Angela... I am happy to hear your dad is ok. What was the payor source for the hospital stay Vs. the SNF...any different? Maybe the Hospital needed to control cost Vs. the SNF billing MCR for the stay. the other issue in your story relates to: What assessments tools did the OT used in the hospital to come up with such irrelevant plan of care? Were you guys included in the initial formulation of goals? Does that even happen is Acute care?
Another uissue...how do we "fight" facilities that provide therapies that do not address the interest of the clients? is there another side to this coin? What is really the role of the acute care therapists...get them ready for a SNF rehab stay? I'm never able to give myself a good-enough answer about this... Thanks Carmen From: "angela jones" <[EMAIL PROTECTED]> Reply-To: [email protected] To: [email protected] Subject: Re: [OTlist] discharge from acute care Date: Sun, 21 Jan 2007 20:00:55 -0500 >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 Duffs 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 >************************************************************************************** Laugh, share and connect with Windows Live Messenger -- 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 **************************************************************************************
