Discharge Planning/WC Intro Part 1 Flashcards
When does discharge planning start?
As soon as you perform the initial chart review, no matter what the setting!
Home Evaluation Procedure Options
W/ pt and family present to see them move within their environment
Take empty WC to home with family present
FT/Zoom with family and have them take measurements upon request
Give pt/family a worksheet to draw floorplan
What should you have the pt consider when renovating their home to make it more accessible?
Do they rent or own?
Checking w/ landlord to see their options (e.g., appropriate procedure to prevent loss of deposit, landlord preferring their own installers)
What are features of the home related to pt safety?
Being able to exit safely through at least 1 entrance (hopefully 2)
Steps (handrails - on which side?)
Smoke alarms
Peephole (usage in pt’s with the inability to stand)
Scald control at the sink (to prevent burns in pts with sensory impairments)
What are some things to consider related to the parking situation at a pt’s home?
Where?
Room to open door/transfer pt
Temp regulation problem (pt) if parking outside
Complex transfers in the rain/possibly unsafe neighborhoods
What are some things to consider related to a pt’s general mobility around their home?
Opening doors
Accessing items in the cabinets/at the stove top
Accessing light switches/telephones
Being able to call for help (Life Line services, smart watches with fall detection alerts)
What are some options to widen the doorway to the patient’s bathroom?
Remove innermost molding
Removing door and replacing with tension rod/shower curtain
Flush mount hinges - help door stick out less
Simply widening the doorway itself (less expensive if not requiring the movement of light switches)
What should you consider when advising a pt on installing a WC ramp?
1 foot at length for each inch of height
Include height of threshold at the door in your measurements
Inclusion of a landing (for pt and/or caregiver to rest)
For sure having a landing at the door (to allow pt to unlock their door w/o rolling backwards)
“Grade Aid” WC Attachment
Particularly beneficial for pts with tetraplegia
Allows pt to push up but “catches” to prevent WC from wheeling backwards as pt repositions their hands
A pt who propels the WC with their feet (e.g., post-stroke) may prefer to do what when navigating a ramp?
Go up backwards
Allows person to push up with quads rather than pull with HS
What is required of ALL WC prescriptions?
Recent face-to-face visit with MD/DO
Diagnosis
Reasons why WC is necessary to perform mobility-related ADL
What questions determine the K (Complexity) Level of WC that the patient will qualify for?
Does patient require WC to perform “mobility related ADL” in the home? (Ideal answer YES)
How long will person sit in WC/day? (~4 hours)
Can pt walk/how far? Have other devices been tried/ruled out?
Can they push a standard manual WC? (50 lbs, least expensive) - lightweight WC (~35 lbs)?: If no, scooter? motorized WC (most expensive)?
What type of pt would likely benefit from using a scooter?
Someone who can walk short distances, but needs power for community distances/doing housework
NOT ideal for pts that are full-time motorized device users
Scooter vs. Motorized WC
Scooter has narrower and longer wheelbase (less stable side to side)
More trunk/upper body control needed for scooter
Scooter may not have armrests/seatbelt, has fewer seating options, and is less expensive
Large pole holding seat = scooter
You can NOT drive an adaptive vehicle from a scooter, only a motorized WC
Power Assist Device
Can be added to manual WCs for loading/unloading into vehicle and then removed
Traditional motorized WCs require lift/ramp into vehicle
Automatic Hi-Lo Seats
Changes height of seat to ease sit to stand/transfers onto variable heights
Tilt vs. Reclining WCs
Tilt-in-Space and Reclining can both be on either a manual or power WC
Tilt in Space will not fold/harder to load + hip angle is fixed
Reclining can fold but is still heavy to load + hip angle changes with recline (possible skin &/or tone issues)
What does a WC with a rear axle and larger wheel base allow for?
Chair more stable from a back standpoint
Pts that throw themselves backward will then not flip the chair, great for amputees/pts imbalanced in terms of weight
A WC axle in a more anterior position allows for what?
More mobility/curb jumping
What does it mean for a WC wheel to have 0 Camber?
Wheels straight up and down
A large Camber (degree/angle) is preferred for sports
Projection Hand Rims
Great for tetraplegia pts
Provides lever for them to push chair forward
What is something to keep in mind about a Desk Length Armrest?
It may not have enough support for attachments
When measuring a pt for a WC, what should be taken into consideration?
Ensure that the measurements are taken with the pt in a seated position
Prosthetics / orthotics are taken into consideration
Seat Width / Seat Depth WC Measurements
Width: Less than 1 1/4” wider than person’s hips / thighs (at widest point)
Depth: 1-2” less than posterior buttocks to popliteal fossa
Seat Height / Backrest Height WC Measurements
Seat Height (Frame of WC to Floor): Consider LL length / transfer type / propulsion method / type and thickness of WC cushion (standard height = 19-19.5”, hemi height = 17-17.5”)
Backrest Height: Consider how much trunk support is needed and freedom of motion in scapulae / shoulders (above OR below inferior angle of scapulae)
Footrest to Seat Distance / Armrest Height WC Measurements
Footrest to Seat: Measure w/ cushion in place and typical shoes on (footrests need to clear the floor)
Armrest Height: Measure w/ cushion in place, but from bottom of seat
Ideal Posture for Normalization of Tone (Shoulder Girdles / UEs)
Shoulders even with / slightly anterior to hip joints
Scapulae protracted
Shoulder slightly ER / abd
Elbow flexed / anterior to shoulder
Forearm pronated to allow WB
Wrist in neutral / slight extension
Thumb abducted /extended
Metacarpals spread w/ transverse arch maintained
Ideal Posture for Normalization of Tone (Hips / LEs)
Equal WB on ischial tuberosities
Neutral rotation of the hip
Hips flexed no greater than 90 degrees
Knees slightly lower than aligned with hips
Ankle in neutral with adequate foot support
DME Funding (Medicare/Medicaid)
Medicare: DME / LMN (letter of medical necessity) forms, Medicaid: Title XIX forms - submitted in addition to standard equipment prescription + LMN
Medicare will pay 80% for DME under Part B (20% copay for pts w/o secondary insurance - secondary insurance will pay the copay ONLY for covered Medicare expenses)
Private insurance tends to follow Medicare
For any WC prescription, how long does a person have to sit in their WC inside their home to qualify under Medicare?
Minimum of 4 hours/day
Qualifying for Light-Weight WCs
Depends on pt’s abilities, not caregiver’s
Need to document arm weakness, breathing / heart problems, and inability to push standard weight WC
Qualifying for Motorized WCs / Scooters
How much the pt is able to walk is scrutinized carefully (HAS to require motorized device to perform mobility-related ADL in routine or normal parts of the home)
Have to require it at least 4 hours / day
Date of face-to-face visit with physician is required on form (date has to be close to date they are getting seated / ordering device - most companies require a < 30 day difference)
Medicare Funding for Bathroom Equipment
NO tub benches / grab bars / elevated toilet seats
Will pay for BSC in certain diagnoses and conditions (urgency, risk of incontinence)
“3 in 1” that they will pay for (BSC, SC, elevated toilet seat) - very uncommonly used
Medicare Funding for Hospital Beds
Medicare will NOT pay for a fully electric bed for any diagnosis
Will pay for a semi-electric (head/foot with handheld control, overall height with crank) for certain diagnoses - fragile caregivers who cannot bend down do NOT count as a qualification
When should you advise a pt to order a hospital bed?
If pt requires a lot of help for transfers
If pt is unable to get into bath/shower or is incontinent (and therefore requires assistance with hygiene in bed)
Can suggest hospital bed for PROM/ hygiene / other caregiver tasks while continuing to possess a shared bed for SO times if the spouse is the caregiver
