Hi Pat,
Sorry about you father. I'm glad to hear he received the treatment that was
appropriate at the SNF. Luckily for your father, you were a good advocate.
Most of my experience has been in inpatient hospital settings. In my
experience, patients (especially orthopedic) spend 3 to 5 days in acute care
then transfer to inpatient rehab where they might stay for 2 weeks if
necessary to return to independent living. If the situation calls for more
time as when the patient reaches a plateau but will likely become
independent, we may refer them to a SNF. The time that they are "allowed" is
based on their diagnosis among other things.
In my opinion, the right doctor (physiatrists tend to be more rehab
friendly) is crucial. There are rehabs that take advantage of the lump sum
they receive for the patient. The sooner they d/c the more money the
facility receives. Or, it is possible that the therapists have just
practiced bad habits without knowledge of the finances
involved........neither is appropriate
This is a good example of the necessity of the 75% rule. There are many
reasons why the scenario you mentioned with your father is not good. I tend
to also consider the fact that medicare does their own statistical analysis
of therapy needs and what they will pay. If we all were sending people home
after 3 days then medicare will finally deduce that all orthopedic injuries
only require a few days of inpatient rehab. This may be true for some but a
a majority of the patients would suffer because of the statistics that say
rehabs d/c orthopedic injuries in 3-5 days. The other problem is that the
therapists you mentioned were obviously scoring your Dad (on the FIM) as
being nearly or completely independent when as you stated, this was not
true....but medicare would only know what they see in the FIM score.
I apologize for the lengthy response. I agree 100% with you and am so glad
to hear that the SNF was a good experience. Too often, SNF's get a bad wrap.
Angie
From: Pat <[EMAIL PROTECTED]>
Reply-To: [email protected]
To: [email protected]
Subject: [OTlist] discharge from acute care
Date: Sun, 21 Jan 2007 11:18:40 -0700
I have never worked in acute care, and I have never worked in an inpatient
setting,
so maybe I am way off base in my feelings about a recent incident...
My 85 year old father fell and broke his ankle last month. He was on the
floor for
probably about 12-20 hours before he was able to drag himself to the phone
(he lives
alone, and won't have it any other way) and call 911. The paramedics had
to go
through a window to get to him. He spent four days in the hospital before
being
transferred to an acute rehab hospital.
I have to confess that I already had it in for the PTA that worked with him
before I
even met her. I have friends who work in outpatient in that facility and
they told
me she wasn't known for her ethics (she apparently documents more time than
she
actually works with patients and discharges them as fast as possible to
lighten her
workload)... and I was livid when she wanted to discharge him after only
five days
of minimal therapy. (He was there 10 days, but got no therapy on weekends
or the
days he was admitted and discharged)
I was warned that the Dr always took the advice of the therapists and that
the treatment
team (in this case the PTA and an OTR) always stuck together and backed
each other up,
but I thought I could fight it and get them to keep him at least a few more
days. There was
NO way my father could have gone home at that point and been able to care
for himself. He
couldn't shower or dress by himself, and he couldn't stand to prepare a
meal. (he is fiercely
independent and wouldn't hear of staying at my house or having someone stay
at his house
with him).
We had a family meeting in which the PTA proudly announced to me that my
father could feed
himself. I was furious. Imagine that... being able to get a fork from a
plate to his mouth with a
broken ankle.. as if that was some great thing she accomplished. I told
her that my idea of
being able to feed himself was to be able to stand at the stove or
microwave and prepare a meal,
and then clean up after himself. She also told me that he only needed min
assist to shower. Well,
he couldn't get the boot off and on by himself, so that translates to NO
shower when he is alone.
I could go on, but the bottom line was the Dr said that as an OT I should
know better than to think
he could keep my father there when he had such glowing reports from the
therapists, and he was
discharged in spite of my protests.
He ended up going to a SNF for three weeks, where he worked with a
wonderful OT and PT and is
now back home on his own (and still driving!) In retrospect, it turned out
to be a blessing that he
was forced out and had to go to another facility, because the new treatment
team worked with him
on things he could actually use and they seemed to care more about him.
The OTR told a friend of mine that I was "unrealistic" in wanting them to
work with him a few more
days (I only asked for three). I guess my question is... was I? Do acute
care facilities only keep
patients until they meet bare minimum requirements? They knew he lived
alone.
Pat
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