One of the first things that patients get at the Roosevelt Warm Springs Institute for Rehabilitation is a shower.

"We believe in water-on-the-body bathing. We know it makes people feel better," said Kathy Clark, RN, MSN, CRRN, assistant director for nursing at the Roosevelt Warm Springs Inpatient Rehabilitation Hospital. "They may have come from critical-care units and had only sponge baths for a long time.

"We start by asking them if they can sit up and feed themselves, and we get them in the shower. They quickly realize that there might be life after the stroke or accident after all."

The healing waters and the goal of empowering people to thrive have been at the heart of this institute for 80 years. It was the 88-degree water used as therapy for his polio that brought future President Franklin Delano Roosevelt to Warm Springs in 1924.

Wanting to share the relief and strength he found there, Roosevelt bought land and established the Georgia Warm Springs Foundation in 1927. It became a world-renowned polio treatment center and was the catalyst for research that led to Jonas Salk's polio vaccine in 1954.

With polio all but eradicated in the United States by the mid-1960s, the Roosevelt Warm Springs Institute for Rehabilitation shifted its focus to help patients recover from strokes, orthopedic problems, and brain and spinal-cord injuries.

Under the direction of the Georgia Department of Labor, the 940-acre campus has grown to include an array of programs that serve about 5,000 clients annually. The facility has separate rehabilitation and acute-care hospitals; a residential vocational rehab program to train people with disabilities for jobs; and specialized outpatient services, such as wound care and wheeled-

mobility clinics.

Disabled-access gyms, pools, a 12-acre fishing lake, a golf course, tennis courts, cabins and paved trails are used for therapy, recreation and competition, including the Roosevelt World Basketball Challenge for wheelchair athletes. Camp Dream in Warm Springs hosts camps for patients with disabilities and diseases.

'The Roosevelt way'

The staffs, buildings and programs at the Roosevelt Warm Springs Institute for Rehabilitation are all connected by what new CEO Gregory A. Schmieg calls "the Roosevelt way," meaning that the facility has always been about the rehabilitation of mind, body and spirit.

"I was overwhelmed by the history of the place when I first walked through Roosevelt Hall," he said. "But this place is a living history, not a memorial."

Schmieg is proud of the private/public funding partnership that built Blanchard Hall, an $8 million, 35,000-square-foot outpatient-services facility that just opened.

He also revels in the Quadrangle's 125 columns, paid for by donations from former staff members, patients and supporters. The column campaign raised $141,000, and 300 people from all over the country attended the dedication.

"Many former patients and their families spoke, and the consistent theme was the caring and compassion they had found here," Schmieg said. "That spirit still lives here. Our doctors, nurses and therapists go about the business every day of focusing on their patients, and that's the way it's always been."

A rehabilitation nurse for 20 years, Clark said that it's a nursing specialty that takes physical strength and patience.

"You see a lot of sadness and suffering," she said. "A lot of patients feel like their lives are over when they come to us. Their mind is occupied in therapy during the day but, in the middle of the night, the nurse hears the tough questions."

A teenager with a spinal-cord injury wondered what he could do with his life or whether anyone would ever want to marry him. A patient debilitated by a stroke said he believes that he's useless.

"We tell them they don't have any control over what happened but that they can't give up. If they try, things can get better," Clark said. "Our job — and it's a team effort — is to build some structure into the chaos, to give them back some control and choices."

There's no time to waste. At one time, patients stayed for 32 days; now Medicare pays for only 14.

"We have to prioritize what we can do that will be the most effective in that time — exercise, bladder and bowel control, activities for daily living, education about managing their disease and medications," Clark said. "Figuring out what each patient needs to know and do is like putting the pieces of a puzzle together. You learn from patient to patient."

Making progress

It's hard for nurses not to intervene when they see patients struggle, but doing so would not help them, Clark said. "When you see someone put a shirt on 100 percent by himself and see the look on his face, then you know you've done what you're supposed to do. I love being able to see a patient progress," she said.

Two three-hour sessions with therapists in the gym make that progress possible, said Sonal S. Nakrani, OTR/L, therapy program adviser.

"With so many different kinds of patients, we're always advancing our skills, and the support from the administration is always to do the right thing for the individual patient. This is a learning environment for everyone. We coach them, we motivate them and we see some very successful outcomes," said Nakrani, who has worked at Warm Springs for 14 years.

Recreational therapists find out what patients like to do and help them learn to do it again with adaptive equipment.

"If someone likes to fish, there's no reason why he should stop because he's been injured," Nakrani said. "A therapist will take him down to the lake to fish, and, at the same time, work on standing, balance and endurance skills."

Therapists help patients get up, dressed and groomed in the morning.

"Instead of the latest gadgets, we do a lot of work with our hands," Nakrani said.

There is little personal space for therapists, said René James, PT. "The idea is to get [patients] out of a wheelchair and into our hands," she said. "Some patients have never had a caring touch. Partly, it's my job, but also it's my nature."

James worked at Warm Springs as an intern, fell in love with the work environment there and joined the staff in 1994. Despite the rural location, "it's not Podunk," she said.

She said the care is progressive, and therapists are encouraged to attend conferences and earn certifications.

"The support I feel here, the people and that feeling of making a difference are why I do it," she said. "So many people don't get to see the results of what they do in their work. When someone walks for the first time, everybody claps and cheers them on."

James recalled the arrival of a patient with Guillain-Barré syndrome, who needed someone to scratch his nose because he couldn't move.

"He had the greatest attitude, and the whole team worked with him. He walked out of here and came back later to thank us," she said.

Sometimes, former patients come back to encourage others. James is proud that many of the dedications on the new columns came from patients who wanted to honor staff members.

"It's the Roosevelt spirit," Nakrani said. "What he started, we carry on."