Unit 3: OT with Adults in the Inpatient Rehabilitation Setting Flashcards
What is Inpatient Rehabilitation?
• Rehabilitation setting in which patients receive active and ongoing intervention of multiple therapies, one of which must be occupational or physical therapy.
• Patients must be able to tolerate intensive therapy for a minimum of 3 hours/ day; 5 days a week.
• Patients are medically stable at time of admission and are typically transferred from a hospital, nursing home, or home.
• 60% of clients must have a diagnosis within centers for Medicare and Medicaid Services 13 diagnostic groups.
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Payment in Inpatient Rehabilitation
• Prospective payment system: (ex. Medicare) There is a predetermined fixed amount that can be based on a diagnosis-related group
• Private insurance or self care
• Managed care
• Workers’ Compensation
• Medicare
• Medicaid
• Unfunded
Billing in Inpatient Rehabilitation
OT services are billed via CPT codes (timed & untimed codes)
Services Provided in Inpatient Rehabilitation
• Rehabilitation physician
• Rehabilitation nursing
• Physical therapy
• Occupational therapy
• Speech-language pathology
• Recreational therapy
• Neuropsychology or psychology
• Social services
• Respiratory therapy
• Dietary
• Pharmacy
• Other services by consultation
Adults in Inpatient Rehabilitation
-Often younger adults were functioning at a high level prior to functional deficit and admission to inpatient rehabilitation.
-Adult roles include worker, family member, volunteer, and many more
The Role of OT: Evaluation
-Comprehensive occupational profile including prior level of functioning, home environment, support systems, important life roles, values, and interests.
-Analysis of Occupational Performance & Client factors: Functional Independence Measure
-Client centered goal setting: Often adult clients have multiple roles; Goals of OT should be to return to engagement in important activities and optimize role fulfillment
-Discharge planning: What kind of supports or equipment might this patient need?
Functional Independence Measure
• Eating
• Grooming
• Upper Extremity Dressing
• Lower Extremity Dressing
• Bathing
• Toileting
• Toilet transfer
• Shower/tub transfer
The Role of OT: Treatment Planning & Treatment
• Pt will participate in at least 60 minutes of occupational therapy 5-6x/wk.
• Therapeutic preparatory activities
• Therapeutic use of occupations and activities
• Education and training
• Advocacy
• Group interventions
The Role of OT in Inpatient Rehab: Discharge
-OT works with the interdisciplinary care team to transition the client home with the proper supports.
-Discharge Planning: What question should you ask yourself? Does the home environment support client engagement and independence? What kinds of supports will the patient need upon DC? (Supervision, physical assist, equipment, assistive devices)
-Will the patient need continued therapy? Home health therapy, Day rehabilitation, Outpatient therapy, Sub-acute rehab (if you do not expect the patient to be able to safely go home after their rehab stay).
Common equipment provided in the inpatient rehabilitation setting
-Bedside Commode: Put next to the bed of someone who’s not able to get to the bathroom safely; Can be put over a toilet to allow for an elevated surface for someone to sit on, and handles for them to push up off of to make a toilet transfer easier.
-Shower Chair. Would be good for someone who has a shower in their home, but they need to sit during shower time for energy conservation or due to balance impairment, something like that. If the person has a tub at their home, a tub bench may be more appropriate. This is a picture of a tub bench here. As you can see, you can see two of the legs go inside the tub, two of them are outside, and the client can sit on the tub bench and then slide themselves over to sit during a bath.
-Front‐Wheeled Walker: To assist with mobility.
-Dressing kit: Assista with lower extremity dressing.
-Long‐handled reacher, a long‐handled shoe horn, a long‐handled shower brush, dressing stick, and also, a sock aid. Hospital bedL the good recommendation for someone who may not be able to get in and out of bed without grab bars, or requires the elevated portion of the headrest due to respiratory issues or difficulty getting in and out of bed.
-Hoyer Lift: Recommended for someone who requires total assistance for transfers and would still like to go home, and has 24‐hour caregivers to assist with the Hoyer lift.
Case example: Client admitted to inpatient rehab who is now preparing to discharge home with the assistance of his wife.
A 62-year-old right-hand dominant male presented to the ER with complaints of persistent headaches that were getting progressively worse, increasing left-sided weakness, and gait instability. Magnetic resonance imaging revealed a large enhancing mass with in the right parietal lobe with extensive surrounding vasogenic edema. Differential diagnoses included a solitary metastasis or a primary central nervous system (CNS) neoplasm. The patient was admitted to the hospital and the tumor was grossly resected the next day. His post-operative course went smoothly without complication and on his 6th post-operative day he transferred to an inpatient rehabilitation facility. Residual deficits include L hemiparesis with L LE functioning roughly 2+/5 to 3-/5 and L UE 2/5 overall. Sensory impairment is evident. Mild L hemineglect is present and he is impulsive. He exhibits mild dysarthria and aphasia, although he is able to communicate verbally somewhat. He has been receiving inpatient rehabilitation services for the past 4 weeks and is now scheduled to discharge.
Client’s FIM scores upon admission and discharg
13 diagnostic groups that make up 60% of the clients admitted to inpatient rehabilitation.
Includes: Stroke, Spinal cord injury, Congenital deformity, amputation, Major multiple trauma, Fracture of the femur, Brain injury, Neurological disorders including Multiple sclerosis, Motor neuron disease, Polyneuropathy, Muscular dystrophy, Parkinson’s disease, Burns, Active polyarticular Rheumatoid arthritis, Systemic vasculitis with joint inflammation resulting in significant functional impairment of ambulation and other ADLs, severe or advanced osteoarthritis involving two or more weight‐bearing joints, knee or hip joint replacement, or both, during an acute care hospitalization immediately proceeding the inpatient rehabilitation stay, and also meets one or more of the following specific criteria.
The patient underwent bilateral knee or bilateral hip replacements during the acute care stay, or the patient is extremely obese with a BMI of at least 50, or the patient is 85 years or older.
