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Question about Scope of Practice/ Potential Duplication of Services/ Ethics in Subacute Rehab

  •  12-13-2012, 8:19 AM

    Question about Scope of Practice/ Potential Duplication of Services/ Ethics in Subacute Rehab

    I have been a therapist for about 6 years, working in acute care, the school system, and now subacute rehab. In the rehab setting I have run into various ethical scenarios regarding keeping pts on caseload if I feel it is no longer necessary/appropriate. I have one such case at this time. My pt is an 86-year-old male s/p R AKA for PVD, now with L foot wounds and in danger of losing the L leg as well. He also has a h/o severe RA with swan neck and boutenniere deformities in bilat. hands, severe shoulder AROM limitations. He has a h/o multiple strokes and prior to the amputation was sedentary, homebound, needed assist with transfers but able to ambulate a few steps to the bathroom. At baseline, family assisted him with all ADL. The focus of OT has shifted away from ADL as the pt is not interested in actively participating. At this point we are working primarily on strengthening to focus on wheelchair mobility and transfers. I am concerned that this is something PT can be doing and that it may be a duplication of service. My supervisor (a PT) says it is appropriate to keep him on caseload as OT can work on commode transfers and PT on chair to bed transfers. In my opinion, a transfer is a transfer. Any ideas on this? Any input is appreciated! If anyone has any resources that could be of help, e.g. Medicare guidelines, that would be great.

     

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