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COTA Thoughts

Are Your Patients Set-Up to Fail?

Published October 2, 2008 10:13 AM by Tim Banish

Going along with the increased number of minutes that most companies want to obtain a high RUG category for your patients, do you find that sometimes the evaluating therapist has to include some goals that you know a patient will probably never achieve?

I tend to see this especially with some long term patients that had a qualifying three day hospital stay which moves them into a Medicare Part A rate. Prior to their hospital admit most of these patients were probably a mod to max assist for many tasks anyway. Trying to progress a patient who fits into this scenario can be a frustrating and almost always an impossible goal to achieve.  This is setting up your patient to fail. When you realize this and ask to discharge the patient, you are probably told to try other methods in order to continue therapy. Being an experienced therapist this can really bring me to my limit, as by then I've usually tried everything in the book.

I usually find an instance like this as the patient is approaching their MDS date. The facility wants to claim therapy minutes for skilling them instead of skilling them under a nursing category, private pay, or Medicaid rate, all of which pay significantly less. Yes, from the business side, it makes sense. However from the therapist's side it can create some real ethical issues.

Unfortunately, what is normally seen after discharge from therapy is that the nursing staff has just so much time to get their group of patients cleaned up and dressed in the morning in order to get them to breakfast on time.  So, the norm is that the aides will bathe and dress the patient rather than allowing them to retain the skills you just spent several frustrating weeks achieving. No, I can't blame the aides, but all this does is make that patient more dependent on staff again. And, you know that when their next quarterly assessment comes up it will show a decline in function. Therapy documents a mod assist; the aides document a max or dependent status. And there is that patient again, back on therapy under Part B.

I can't tell you how much time I've spent instructing aides with a particular dressing task and the patient's ability, only to see that it hardly ever gets followed anyway. Asking the aides about this patient a few weeks later will normally get a response that the patient can't do it. The honest aides, however, will tell you there is just not enough time to allow the patient to complete these tasks.  If it takes the patient five to ten minutes to don their pants, and the aide can do it in one to two minutes, it's a no brainer.

Of course, all you really have to be concerned with is getting that patient back to the level they were at prior to their hospital admit. If your evaluating therapist is setting goals to surpass their former status, then that is a failure waiting to happen.

So, we continue to provide therapy for these patients as best we can, send them back to nursing only to find that their skills decline. And the revolving door continues........

Until next time, hope all your thoughts are good,

Tim

8 comments

RE:  elective TKA, THA and changing medicare A days to 50.  I work at a SNF and we see a lot of short term rehab patients.  High level elective surgery patients rarely stay beyond two weeks.  This is in part because they are high level and because they quickly realize it is much better to be home. The Hip and knee patients that use up their 100 days usually have multiple diagnses like macular degeneration, dementia, a prior CVA, osteoarthritis, osteoporosis, etc.  We want to get these patients as good as they can get before sending them home to their elderly spouses, children who have to work during the day or to an ALF with limited assistance.  If they did change the covered days to 50, we may indeed see these people going home a lot sooner even though they are still making progress, because their families cant afford the $5-6000/month to stay.

Susan Sullivan, Geriatrics/Dementia - OTR February 26, 2009 7:38 PM
Greenville SC

Helen-

Good points. Resentment by the aides and other staff at some facilities will impede the progress and abilities of the residents. And I know what you're saying about lost and damaged equipment. Recently a splint issued to a resident lasted from Friday to Sunday. On Monday when I returned it was already torn and useless. The worst issue though is the fact that some of the "less-needy" residents are ignored, leading to pressure sores and muscle loss.

Change for the better? Hmmmm, not sure.....

Tim Banish, LTC - COTA/L November 13, 2008 7:31 PM
Cincinnati OH

Hi, regarding the revolving door therapy patients.  When someone goes out and comes back with Medicare A days, the therapist should do a screen first.  If after talking with the CNAs and Nurses and observing the patient, the therapists determine if the patient has had a significant change, and is likely to make progress or benefit from staff education, then evaluate and treat.  If, however, the patient is basically the same as they were before, then only write up the screen and do not recommend the Evaluation.  If someone was max assist prior to the Hospital stay, and are now dependent, Medicare will not pay to have someone get to a max assist level in a SNF.  Well, they do if they dont audit the chart. It is up to us to use our clinical judgement in these matters.  If we stop treating those who don't need it or won't likely benefit from our treatment, then we will be better Therapists and companies will have to become more ethical.  I am not afraid to make copies of Medicare and Medicaid guidelines and give them to administrators and careplan coordinators and family members looking to get the patients stay paid for.  

Susan Sullivan, Geriatrics/Dementia - OTR, n/a November 7, 2008 9:36 PM
Greenville SC

I must say that a good many nurses/aides show resentment toward the therapists, and are mostly uncooperative.  With that attitude, how are we supposed to know what possibilities there are for some kind of positive outcomec for those whom we treat?

I realize the challenges nursing has, but those challenges are not our fault, and they most often ignore our recommendations, causing more contractures, bedsores, etc.  The next thing you know, the resident is back on the caseload, and they are never held accountable.  Never mind habitually lost equipment!

Why has no suspicion been voiced by our Medicare system?  Hmmm....

Do any of you out there think that things will ever change for the better??

Helen, Geriatrics - COTA, SNF October 29, 2008 9:23 PM
Philadelphia PA

Thanks everyone for your comments.

I do know that a "Joint Camp" may be able to get someone home in 4-5 days, but from my experience these are usually younger and fairly fit patients. In the SNF with a multitude of diagnoses along with the TKA or THA, they usually take 4-8 weeks. If they end up a LTC patient, expect them to be on caseload for 8+ weeks, and possibly later on under Part B.

Tim Banish, LTC - COTA/L October 19, 2008 7:05 PM
Cincinnati OH

Hmmm...

Our Acute Orthopedic "Joint Camp" fast track unit can usually discharge a TKA or THA patient indedepdantly to home with PRN assist in 4 days or less. A SNF may take a minimum of 3-4 weeks to do the same - I know because I have worked in both.

...it really makes one wonder.

We have a 99% patient approval/satisfaction rating and do frequently discharge patients who live totally alone to complete rehab in a SNF.

If suddenly Medicare A was limited to 50 days, how many elective surgical patients would miraculously recover to return home in half the time?

Alan

Alan, Phys Dis - COTA/L, UHGMC October 17, 2008 12:38 PM
Chardon OH

Well Tim I'm so glad that my experience is a common one amongst other therapists.

How do we keep from burnout trying to do the best for our patients who are caught in this revolving door called therapy?

Joan, OT - COTA/L, SNF October 16, 2008 7:22 PM
Cape May Court House NJ

I transitioned from an LTAC to a SNF a year ago, you hit the nail on the head.   In an LTAC you get a short time to do alot, the CNA's, nurses and therapist all work together to get the highest ind level possible. In the SNF I spend sometimes the 100 days getting the patient back to their PLOF discharge to restorative for 8 weeks and then all of a sudden I get a referral for part B tx.  The aides tell me the same thing, they know the pts can do it, they just don't have the luxery of time to let them.  

Unfortunately, no support from administration because of the bottom line.  

Maybe there is a brilliant OT/COTA that can find a way to fix the revolving door.  Somehow we need to get Medicare to pay for maintaining patients for a period of time out of the therapy realm and allow those who really need therapy to be skilled for a shorter period of time with a good reimbursement rate that doesn't require 80 yr old SNF patients to do more therapy than an middle aged outpatient.

I know the wheel of govt. turn slow, maybe it will be worked out before I'm admitted and ruin the depts. RUG levels.

God Bless the OT's of the world, do much with little and always leave the patient smiling and feeling more useful.

Kelly October 14, 2008 11:29 PM

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