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7 Geriatrics > Final > Flashcards

Final Flashcards

1
Q

Palliative Care Definition

A

care meant to improve QOL who have a serious or life-threatening disease

approach to care that addresses the person as a whole, not just their disease

goal is to prevent, treat the s/s and side effects of disease and its treatment in addition to any psychosocial problems

anyone can receive regardless of age or stage

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2
Q

Three roles of palliative care team

A
  1. identify the individuals goals of care
  2. Symptom management (Total Pain model of care)
  3. Advanced Care planning (AD, POLST)
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3
Q

How many people prefer to die at home?

A

70%

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4
Q

How many people die at an hospital?

A

76%
they receive more aggressive, invasive, poorer quality care than they would ad home

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5
Q

Hospice Care

A
  • type of palliative care
  • goal is to improve quality of life through multidisciplinary care through s/s management, spiritual care, psychosocial care
  • can receive medical treatment for s/s mgmt, not curative
  • offered at the end of disease process
  • must have terminal prognosis with 6 mo or less of life left
  • payment is through specialized benefit
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6
Q

Palliative Care overview

A
  • goal is to improve WOL in combination with primary medical tx for disease
  • goal is to improve QOL through multidisciplinary care including s/s mgmt, spiritual care, psychosocial care
  • can still receive curative tx
  • can be offered at disease diganosis
  • not time limited
  • also called supportive care or symptom management
  • payment through traditional methods
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7
Q

Durable power of attorney for health care

A

lets the pt name one of more people to serve as health care agent or proxy, giving them power to make medical decisions on behalf of pt

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8
Q

Living Will

A

lets pt specify what type of care or treatments they wish to receive and list the circumstances in which they’d like them to be used

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9
Q

If you do not have an AD

A
  • state laws dictate who can make the decisions for you
  • in Oregon, it goes down the line as follows: spouse, adult children, your parents, siblings.
  • in OR, unmarried partner cannot make decisions unless named as proxy
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10
Q

Situations in which an AD would not be followed

A
  • complex medical situation where it is unclear what you would want
  • goes against health care providers conscience
  • against health care institution policy
  • does not meat accepted health care standards
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11
Q

POLST/MOLST

A
  • forms that provide guidance about your medical care that health care professionals can act on immediately in an emergency
  • typically created for persons with a serious progressive illness
  • OR founded the program
  • pink form
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12
Q

AD overview

A
  • for those 18+
  • legal document that you, HCP, witnesses sign
  • do not need a lawyer
  • pt keeps the form and gives copy to HCP
  • it can be changed
  • HCP will make sure AD is followed
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13
Q

POLST Overview

A
  • for those with serious illness or are old/frail
  • medical order
  • doctor fills it out with pt input
  • do not need a lawyer
  • HCP and electronic POLST system keeps a copy, as well as pt
  • can be changed with doctor approval
  • doctors, medical staff will make sure it is followed
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14
Q

Medicare part A

A
  • covers hospital, IRF, skilled nursing, home health, hospital
  • catastoprhic insurance
  • very specific criteria for coverage
  • short-term treatment
  • no premiums, but includes dedctibles, co-pays
  • does not fover custodial care
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15
Q

Medicare Part B

A
  • optional insurance for > 65 or distabled can purchase
  • premiums = $175
  • deductible = $240 per year
  • covers outpatient services, medically necessary, preventative services
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16
Q

Medicare Part C

A
  • medicare advantage plans
  • private insurance that provides medicare benefits
  • can offer additional coverage including part D, dental, vision
  • premiums vary greatly, can be more expensive or economical vs medicare
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17
Q

Shared Risk Model

A

part of medicare part c

plan manages a group of lives and are paid per life managed

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18
Q

What % of Medicare Advantage have United Healthcare or Humana

A

47

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19
Q

Medicare Part D

A
  • drug or prescription coverage
  • you have to sign up for Part A/B before enrolling Part D
  • drugs are divided into tiers, more expensive being in higher tiers
  • certain “formularies” are covered by certain plans
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20
Q

CPT vs ICD-10 Codes

A

CPT: identify services rendered
ICD: represents pt diagnosis

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21
Q

Resident Assessment Instrument (RAI)

A

determines quality of life for patients in nursing homes or facilities

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22
Q

OASIS Manual

A

patient-specific, standardized assessment used in Medicare home health care to plan care, determine reimbursement, and measure quality

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23
Q

Three Guiding Principles for Documentation

A

Medical Necessity
Skilled Service
Reasonable and Necessary

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24
Q

Medical Necessity

A
  • New onset
  • Change from previous level of function
  • significant risks/deficits/impairments would be there without care
25
Q

The prognosis and diagnosis cannot be

A

the sole factor in deciding that a service is or is not skilled or necessary

26
Q

Skilled Services

A
  • knowledge
  • skills
  • judgement

services provided must be of a level of complexity and sophistication, or conditions must require the following skills of a PT

27
Q

Reasonable and Necessary

A
  • Time
  • Goals
  • generally predictable
28
Q

The POC at minimum needs to include

A
  • diagnoses
  • long term goals
  • treatment approaches
  • duration
  • frequency
29
Q

A therapy’s POC is

A

a PT’s prescription

30
Q

in POC, you should do the following when writing it

A
  • be specific, reasonable, appropriate to each pt
  • represent the major impairments and deficits identified
  • match approaches, frequency, and duration to the needs
31
Q

Common mistakes in POC

A
  • not matching the frequency and duration to the assessment and goals
  • using a treatment code (CPT) without providing supportive information
  • lack of specificity
  • make long term goals the same but slightly harder versions of short term goals
  • repeating things you have already stated in clinical impressions
32
Q

When selecting treatment diagnosis codes

A
  • be specific, including body part and type specific
  • avoid general codes
  • avoid medical diagnoses
  • must be compliant with medicare coverage documents
33
Q

Long Term Goals should

A
  • not mirror STGs
  • be comprehensive or global
  • answer “what do we want the pt to do by the end of therapy services or the episode of care?”
34
Q

Use of Clinical Impressions Box

A
  • helps auditor understand clinical reasoning or justify PT services
  • not to repeat information
  • needs to be patient specific
  • can answer what would happen without skilled OT services and detailed plan provided by PT
35
Q

General Supervision

A
  • supervisor is available for direction by telephone or other form of telecommunication
  • not required to be on site
36
Q

Direct supervision

A
  • supervisor present on site
  • immediately available for in person direction
37
Q

Personal Supervision

A
  • supervisor is physically present
  • within direct line of site
38
Q

Institutional

A

long term care
hospital OP
rehab

(everything besides private practice)

39
Q

Professional

A

private practice settings

40
Q

Medicar advantage follows

A

medicare regulations, as an assumption

41
Q

Medicare Part A Supervision, PTA

A
  • General supervision
  • PTA may write progress notes and discharge summaries with co-signature
  • decision to d/c and update LTC/POC is by PT only
42
Q

Medicare Part B Supervision, PTA

A

Institutional = general
Professional = direct

current waiver allows direct via telehealth through 2024

43
Q

Progress Notes in Part B

A

completed by PT

44
Q

Always follow the most

A

conservative supervision rules

45
Q

Part A inpatient SNF (aides)

A
  • may not provide skilled services
  • set up time preceding therapy by an aide may be coded by PT/PTA
  • direct supervision is required
46
Q

Part B outpatient (aide)

A
  • cannot provide skilled services
  • unskilled services are not reimbursable even when provided via direct supervision of PT/PTA
47
Q

Part A Inpatient/SNF (students)

A
  • on site supervision, line of site is not neccessary
  • can report time on MDS
  • state decides about documenting, co-signing, billing with a student
48
Q

Part B Outpatient (student)

A
  • personal supervision in room and directing service
  • supervisor not engaged in other tasks or treatments
  • supervisor bills, signs all documentation
49
Q

Individual Mode

A

student and supervisor are only providing service to one patient at a time

50
Q

Concurrent Mode

A

if student is treating one patient and supervisor is treating another at same time

51
Q

Group Mode

A

2-6 pts performing same activities. student and supervisor may only be providing services to the patients in the group

52
Q

A PT is a person who is

A
  • licensed as a PT by the state in which they are practicing unless licensure does not apply
  • has graduated from an accredited PT program
  • passed national exam approved by state in which PT services are provided
53
Q

New Grad PTs and Medicare

A

new grads that haven’t passed their exam cannot provide services to medicare/medicare advantage pts even if they have a temporary license

54
Q

Abuse of Elderly Includes

A
  • physical harm or injury
  • failure to provide basic care
  • financial exploitation
  • verbal or emotional abuse
  • involuntary seclusion
  • wrongful restraint
  • unwanted sexual contact
  • abandonment by caregiver
  • self-neglect due to lack of supervision
55
Q

What is “adult abuse”?

A

age 65 +
age 18+ who have disabilities

56
Q

What happens after report of abuse?

A
  • law protects mandatory reporters, if reporting in “good faith”
  • state law protects confidentiality, and will only be given in certain legal situations
  • local AAA offices will determine if abuse or neglect has occurred and contact authorities if there has been a crime
57
Q

Timeframes for reporting

A
  • 24hrs if abuse or crime
  • 2 hours if serious bodily injury occurs
58
Q

Elder Justice Act

A
  • established timeframes for reporting
  • financial penalties for not reporting or retaliation for reporting
  • expanded mandatory reporter list in long term care facilities
  • created elder justice council
59
Q

At Risk Driver Programs

A
  • PT are required to report to DMV a person whose cognitive or functional impairment affects ability to safely operate a car
  • impairment has to be severe and uncontrollable, impacts ability to perform ADLS and is permanent
  • requirement of PT only if driver has been seen clinically and if PT has witnessed the impairment
  • reporting is not a HIPAA violation

7 Geriatrics (9 decks)

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