Lecture 4 - Overview of Settings 1

Question 1

Assisted Living (AL)

Answer 1

• allow for privacy
• for people who do NOT need skilled medical care
• can still have independence in some areas, but may need help with ADL and med management

Question 2

What is OT’s role in AL?

Answer 2

• consultive in nature, assist with modifications and adaptations, programming and promoting safety
• direct services (ADL, safety, iADL, social activities)
• education of direct service staff regarding issue on aging, occupation and health promotion

Question 3

Skilled Nursing Facility (SNF)

Answer 3

• require special 24 hour care for either a short or extended time period
• “bridge the gap” with another level of care
• admitted from acute care hospital
• usually requires some type of skilled nursing intervention

Question 4

What is the OT’s role in a SNF?

Answer 4

similar to IRF, but less intensive (less than 3 hours per day)

• ADL/iADLs
• team approach

Question 5

Extended Care Facility (ECF) or Long Term Care (LTC)

Answer 5

• requires 24 hour care for an unknown amt of time
• “functional recovery” may not be possible (lack of financial resources or support at home)
• may transfer from hospital, nursing home or home
• needs assistance with self-care
• classic nursing home
• LOS is variable and indefinite

Question 6

What is the OT’s role in and ECF or LTC?

Answer 6

• direct or consultive in nature

- typically min to no OTs in this setting

Question 7

Omnibus Budget Reconciliation Act (OBRA)

Answer 7

mandates that nursing homes must care for residents in such a manner and in such an environment as will promote the maintenance of enhancement of QOL of each resident

Question 8

What are factors contributing to nursing home placements?

Answer 8

long-term care insurance and shorter LOS in hospitals

Question 9

What are the three main categories of nursing home care?

Answer 9

1. Skilled (ventilator, high-level medical care after hospitalization)
2. Rehabilitative (improvements expected with discharge to “less restrictive environment”
3. True long term care

Question 10

General activities program

Answer 10

“events or tasks designed to provide incentive and opportunity to engage in continuing life experiences and hence to satisfy interests and meet general activity needs (focus on enjoyment, stimulation, and repetition of present skills)”

Question 11

Pioneer Network

Answer 11

organized to identify “deep systematic change” that will allow for a “person centered” focus of care
- members include practitioners, educators and other professionals who are seeking alternatives from the medical model

Question 12

The Green House Project - Eden Alternative Philosophy

Answer 12

1992 - encourage a more homelike environment in the nursing home and to allow direct-care workers to be more involved in decision making

Question 13

Wellspring Model

Answer 13

1994 - encourage nursing homes to work together to teach line staff the best clinical practices and to move away from the typical nursing home culture of control

Question 14

LEAP Initiative

Answer 14

2001 - alter how nursing home workforce was viewed and treated by nursing home management

Question 15

Shared Governance

Answer 15

gives frontline staff responsibilities for making decisions related to their practice

• based on professional values and principles of autonomy, shared decision making, and engaged participation
• empowering staff