period. No other model like it exists in Israel. Not only does it allow for more flexibility for our elderly clientele, it also means that we are prepared, in the case of another wave of Corona or something similar.

Directly after Pesach, I was approached by the Knowledge Development of JDC-Eshel, and the Geriatric Department of the Ministry of Health, to assist them in training emergency response teams for nursing homes. Promising good wages, they had managed to recruit quality people of all ages and backgrounds, people who under normal circumstances would not have considered working in nursing homes. But they needed to learn the job. 

As education is my other love, I was thrilled at the opportunity. Over a period of three weeks, we educated over 100 people, providing a crash course in the nursing care of the elderly —How to Be a Carer in 12 Hours — all via Zoom. I taught people how to change a diaper using videos, explanation, and discussion, as well as covering all the other aspects of nursing care.  On finishing their two days of training with us, the trainees were assigned to work in nursing homes all over Israel. 

Life is slowly returning to normal: David is back at his school in Tel Aviv; Itai is back at university in Haifa; and the other kids are back at school. I’m still working from home, though, focusing on rehabilitating my rehabilitation centers with our new model. Only now I don’t feel the same sense of guilt. I know with full certainty that I made an important contribution. Treating tens of people in a hospital or a nursing home may seem insignificant in the face of a global pandemic, but each life is precious and impacts many more. The new techniques we implemented will go on to impact many, many more in the future. And if I could do that while sharing some quality time with my family, that’s even better.

Amanda Klahr is a nurse practitioner and the Program Director of Geriatric Rehabilition Centers for JDC-Eshel in Israel.

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