Notes from the desk of our CEO Kris Mastrangelo

 

Avoid the Pitfalls of terminating Rehab services due to an assumed plateau in function or misinterpreted assessment of "reached maximum potential".   This two part article provides discussion points for managers to utilize during patient review meetings with the Medicare team.
 
A number of geriatric patients are admitted to SNF for rehabilitation after hospitalization related to traumatic injuries.  These injuries may include falls with an inability to rise and subsequently a prolonged period of helplessness on the floor for many hours or even a number of days.  The result of traumatic injuries or events can significantly impact the course of rehabilitation and ability to return to pre-morbid status. 
 
It is essential for document progress on a graded level to support the skilled needs of the patient to support continued coverage.  The following information details the effects of trauma with the elderly. 
 
Like others with Post Traumatic Stress Disorder (PTSD), older adults respond to trauma with symptoms of re-experiencing, emotional numbing, behavioral avoidance, and increased physiological arousal. Because of age-related changes and associated disease processes, stress reaction in older adults may lead to a deterioration of function and a worsening of existing conditions. Therefore, older adults should be considered a high risk group following a disaster.
 
Several factors in adapting to disaster have been recognized as important in the older adult: 
    +  an increased sense of insecurity and vulnerability;
    +  a loss of sense of control and predictability; and
    +  a need to reaffirm familiar relationships, attachments and routines and to remain independent. 

(Cited source; The Hartford Institute for Geriatric Nursing, Division of Nursing, New York University)
 
Points to consider when determining the plan for a patient who experience a medical set back during a Medicare Part A stay or is at risk for loss of function upon discharge from skilled therapies.
 
1.      Measuring progress should include all levels of participation with program. A patient may only be able to tolerate sitting at the edge of the bed vs. ambulating and completing self care tasks as they had the week prior.  The fact that the patient has had a change in functional performance which is lower than the previous week should not negate the need for continued skilled services.  Therapies continue to be of value to maximize function from the newly assessed level.
 
2.      Patient's who are severely medically compromised are likely to progress at a slow rate.  Gains should be noted at graded intervals with credit given when the patient is highly motivated and is able to participate in the full length of a treatment session. 
 
This article will be continued in next week's newsletter.
 

HARMONY UNIVERSITY