Aging II Flashcards
What does acute care hospital consist of?
- Emergency department
- Critical care
- Complex medical conditions
When a patient has medicare how long are they expected to need medically necessary hospital care in order to be admitted?
2 or more nights
What is the number one cause of acute care hospitalization?
Congestive heart failure
What does the acute care physical therapist do?
- Perform thorough chart review
- Tries to establish patient’s prior level of function was
- Assess strength & balance
- Assess functional mobility
- Monitor vitals & tolerance to activity
What is the goal of acute care physical therapy?
- Assess patients mobility and provide recommendations for discharge planning
Describe the type & number of patients an acute physical therapist will see? And the setting?
- Patients tend to be very ill, post-surgical, complex
- PT tend to see a high volume of patients
- Setting is fast paced & unpredictable
- Treatment session tend to be short
T/F: As an acute care physical therapist you will have to make justification for medical necessity of DME for insurance reimbursement
True- EX may be walkers, canes, wheelchairs, hospital beds, transfer boards, crutches
What is the average length of stay in acute care physical therapy?
2-3 days
What should be considered in discharge planning?
- Determine appropriate D/C location
- Identify needs for smooth transition
- Begin process of meeting pre/post DC needs
- Consider all disciplines
- Provide realistic options to pt
What documentation for inpatients acute rehab is required daily?
- Pre-admission screen & post admission evaluation
- Comprehensive plan w/ multiple services
- MD overseeing care
- Progress notes
- Team conferences
What is the criteria for admission to inpatient acute rehabilitation facility?
- Active ongoing therapy from multiple discipline (one must be PT or OT)
- Intensive rehab (over 3 hours/day, 5 days/week)
- Reasonable expectation of significant benefit & measurable improvement
- Physical supervision
- Intensive, coordinated interdisciplinary approach
Name some conditions commonly treated in acute inpatient rehab
- Stroke
- SCI
- Amputation
- Major multiple trauma
- Brain injury
- Neurological disorders
- Arthritis medical conditions
When can knee or hip joint replacement be treated in acute inpatient rehab?
- If bilateral
- Pt BMI greater than 50
- Patient was 85 or older
What is subacute rehabilitation?
Short - term program of care which typically include 1-3 hours rehab per day for at least 5 days per week
How does someone qualify for sub acute care rehab?
Patients must have a definitive rehab goal & identified needs for skilled care
What is home health care?
Agency provides services within patients home
What is the eligibility criteria for home health care?
- Under physicians care
- Require 1 or more services
- unable to regularly leave home (homebound)
What does it mean for a patient to be homebound?
Challenging and taxing to leave the home, may require assistance or assist devices
On average what is durations and frequency of a home health care session?
- 30 to 60 min
- Average 1-3x per week
What assessment is conducted on start of care, discharge of services or resumption of home health care?
Outcome and Assessment Inform Set (OASIS)
What are adult day services?
- Adjunct facilities to Rehab centers
- “day hospitals”
- Provide respite care for family caregivers
Describe independent living
- Handicap accessible
- Dinner may be included
- Does not require 24 hour supervision
Describe assisted living
- Meals included
- Medication management
- Prefer environment 24 hr supervision
- Can have needs safely met
What are some possible reasons that someone may go to assisted living?
- Possible visual/hearing impairments
- May require some ADL assistance
- Independent transfer, walk, w/c
Why may someone go to an enhanced care memory unit?
Require additional care due to memory deficits
Describe Long Term Care
- SNF or floor of acute care hospital
- Assistance needed 24/7
- Therapy services available if necessary
- Manage chronic conditions
Describe wellness centers
- Community or medical facility based
- Focus on general fitness, prevention, health & wellbeing
- General or disease - specific
What is the goal of wellness centers?
- Enhance function & fitness
- Decrease risk of disease or adverse event
How is care often delivered in wellness centers?
- Group settings
- Fitness instructors/personal trainer
Describe hospice care
- Compassionate care for people with life-limiting illness or injury
- Considers patients needs and wishes
Where can hospice care be provided?
- Home
- Long term care
- Hospice center
What is an advanced directives?
- Documents that are completed by a patient prior to onset of an illness that dictate how the patient want their end of life care to be carried out
- Durable power attorney and a living will are two types of advanced directives
What is a living will?
Legal document in which a patient dictates their preference for health care treatment, which become especially important, if the patient becomes terminally ill and can no longer express their wishes
What is a DNR?
- Do not resuscitate
- Medical order written by doctors that documents a patients wishes to not be resuscitated with CPR if they stop breathing or heart stops beating
What is the definition of hospice?
- Form of palliative care for terminally ill patients who have a limited life expectancy that focuses on the management of their pain & other symptoms as well as the acceptance of their own death
- Goal is to allow patient to remain in their home as they near death, though there are inpatient facilities that provide these services as well
What is palliative care?
An approach to a patients care that aims to relieve their pain and suffering as well as address and psychological, social, & spiritual problems with the goal of improving the patients quality of life
What are 7 essential care transition interventions?
- Manage medications
- Transitions planning
- Patient & Family engagement and education
- Information transfer
- Follow up care
- Health provider engagement
- Shared accountability
Medicare is a federal health insurance program given to people 65 years or older who meet what criteria?
- Qualify for social security benefits
or
- currently reside in US an are either (A US citizen or a permanent US resident who has lived continuous in US last 5 years)
Medicare is a federal health insurance program given to people under 65 years who meet what criteria?
- Have a disability (usually 2 year wit period)
- End stage renal disease
Does a patient pay a copay with medicare or medicaid?
Medicare
What is medicaid?
Federal - State health insurance program for low-income & needy people
What is a fall?
Even where an individual unexpectedly comes to rest on the ground or another lower level without known loss of consciousness
Falls forward or backward often result in what fractures?
Wrist fractures due to reaching to prevent falls
Falls to the side often result in what fracture?
Hip
Falls on buttocks result in what fracture?
None usually
Name some risk factors for falls
- History
- Age
- Living Alone
- Meds
- Medical condition
- Muscle weakness
- Gait & balance problems
- Fear of falling
- Nutritional deficiencies
- Impaired cognition
- Visual impairments
- Environment hazards
- Footwear/clothing
- Inappropriate walking aids or assistance devices
What does a multi factor falls risk assessment include?
- Focused history
- Physical exams
- Functional exam
- SOM
- Environment assessment
What is the recommended amount of moderate or vigorous intensity exercise?
- Moderate: Aerobic exercise greater than or = 30 min, greater than or = 5 days/week (150 min total)
- Vigorous: 20-60 min greater or = 3days/week for at least 10 min durations
What is the recommended amount of balance exercises?
Greater than or = 2x/week for patients with balance problems or history of falling
What is the recommended amount of strength training?
Major muscle groups greater than or = 2x/week at range of 8-12 reps
