Final Flashcards
Emphasis of self-care skills
preserving function and developing strategies to maximize QOL
Self-care
daily activities composed of duties and chores ranging from basic or personal care to personal business
occupations included in self care
ADL, IADL, rest/ sleep, health management
significance of self-care
- health and safety
- self identity and socialization
- psychological well-being
theoretical approaches to self-care
- self-determination theory of motivation (SDT)
- Person-environment fit
- other: competence, value, and meaning
assessments for self-care
- occupational profile
- assessment of performance of self-care skills (e.g. Kohlman eval of living skills)
- assessment of ADL (e.g Barthel Index)
- assessing environmental skills
- special considerations (sensory/sensorimotor and cognitive)
interventions for ADLs
- skills training
- task modifications
- assistive tech devices
- environmental modifications (mobility and bathroom/dressing areas)
T/F: aging and health conditions can lead to declines affecting self care (sensory, cognitive, motor)
T
health definition
a state of complete physical, mental and social well-being; not merely the absence of deformity
The PERMA Theory of Well-Being
Five essential components that enable human flourishing and promote well-being
What occupations are included in health management
- social/emotional health promotion and maintenance
- symptom/ condition management
- communication w/ healthcare system
- med management
- physical activity
- nutrition
- personal care device management
Social determinants of health
the conditions in which people are born, grow, work, live and age and their access to power, money, and resources
affects health, wellness, and QOL outcomes
create barriers to occupational performance and participation
Barriers to healthcare access
- cost
- lack of info
- lack of specialists
- long wait times ( tests, procedures, appointments)
- poo coordination and communication
- patient educations level
- health literacy
impact of health conditions on health management
- vision
- hearing
- cognition
- mobility
- social support and socioeconomic status
What are the effects of poor-quality sleep on daytime occupational performance
- impaired driving
- decreased productivity
- strained social relationships
- increased fall risk
relationship between sleep and chronic conditions
- less than recommended hours of sleep
- decreased sleep quality
-symptoms of sleep disorders
relationship between sleep disorders and health conditions
increased risk for heart disease, stroke, mortality, and morbidity
Theoretical approaches for successful health management
KAWA
MOHO
PEOP
interventions to address health management
- lifestyle redesign
- do-live-well framework
- self-management programs
- health literacy education and advocacy
- cognitive orientation to daily occupations (CO-OP)
- teach-back method
- fall prevention
- yoga, tai chi chuan, and dance
- nutrition management
- personal device management
- sleep and rest (e.g. sleep education, cognitive behavioral interventions, environmental modifications, multicomponent interventions)
home management activities
meal prep
clothing care
safety and emergency maintenance
disaster preparedness
care of others, including pets
impacts of health conditions on home management/IADLs participation
complexities of aging
age-related changes
disease related changes
MCI
safety issues
theoretical approaches to working with home management
Environmental press theory: how people and environments interact and adapt
PEOP
task oriented approach: considers task performance in relation to a person’s valued life roles
Assessments for home management and IADLs
occupational profile
COPM
Lawton IADL Scale
Texas Functional Living Scale
Independent Living Scale (ILS)
Assessment of Motor and Process Skills (AMPS)
Kohlman Evaluation of Living Skills (KELS)
Executive Function Performance Test
Kitchen Picture Test (KPT)
Performance Assessment of Self-Care Skills
Independent Living Scale (ILS)
gathers info about the individual’s to achieve successful community living
5 sub scales: memory, orientation, managing money, managing home and transportation, health and safety, social adjustment
Lawton IADL Scale
determine level of independence in IADLs (self-report)
Assessment of Motor and Process Skills (AMPS)
standardized tool to evaluate quality of IADL performance for activities that have been prioritized by client (need special training like MoCA)
Kohlman Evaluation of Living Skills (KELS)
observation and interview based tool testing 17 skills (self care, safety, health, money management, community mobility, telephone use, employment and leisure)
Performance Assessment of Self-Care Skills (PASS)
performance based criterion referenced observation tool. Include two IADL domains, physical and cognitive
Home safety assessments
In Home Occupational Performance Evaluation (I-HOPE)
Westmead Home Safety Assessment (WeHSA)
SAFER-HOME V3
Cougar Home Safety Assessment (CHSA)
Home Environment Assessment Protocol (HEAP)
Interventions for home management and IADLs
establish/restore
modify
task adaption
energy conservation
task specific and skill training
AT
home modifications
disaster preparedness
care partner training
home modifications for home management and IADL performance
de clutter
secure carpets and wiring
lighting
non slip mats
seating in work areas
counter heights in kitchen
appliance choice
color contrast in kitchen, office, etc
door/cabinet handles
kitchen faucet (maybe touchless)
who benefits from home accessibiltiy
older adults aging in place
caregivers
adults w/ disabilities
adults planning for future/ families bringing aging parents into home
children/families of children w/ disabilities
people of all ages
why are home modifications important
QOL
home safety
cost effective (reduce healthcare costs/ delays institutionalization)
majority of older adults live at home
support for service delivery
common challenges in the bathroom for older adults
toilet height
accessibility for devices
slipper surfaces
visually distractions
tub/shower thresholds
sink/countertop access
inadequate lighting
toileting habits (hygiene, clothing management)
common kitchen challenges for older adults
reaching (cabinet, oven, stovetop, etc)
inadequate lighting
inadequate support
transferring heavy items
home assessment tools
interview/observation
safety and hazard checklists
performance/ functional measures
functional performance
observable elements of action that include purpose and skill
occupational performance
accomplishing selected occupation as a result of dynamic interaction among client, context, and occupation
normative assessment
compares data obtained against a sample of the general population
criterion-referenced assessment
measures how well a person performs against specific criteria
ipsative assessment
compares the person against themselves in the same area over time
changes in independence from aging
decreased QOL
increased dependence on others
poor physical and mental health
screenings to determine formal assessment
MoCA
Functional Activities Questionnaire (FAQ)
Rapid Geriatric Assessment
Berg Balance Scale
Descriptive assessments
Functional behavioral profile
AMPS
Discriminative assessments
weekly calendar planning activity
predictive assessments
Cognitive Performance Test (CPT)
TUGeva
evaluative assessments
Continuity assessment record and evaluation (CARE)
COPM
things to consider when choosing assessment tools
Approach:top-down, bottom-up, mixed
administration procedures
psychometric properties
ethical considerations
models around assessment
conceptual frameworks: ICF, OTPF
theoretical models: CMOP, MOHO
specific issues related to evaluation of functional performance in older adults
sensory changes with aging
fatigue
education
caregiver support
T/F: The Federal Government provides guidance to the State on what must be covered. Federal dollars are included to assist States in providing coverage.
T
T/F: Typically, it is the State that manages Medicaid. Each state is unique!
T
Centers for Medicare & Medicaid Services (CMS) FEDERAL
- Medicare A
- Medicare B
- Medicare C
- Medicare D
- Medicare D
Difference between Medicare and Medicaid
medicare is federal
Medicaid is by state
Medicare A
for hospital care, inpatient hospital stays, skilled nursing care, hospice care, and limited home-care services.
Medicare B
usually covers outpatient services (includes emergency dept)
Medicare C
Medicare advantage, everything in A&B plus extra benefits, prescription benefits
Medicare D
optional drug prescription drug coverage
Medicare E
Medigap, private insurance used w/ Medicare A&B to help cover certain Medicare out of pocket expenses
MAC
Medicare Administrative Contractor
- receives claims
LCD
Local Coverage Determination
- used by MAC to determine coverage
- used for reviews and denials
PDPM and PDGM
PDPM: Skilled Nursing
PDGM: Home health
- Budget neutral – Medicare Part A beneficiaries
- Client / Patient Characteristics and factors driving reimbursement (diagnosis, therapy disciplines, GG status (skilled nursing) , nursing, non therapies)
- Must demonstrate the Value of OT
- Requires Clinical Reasoning
Medicaid
- Joint federal and state program
- States may elect to provide additional coverage
- Federal government mandates States to cover certain groups:
Supplement Security Income (SSI)
Aged, Blind and Disabled Individuals
Poverty level Aged or Disabled
Medically Needy Aged
Medically Needy Blind
Medically Needy Disabled
Acute care billing
“bundling” services
- Emergency Medical Services (EMS)
- Primary Care Provider
Acute Care
- Average stay 2 to 9 days, fines for readmissions
- Frequency of tx (1-2 x day, 15-30 /45min) (fluctuated based on their needs, usually not 2 x day)
- typically covered under Medicare Part A
- Assessment: AM-PAC Inpatient Activities
AM-PAC Inpatient Activities (6 clicks)
How much help from another person does the patient currently need?
Putting on and taking off regular lower body clothing?
Bathing (including washing, rinsing, drying)?
Toileting, which includes using toilet, bedpan or urinal?
Putting on and taking off regular upper body clothing?
Taking care if of personal grooming such as brushing teeth?
Eating meals? (not swallowing, getting food to mouth
Scoring for AM-PAC
Out of 24, same for both activity and mobility
1 = Total Assistance
2 = Require maximum to moderate assistance ‘a lot’
3 = Requires minimal assistance, CGA or Supervision ‘a little”
4 = None == patient is independent
AM-PAC Inpatient Mobility (6 clicks)
How much help from another person does the patient currently need?
Turning from your back to your side while in a flat bed without using bedrails?
Moving from lying on your back to sitting on the side of a flat bed without using bedrails?
Moving to and from a bed to a chair (including a wheelchair)?
Standing up from a chair using your arms (e.g., wheelchair or bedside chair)
To walk in hospital room?
Long-Term Care Hospital (LTCH)
Inpatient services include rehabilitation, respiratory therapy, pain management, and head trauma treatment. Client continues to require intensive medical management.
Average Length of Stay: 26 Days
Frequency of Treatment: Dependent on the needs of the client. Anticipate 7 Days a week with multiple short sessions (15 minutes)
Inpatient Rehabilitation Facility (IRF)
- Have to need at least two disciplines
- have to have 3 hours per day of therapy
- go by FIM rating or PAI
- average stay is 13 days
Skilled Nursing
- average stay up to 39 days
- no mandate for frequency of therapy
- they want to take patients who need the most services because they get reimbursed the most
- uses GG codes
- use interprofessional assessment: MDS-OBRA
Long-term Care, Assistied Living, Residential Care
- least restrictive environment residence for an individual, referred to as resident
- Typical reimbursement is Med B
- use interprofessional assessment: MDS-OBRA
Home Health Agency (HHA)
Skilled nursing or therapy services provided to Medicare beneficiaries who are homebound
Homebound (physician visits, infrequent visits outside of the home including to receive a hair cut, buy groceries, attend religious services, holiday and special family gatherings)
usually nurses start plan of care
Out-Patient
Client receives out-patient rehabilitation therapy multiple times per week.
Average Length of Stay and Frequency of Treatment: Negotiated with Case Managers if private insurance.
Assessments: At least one functional measure relevant to the diagnosis.
Outpatient Quality Reporting (OQR) – Outpatient Surgery (currently)
CONSIDER: Quality Reporting Measures – Section GG
OASIS
out patient
GGs
long term care
PAI
in patient
MDS
Cares
5 key messages about dementia
T/F: Dementia is not normal aging
T
10 signs and symptoms of dementia
communication tips w/ dementia
What to do if someone w/ dementia havinf trouble communicating
