Continuum of Care Flashcards
Inpatient Acute Hospital (Short Term Acute Hospital - STAH)
- 24-hour physician and nursing care
- Admit from Emergency Department (ED), direct admit, or transfer from another facility
- Need for medical/surgical management
- May have trauma center or not
- May treat people in the Intensive Care Unit (ICU)
- Length of stay (LOS) varies depending on the diagnosis & recovery
- LOS can be anywhere from 2-3 days to 1-2 weeks…if it’s anything more than this, there has been complications or a need for continued hospitalization.
- Role of the OT: may be direct or consultative in nature: safety assessments, assessing client’s abilities, ADL, ADL transfers, safety, recommend disposition/discharge place, recommend continued services/HHC/IHSS. Discuss typical precautions: swallowing, fall precautions, cardiac, spinal, hip, vitals
Long Term Care Hospital
Require 24-hour care for an indefinite period of time…physical and mental health
Doctor & nursing staff available 24/7
“Sickest of the sick”
Transfer from hospital, nursing home, or home
Average length of stay is > 25 days
Not “forever” care – not a nursing home
Minimal rehabilitation
OT services direct or consultative in nature
Diagnoses Named in the “75% Rule”
- Fx of Femur (Hip)
- Stroke
- Spinal Cord Injury
- Brain Injury
- Burns
- Congenital Deformity
- Amputation
- Major multiple trauma
- Neurological Disorders (MS, MD, polyneuropathy)
- Polyarthritis (including rheumatoid arthritis)
- Systemic vasculidities with joint inflammation
- Severe/advanced osteoarthritis
- Hip or knee joint replacement (1. If the patient underwent bilateral knee or bilateral hip joint replacement surgery during acute hospitalization.
- The patient is extremely obese with a Body Mass Index of at least 50 at time of admission to inpatient rehabilitation hospital.
- The patient is age 85 or older at the time of admission.)
Skilled Nursing Facility/Transitional Care
Require special, 24-hour care for either a short or extended time period
“Bridge the gap” with another level of care
Admitted from acute care hospital
Can be a unit in a hospital or a free-standing nursing home
Short-term stay: up to 100 days, Long-term stay: as long as needed
Role of OT and precautions - similar to acute rehabilitation; however, intensity is not the same
Person can be sent home after a stay at this setting, or can go back to acute rehabilitation if they need more/can tolerate more intensive therapy
Extended Care Facility (ECF) or Long-Term Care (LTC)
Require 24-hour care for an unknown amount time
May transfer from hospital, nursing home, or home
Person needs assistance with self-care
LOS is variable and indefinite
OT Role is direct or consultative in nature
Home Health Care
Promote engagement & participation in all areas of occupational performance
Ultimately decrease the need for continuous care
In 1965 the Medicare Acts (Title XVIII of the Social Security Act) and Medicaid (Title XIX of the Social Security Act) resulted in the inclusion of home health care
Gatekeepers for home health services are nurses, and the next most utilized service is PT and then social work, OT, and SLP.
PT referrals are double the amount of OT referrals
The Role of OT in Home Health
Home health aides typically performed the ADL and IADL FOR the clients
OT plays a critical role on the home health team because of the focus on the client’s performance & skills.
Requires skills in cultural competency, advocacy, context sensitivity, ethics, situation analysis, conflict management, & flexibility
Pros & Cons of treatment in the home – idea of transferability
OASIS (Outcome and Assessment Information Set)
Palliative Care
Medical specialty for those who have illnesses which cannot be cured
Symptom control, quality of life, living life to its fullest, communication, collaboration, spiritual support, multidisciplinary team
Hospice is a philosophy of care that is a foundation for the palliative approach
Outpatient Therapy
Need for medical or surgical care, need for skilled intervention
Usually live at home and attend 2-3 times per week…sometimes more depending on diagnosis
Free-standing or part of a hospital
Number of visits varies on diagnosis, insurance, skilled need
OT Role: ADL, IADL, community reintegration, “fine-tuning”
Day Programs/Community Based Programs
People requiring socialization or supervision (however, live at home)
Social or medical services are provided (programming includes: social, medical, and dementia-specific)
OTs modify and adapt activities for specific client needs, direct care provided for ADL, IADL, safety
Assisted Living
Housing & personalized support for those needing help with ADL
Can still have independence in some areas, but may need help with ADL and medication management
Allow for privacy
For people who do NOT need skilled medical care
Services available: linen service, meals, social activities, local transportation, laundry, housekeeping
Private pay, state assistance, Medicaid voucher
Can receive personal care, but not skilled medical care
OT’s role can be consultative in nature, assist with modification and adaptations, programming and promoting safety throughout the facility
Direct services to residents: safety, ADL assessments, IADL assessments & interventions, social activities
Education of direct service staff regarding issues on aging, occupation, and health promotion.
Continuing Care Retirement Community (CCRC)
Campus providing a continuum of care: independent living to assisted living to skilled nursing care (all in one location)
Services: dependent on level of care
Cost: monthly fees, buy-in/entrance fees, depends on type of contract
State-regulated
Payments vary: can be an extensive contract, modified contract, fee-for-service
Can enter into a contract when the older adult is healthy; preparing for the future and anticipating that he/she might need nursing care/medical assistance later in life
Can live in the Independent Living section in his/her own house/condo; if/when start needing assistance with ADL, can move into Assisted Living portion…if hospitalized and needs rehabilitation, can go into the Skilled Nursing portion…he/she is always reassured of getting the care needed without re-locating!
Payment in terms of contract: extensive contracts can offer unlimited LTC for little or no increase in monthly fees as older adult continues to live there…modified contract means that a specified amount of health care is agreed upon, but then extras would be an extra cost. Fee-for-service could be the least expensive: only pay for what you need…but if something happens & person needs extensive medical care, can be a risk and cost can be very high…
Independent Living
Residence in private apartment or house in a community living setting
No custodial or medical assistance
Optional services available
Cost is dependent upon location, local market, services provided
No formal regulations from the state or federal government
Private pay, but some subsidized housing through Section 8
