Last week's column described inpatient rehabilitation facilities, IRFs, also called rehabilitation hospitals. These facilities treat patients with severe problems typically following a hospital stay for a major illness, injury or surgery with complicating factors. Mountain Valley Regional Rehabilitation Hospital in Prescott Valley (, with 40 beds, is the only freestanding IRF in north central Arizona.

Its parent company, Ernest Health, Inc. operates 19 facilities primarily in the south and west. Astonishingly, every one of its rehabilitation hospitals ranks in the top 10 percent of such facilities nationally.

To be discharged from a regular hospital to a rehab hospital, people need to meet two milestones. First, they must be medically stable, meaning that life-threatening conditions are under control and no longer pose an immediate danger. Second, they must be physically, mentally and emotionally able to participate actively in various intensive treatments such as physical therapy, which might start as early as 6:30 a.m. and be scheduled throughout the day.

Patients may still have medically complex cases. For example, they may have a breathing tube and/or a feeding tube. Mountain Valley has at least one doctor on site six days a week; patients can see a doctor almost daily if needed.

Mountain Valley, which opened in 2006, is laid out with an excellent but uncommon design: no patient room is more than five doors away from the central nursing station. This layout means that nursing staff can quite easily get to any room very rapidly. A few of the rooms closest to the nursing station are set up with extra equipment for patients who require the greatest amount of care.

The first feature of the facility that visitors are bound to notice is that surfaces everywhere are blindingly clean. Floors, walls, counter tops - the facility looks as if it just opened for the first time 20 minutes ago.

The second striking feature is that care is designed to help ensure that patients never feel as if they are simply a room number or a medical case. All employees, not just those whose jobs involve direct patient care, are expected to greet all patients - and their visitors! - by name whenever they see them, even though most patients stay only two or three weeks. Even administrative employees regularly help patients get to the dining room for meals.

A third impressive characteristic is that family members are actively encouraged to be involved in the patient's care and to join the patient for meals. They, like patients, are encouraged to ask questions. This deliberate stance toward family members is a welcome change from sites where harried staff members may view the presence of family members as an irritation and questions as annoying.

About a week before an individual is expected to leave the rehab hospital, Mountain Valley escorts them on a visit to their home. Mountain Valley staff work with the patient and family members during that field trip to identify needed modifications or equipment that will allow the patient to function successfully once at home. When people are discharged, all available staff gather in the lobby to cheer them on and wish them well.

How do all these arrangements work out for patients? For Joan, transferred to Mountain Valley after her second hospital stay in three weeks to deal with multiple serious side effects of previous treatment, the care was nothing short of spectacular.

She reported, "They were unbelievably wonderful. They were just unreal. Talk about a top-of-the-line place. They had every option there. The doctor on staff came in every single day to talk with me, every single day. At one point, he asked me if I wanted to talk with a psychologist, given everything I had been through. I agreed, and they came in - every single service that you wanted was there. They offered it. You were aware of what was going on. You had instant reaction. If I had to go to the bathroom - I couldn't get there by myself - if I pushed that button they were right there. I can't even say enough about how good the care was."

After 16 days, Joan was well enough to be sent home. The next column discusses her experience with home health care.