I was angry enough that I accused them of it being about the money (medicare), but my father is retired military with 40 years of active duty, and tricare was picking up everything that medicare didn't pay. He also is financially well off enough that he could have paid out of pocket. I told them that if it was about the money they didn't need to worry about getting paid, but we decided that he didn't really want to be where the therapist didn't want to work with him.
It was actually two days between the family meeting and when he was transferred to the SNF, and during that two days the PTA never set foot in his room again. I told her, in no uncertain terms, that for the remainder of his time there I wanted her to work on something USEFUL... that was the last either of us saw of her. For someone like me, a broken ankle would be no big deal... I could hobble along with crutches and my life wouldn't change drastically. I can see someone younger only needing a couple days in acute rehab, or even just outpatient (or no rehab at all). For him, balance was a major issue and the boot made his balance much worse and he was a high fall risk. I pointed that out to the PTA and OT, but it fell on deaf ears. Pat At 06:00 PM 1/21/2007, you wrote: >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 >> >> >> >> >>-- >>Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >>Archive? >> www.mail-archive.com/[email protected] >> >>************************************************************************************** >>Enroll in Boston University's post-professional Master of Science for OTs >>Online. Gain the skills and credentials to propel your career. >>www.otdegree.com/otn >>************************************************************************************** > >_________________________________________________________________ >Get Hilary Duff's homepage with her photos, music, and more. >http://celebrities.live.com > > > > >-- >Options? > www.otnow.com/mailman/options/otlist_otnow.com > >Archive? > www.mail-archive.com/[email protected] > >************************************************************************************** >Enroll in Boston University's post-professional Master of Science for OTs >Online. Gain the skills and credentials to propel your career. >www.otdegree.com/otn >************************************************************************************** > > -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
