Are Your Patients Set-Up to Fail?
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