Final Flashcards
In-patient hospitals
Medically stable, can handle 3 hours of therapy
In-patient acute
Free-standing
Acute care and acute rehab
Subacute Rehab (SAR)
Philosophy –> different than LTC
Roles (1) OT role is similar to acute rehabilitation (2) staff has different demands
Goals –> increased independence whether it is home, assisted living, or a SNF
post-acute rehab care/subacute care
Post-acute care, medically complex, and multi-system complications
Long term acute care (LTAC)
T or F: in both LTAC and SA the patient cannot tolerate the conditions of acute care or acute rehab, but can still do some rehabilitation
True
intermediate/transitional care settings
assisted living & independent living
T or F: in booth assisted living & independent living, the patient can still get some rehabilitation as needed
true
T or F: In LTC, SNF, and NH the patient can still get some rehabilitation as needed
True
Services medical needs of all residents
Interdisciplinary approach: OT, PT, SLP, social work, recreational therapy, chaplain
Uses biospsychosocial model
SNF or nursing home (NH)
For this setting patients are either getting rehab to return to community or have no where to go and cannot afford care at home
NH
What model of wellness and medicine that examines how thee 3 aspects - biological, psychological, and social - occupies roles in relative health or disease
Biopsychosocial model
T or F: in community based LTCC services patient can still get some rehabilitation as needed
true
LTAC and SAR treat complex medical conditions; more intensive than LTC but less intensive than acute care
Purpose of LTSAC and SAR
LTAC & SAC are goal-oriented, comprehensive care for acute illness/injury/disease
philosophy of LTAC & SAR
Evaluation process
- considerations: home environment, social supports, prior functioning
- evaluate home for modification recommendations, equipment recommendations, and assistive devices
- needed services/ assistance
- patient/ caregiver education
- referrals for home care or community-based services
- home programs
For discharge: must demonstrate progress
OT role in SAR and LTC
Issues in LTC settings
Staff shortage
Residents refusing to participate
Increased time to carry out the program
Splints or assistive devices may be to cumbersome to put on or to maintain
Regulations & guidelines for LTC
- must be MD ordered and approved every 30 days
- must be reasonable and necessary
- need for skilled services –> must be necessary, consideration of prior level of functioning and premorbid conditions, must have rehabilitation potential
Assessment procedure for LTC & SA
Made up of “triggers and guidelines”
Triggers - target conditions
Guidelines - care planning & evaluation of problem areas
Protocols for LTC & SA
Decision Making (resident assessment protocols RASPS)
- delirium
- visual function
- ADL function
- mood state
- behavior problems
- activity
- feeding tubes
- dental care
- restraints
- cognitive loss/ dementia
- communication
- continence
- psychosocial well-being
- falls
- nutritional status
- dehydration/ fluid maintenance
- pressure ulcers
- psychotropic drug use
Care Plan Development: based on RASPS
Care Plan Implementation
Evaluation: validtaes medical necessity
Role of OT in restraint free environments
- identify problems that “caused” the “need for restraints”
- create interventions
- know allowable use for restraints/ guidelines for restraint use (aka used alternative resources already)
- collaborate with interdisciplinary team
alternative to restraints
client education
physical assessment
medical work-up
environmental assessment
activity engagement
toileting schedule
schedule change
responsiveness to client needs
proper positioning
ambulation programs
alarms and monitors
environmental modifications
reduce clutter
low beds
fall mats
comfortable seating
non-skid cushions
documentation and reimbursement mechanisms in LTC & SA
Based on section GG of the minimum data set (MDS)
- MDS: a comprehensive interdisciplinary evaluation that looks at functioning in a wide scope of areas
- must be completed by day 5
- section GG drives the reimbursement rates for facilities
Skills & strategies for COTAS & other therapeutic professionals on therapeutic interventions in LTC/SAC
- COTAs can do assessments but cannot interpret results
- COTAs may need to be supervised directly depending on state law
- can collaborate on intervention
- COTAs can be train a CNA to position a client but must collaborate with an OTP
Patient-driven payment model (PDPM)
Medicare Part A SNF payment with 6 components
- OT
- PT
- SLP
- Nursing
- non-therapy ancillary (NTA)
- Non-case mix
All components contribute to facility’s daily rate
Focus is on value of outcomes: patient characteristics and functional level (not amount of patients seen or therapy minutes clocked)
Positive factors that influence cognitive health in OA
social interaction
education
intellectual pursuits
Cognitive remediation
Negative factors that influence cognitive health in OA
poor health
poor sleep hygiene
poor nutrition
depression
anxiety
substance use
