Professional Responsibilities Flashcards
Elder Justice Act
Addresses/prevents abuse (physical, emotional, sexual, financial, neglect, abandonment)
Types of financial abuse
Financial neglect
Financial exploitation
Healthcare fraud
Financial neglect
Ignoring person’s financial responsibilities i.e mortgage insurance bills
Financial exploitation
Misuse/mismanagement of property/assets under false pretenses, w.o consent, with intimidation
Signs of abuse
Withdrawn, agitation, trauma response (rocking back and forth), scars, cuts, marks, preventable conditions (uti, dehydration, pressure ulcers), living conditions, financial loss, matting of hair or poor dental hygiene
Investigative Agencies
APS
Long term Care Ombudsment: advocates needs of residents in AL/LTC
National Center of Elder Abuse: how to report abuse, where to get help, state laws
Long term effects of Abuse
Early death
Decreased social/family ties
Financial loss
Depression
Tx small group and counseling
5 sections of ADA
Employment
State and local governments
Public transportation
Businesses open to public
Telecommunications
ADA Employment
Applies to companies with 15+ employees, equal opportunity to benefit from employment opportunities
ADA state and local governments
Education, transportation, recreation, healthcare, social services, courts, voting, emergency services, town meetings
Focuses on equality and integration
ADA exceptions to integration
Different treatment needed for person to participate
If it fundamentally alters nature of activity
ADA Business open to public
Built environment: weighs accessibility vs financial restraints
Readily achievable barrier removal = easily accomplished without difficulty or expense
Resident Rights
- Treatment with respect/dignity (make own schedule)
- Participate in activities
- Free of discrimination
- Free of abuse/neglect
- Free from restraints (side rails, chemical for staff convenience)
- Make conplaints
- Proper medical: informed in language you understand
- Participate in decisions
- Access your record or your legal guardian access records
- Make complaints about tx
- Representatives notified of changes accidents or transfers
- Info on services/fees
- Manage your money
- Privacy and proper living arrangements
- Spend time with visitors
- Access to social services: counseling, problem solving, d/c planning
- To leave or move out
- Unfair d/c’s: cannot make you leave when you are waiting for medicaid, need 30 days notice of plan and reason of transfers
- Participate in groups
- Have family/friends involved
Exceptions to d/c
D/c for health and safety of person or others
Health improved
Nursing home hasnt been paid
Nursing home closes
AOTA Code of Ethics: Core Values
Altruism, equality, freedom, justice, dignity, truth, prudence
AOTA Code of Ethics: Principles
- Beneficence: concern for well-being
- Non-maleficence: do bo harm
- Autonomy
- Justice
- Veracity: objective accurate info when representing profession
- Principle/fidelity: respect, integrity, fairness, discretion
PDPM
Patient driven payment model: determined by pt characteristics rather than minutes
Payment=primary reason for admission (dx) + MDS assessment (section GG)
25% limit for group/concurrent per discipline, clinician judgement for mode of intervention
Concurrent treatment
See 2 pt’s together, interventions different for each client, not used for novel intervention, but for mastering skill
Group treatment
Skilled and medically necessary, intervention should be the same or similar
PDGM
Patient driven group model (2020), pt characteristic determine payment vs # of tx
PDGM Groups
12, based on dx, clinical characteristics, admission source, episode timing, functional impairment determined by OASIS (outcome and assessment information set) M1800s, comorbidity adjustment
Document ICD of comorbidity you are treatinf
OASIS
Cannot be initiated by OT, outcome and assessment information set, OT can contribute within 5 days of completing, OT educate other disciplines on assessing self-care
M1800S. Of OASIS
Grooming, UBD, LBD, bathing, toileting t/f,, t/f, ambulation/locomotion, risk of rehospitalization
Medicare Home Health Flexibility Act
Not signed yet but would allow OTs to start OASIS on therapy only cases
Civil Money Penalty
Grants available to skilled nursing home for training, tech to increase quality of care, finances through fine due to noncompliance with govt reg
Letter of medical necessity
Advocacy to determine approval or reimbursement of a service-/ Equipment
Clof, limiting factors, why equipment/services is needed, risk if not provides and resources that support its needed
Documentation Audits
CMS: MAC medicare administrative contractors
Supplemental medical review, comprehensive error rating test, unified program integrity contractors (fraud base)
HMO humana UHC anthem, medicare advantage
Common reasons for deni
No or late response
Missing technical components
Duplication of services
Excessive services
Documentation did not support medically nevessity
Prior authorization denials: medical necessity
Lack info, overlapping authorizations, excessive frequency/durations, lack of overall function, lack of documented skilled interventions
Commercial payor denials
Specific intervention code not allowed
Medicaid
State rub or through state run managed care
May reimburse in bundle or fee for service
Need standardized test or detailed clinical observation
OT goals
Functional measurable and linked to deficits or delay
COAST
Client
Occupation goal relates to
Assist level
Specific condition
Timeline
SMART
Specific, measurable, achievable, realistic, timely
Progress notes
Formal/informal analysis of client’s response to treatment, address barriers and what can be done differently to account for barriers, update standardized testing, client/caregiver education, carryover of training
Intraprofessional collaboration
Collaboration within discipline, OTA:OT
Amount of collaboration of OT/OTA
Varies based on:
Client complexity
Knowledge/skills
Requirements of practice settings
Service delivery model
Payor requirement, cms requires collaboration at certain frequency
Type of supervision
Direct face to face
Indirect: via phone, virtual interaction
Occupational therapy aide
Delegated by ask by OT/OTA
Clerical work
Client related work: trained/competent, instructed specifically to carry out task, knows precautions/signs/symptoms, not billable functions
Need to document supervision
Technical details to approve documentation
POC signed by MD in 30 days
10th supervisory note by therapist timely/completed fully
OT skilled nursing facility evaluation checklist and quality measure
Guides evaluations and quality measures
Strategies to reduce ageism
1) policy and law: lobby for policies within practice area
2) education: educate others to raise awareness (role playing, simulations, exercises to promote engagement, compassion, and empathy)
3)intergenerational intervention: opportunities with OT to collaborate with younger family members and integrate into activities
Cultural competence
Gaining sufficient knowledge about each culture to act w/in norms
Cultural humility
Shift from cultural competence
Lifelong learning and self-reflection when working/collaborating from different backgrounds, how do my biases (implicit) affect my practice, flexible, recognize role of power in healthcare
Ways to practice cultural humility
1) recognize no culture is better than another
2) engage in self-reflection
3) be honest when you’re not sure
4) learn about other cultures
Cultural competence vs cultural humility
Cultural humility consistent learning, recognizing gaps in knowledge without shame w. Deeper engagement vs cultural competence is knowing about culture focuses on differences
Cultural humility creates expectations for differentiation b/n and within cultures vs cultural competence emphasizes personal culture and how it differs from others (does not address implicit bias)
Cultural humility recognizes power dynamic vs cultural competence is silent on. Power issue
4 Ms of age friendly healthcare
1) what MATTERs to pt
2) MEDICATION: deprescribe, review high risk med use, do not interfere with other Ms
3)MENTATION: monitor mental and cog well-being, document concerns, address change. Tx and prevent ID—dementia, depression, delirium
4) MOBILITY: ensure earl/safe mobility, create safe home environment for mobility, identify safe mobility goal
Strategies to promote age friendly care
Client centered care
Communicate: consider communication needs, avoid assumptions regarding decisions
Written material: in preferred language and literacy level, watch for visual deficit, avoid jargon
Asses cog: reorient
AT/AE: dentures, hearing aids, AD, glasses
Asses mobility during meaningful times asks ie environmental distractors
Cultivate inclusion: needs vs. barriers, model inclusive practice
5 steps to EBP
1) ID a question or need
2) search for evidence
3) appraise and synthesize evidence
4) apply evidence
5) evaluate
Limitations to apply EBP
Intervention may be effective, but unable to use in practice due to things like needing special certification, intervention not aligned with what matters to pt, resources
MOHO
Volition=motivation
Habituation=organizing occupations into patterns, routines
Performance capacity=physical/mental abilities
Factors in physical/social environment
Motivation, habits, and abilities can shift which alters throughput
MOHO: organized
Adjust throughput in accordance with environmental factors for continued occupation
MOHO: disorganized
Incongruence with volition, habituation, and performance capacity
KAWA Model
Culturally sensitive uses river metaphor to symbolize one’s life, based on clients POV
KAWA components
1)river = life’s flow
2) banks/rivers = physical/social environment
3)Rocks = problems
4) driftwood = +/- personal attributes and resources
Decrease rocks and focus on positive supports/personal attributes = water flowing = well being
QUAPI
Quality Assurance and Performance Improvement
5 elements
1) design/scope
2)governance and leadership
3) feedback, data systems, and monitoring
4) performance improvement project
5) systemic analysis and systemic action
QUAPI: design/scope
First step
Ongoing and comprehensive, full range of services and all systems of care
QUAPI: governance and leadership
2 element: seek input from staff, residents, and family, governing body assures adequate resources to conduct QUAPI, staff account
QUAPI: feedback, data systems, and montioring
Put’s systems in place to monitor care and services, feedback systems such as performance indicators
QUAPI: Performance Improvement Projects
4th element
Concentrated effort on a particular problem problem in one area of the facility or facility wide
QUAPI: systemic analysis and action
5th element
In depth analysis to fully understand problems, its cause and change, continual learning and improvement
PDSA
Guides changes after Identifying need
Plan = objective measurable goal
Do = plan in motion, data collected throughout process
study = analyze/summarize data
Act = what next? Shift focus if goal achieved, if not why didnt the goal get achieved
Screens
Document referral source and reason for OT screen
Client information: hx, experience, performance, health status, developmental dx, precautions, contrindications
Brief occupational profile: why seeking out, areas of occupation with success and challenge
Assessment (interviews, record reviews, observations)
Recommendations: professional judgments regarding need for complete OT eval
