Discharge Planning from Acute Care Flashcards
Discharge Planning from Acute Care
Post Acute Care (aka Inpatient Facilities) include?
- Inpatient Rehab Facility
- Skilled Nursing Facility
- Long Term Acute Care Hospital
Discharge Planning from Acute Care
What facility?
- Inpatient care to residents that are relatively medically stable.
- 24 hour nursing care, a minimum of weekly physician visits
- Patients participate in at least three hours, five days per week of skilled therapy.
- Dx such as CVA, TBI, SCI, amputations, complicated post surgical/medical conditions or other neurological disease processes
- Average Length of Stay 13.1 days
Inpatient Rehabilitation Facility (IRF) or
Acute Rehab Facility (ARF):
- Patients May need multiple therapy disciples (at least two therapies is required).
- Patients Need additional help to recover from an injury
- Patients are unable to return to prior living arrangements upon D/C from hospital
- 60% of ALL IRF patients must be within the 13 diagnostic categories
- May require social work assistance for discharge planning
Physical Therapists in Inpatient Rehabilitation:
- Offer intense therapy to maximize functional outcomes
- Work as part of the healthcare team for discharge planning
Discharge Planning from Acute Care
What facility?
- Requires very close medical supervision
- Patient cannot be effectively managed at a lower level of care
- Patient typically requires >25 day LOS
- Can receive therapy services, but likely limited in time
- Common Dx: Respiratory failure and unable to wean from ventilator, evolving wounds
Long Term Acute Care Hospital (LTAC or LTACH):
- Requires very close medical supervision (slightly less than hospital as pt is considered stable)
- Patient cannot be effectively managed at a lower level of care
- Patient typically requires >25 day LOS
- Medicare Part A or private insurance
- Discharge to home setting: 27% (2006 data)
- Can receive therapy services, but likely limited in time
- Common Dx: Respiratory failure and unable to wean from ventilator, evolving wounds
Physical therapists in LTACH:
- Skilled intervention
- Determine if there is a potential for improvement (need for post acute)
Discharge Planning from Acute Care
- Prolonged ventilator use or weaning
- Ongoing dialysis for chronic renal failure
- Intensive respiratory care
- Multiple IV medications or transfusions
- Complex wound care/care for burns
Typical Patient Diagnoses in?
Long Term Acute Care Hospital (LTAC or LTACH):
Discharge Planning from Acute Care
What facility?
- Inpatient care with 24 hour nursing supervision
- Require medical and/or rehabilitation services in order to maximize functional outcomes
- Require supervised living conditions
- Must be able to tolerate at least 1 hour of skilled physical rehabilitation per day up to 2.5 hours
Sub Acute/Skilled Nursing Facilities (SNF):
- Inpatient care with 24 hour nursing supervision
- Nursing and/or Rehabilitation
- “skilled”-inherent complexity of the service can only be performed safely and/or effectively by or under the supervision of a skilled therapist.
- Require medical and/or rehabilitation services in order to maximize functional outcomes
- Require supervised living conditions
- Must be able to tolerate at least 1 hour of skilled physical rehabilitation per day up to 2.5 hours
- Physical or occupational therapy services in most cases, SLP available
- Pts may be recuperating from any host of diagnostic categories
- Discharge to home setting 45%
Discharge Planning from Acute Care
What facility?
- Private Pay for temporary stay in Assisted Living Facility
- Patient who demonstrates ability to perform in a home setting with intermittent services but unable to live in usual home setting due to architectural/service barriers related to current injury/illness
Assisted Living with Respite Care and Home Health Services:
- Private Pay for temporary stay in Assisted Living Facility
- “Respite Care”- a short period of relief from something difficult or unpleasant
- Home Health services covered by Medicare Part B
- Patient who demonstrates ability to perform in a home setting with intermittent services but unable to live in usual home setting due to architectural/service barriers related to current injury/illness
Discharge Planning from Acute Care
What facility?
- Services including skilled nursing and rehabilitation delivered in the home setting
- Pts are medically or sufficiently stable to be discharged from an acute or post acute facility
- Must be homebound
Home Health Care (HH):
- Services including skilled nursing and rehabilitation
- Delivered in the home setting
Pts are medically or sufficiently stable to be discharged from an acute or post acute facility
Must be homebound
- Patient requires assistance to leave home OR
- Leaving home poses a taxing effort for the patient
- Simple lack of transportation does not count as homebound status
- Patient may make occasional outings to hair salon, church or for special occasions
Physical Therapists in Home Health:
* See a broad range of clinical problems
* High degree of clinical problem solving
* Potential limitations in interventions
Discharge Planning from Acute Care
What facility?
* Ambulatory care environments (Day Program vs Traditional)
* Varying levels of complexity
* Large exposure to the musculoskeletal practice pattern
* May be a single service line, may receive multiple (OT, PT, SLP)
Outpatient:
- Ambulatory care environments (Day Program vs Traditional)
- Variety of age groups, clinical may choose to specialize/market
- Broad range of clinical problems
- orthopedic sports to neurological cases
- Varying levels of complexity
- Large exposure to the musculoskeletal practice pattern
- May be a single service line, may receive multiple (OT, PT, SLP)
Discharge Planning from Acute Care
What facility?
- Varying levels of supervised living arrangements (RN/LPN)
- Clients are unable to safely manage independent living (Debility/Cognition/Self Care)
Long Term Care Facilities (LTC):
* Varying levels of supervised living arrangements (RN/LPN)
* Clients are unable to safely manage independent living (Debility/Cognition/Self Care)
Physical therapists in LTF:
* Skilled intervention if a change in functional status
* Determine if there is a potential for improvement
