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End Stage conditions in the SNF setting

Last post 03-21-2008, 10:25 PM by audramray. 2 replies.
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  •  02-29-2008, 12:03 PM

    End Stage conditions in the SNF setting

    I am having some issues with some of the admissions of a SNF and therapy.  We have been getting some folks with end stage types of conditions, end stage COPD, end stage cardiomyopathy and moderate to severe dementia combinations.  When I evaluate these folks, they have dealt with these conditions for so long and are quite aware of the usual stuff like in the case of the man with end stage COPD with energy conservation, etc.  I don't pick these people up for treatment unless there are issues like caregiver training etc for the family.  I almost feel like self care at that point in life should be done by the caregiver so that they person can be more comfortable.   In the case of woman with end stage cardiomyopathy and moderate to severe dementia and a PEG tube who will be LTC, I really feel that there is not much potential with OT.  I always have a PT saying that the patient NEEDS OT for both of these cases.  In actuality, the PT really wants me to pick the person up for therapy so that she can reshift her minutes to me since she is so busy!!   I sometimes think that these PTs forget that our occupations over time changes and that being independent is not always a person's goal whether they state it or not.  What are your experiences with these situations if you have had any?

    JMK
  •  03-02-2008, 10:45 PM

    Re: End Stage conditions in the SNF setting

    I would agree that sometimes there is borderline Medicare abuse for residents who have no functional outcome. I do look at other issues if I do a screening on them, and am sure you do this also. I check for positioning and comfort, especially if there are concerns for skin breakdown. I may need to address contracture management, etc. Sometimes I will pick them up for a restorative program to address ROM and simple adl's that the facility could address. But, as you say, sometimes there simply are no issues and I just document this. If the rehab company wants to make an issue out of it, (if you are a contract co. in a facility), make it clear that it is your licensure that is in jeopardy, and that as a gatekeeper for Medicare you are responsible for the level of care provided.

    Good luck here,

    Tim 

  •  03-21-2008, 10:25 PM

    Re: End Stage conditions in the SNF setting

    At those times, I ask what is important to the patient. What are they most concerned about? Contacting family - can they use/dial the phone/computer? Being able to feed themselves? Being able to work the remote control to the tv? being able to get to the bathroom? Etc.

    The main point of end-stage is what is of significance to the patient and what WE can do to enable them to have a meaningful rest of their life.