Download Long-Term Care and Skilled Nursing: Definitions, Eligibility, and Differences and more Quizzes Health sciences in PDF only on Docsity!
What constitutes long term care?
services delivered for sustained periods to individuals who have demonstrated need usually measured by some index of functional incapacity TERM 2
What constitutes subacute
care?
DEFINITION 2 The management of discrete episodes of illness requiring medical management and/or functional rehabilitation within the SNF. TERM 3
Eligibility for Medicare SNF benefit is defined
as what?
DEFINITION 3 the need for daily (5 days per week) skilled nursing or rehabilitation services TERM 4
Skilled rehab only provided if there is a
reasonable expectation for what
DEFINITION 4 for improvement or to establish a maintenance program to be carried out by others TERM 5
For acute rehabilitation Medicare requires
that the patient be able to participate in how
many hours of therapy?
DEFINITION 5 3 or more hours of therapy per day (can be OT, PT and SLP combined)
Difference between a SNF and a
NH?
The different between the two is determined by whether skilled care or custodial care is needed and provided TERM 7
SNF
DEFINITION 7 A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services with the goal of returning the patient to their home.Cant be provided on an outpatient basisincluded IV, PT, OT, speech therapy TERM 8
Nursing home
DEFINITION 8 Is a residence facility that provides a room, meals, and help with activities of daily living and recreationDoes not provided skilled care TERM 9
Skilled Nursing Care
DEFINITION 9 A level of care that includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse). TERM 10
Skilled care
DEFINITION 10 A type of health care given when a person needs skilled nursing or rehabilitation staff to manage, observe, and evaluate the care provided.
RUGs
Classification schema used by Medicare Prospective Payment System Requires accurate and comprehensive information gathering about a residents characteristics and needs Extremely important because classification has major implications for reimbursement and Medicare coverage Higher categories provide greater reimbursement HCFA automatically presumes those residents classified within the top 26 classifications automatically meet Medicare TERM 17 coverage criteria
Major RUG categories
DEFINITION 17 Rehabilitation plus extensive Services* Rehabilitation* Extensive Services Special Care Clinically Complex Impaired Cognition Behavior Problems Reduced Physical Function ** The rehab groups include all residents who receive at least 45 minutes of PT, SLP, and/or OT therapy weekly TERM 18
History component of PT exams in a nursing
home
DEFINITION 18 Patient history may be limited due to lack of chart information May have to rely on patient or interviewing family and friends Knowledge of prior functional level is important in order to form an accurate clinical impression and to establish realistic, obtainable goals Obtain history of falls Is patient/resident a risk to self and/or others? TERM 19
Most common causes of falls?
DEFINITION 19 Gait and/or balance impairments LE weakness (especially quads) Dizziness or vertigo Environment-related factors Confusion Others TERM 20
Risks for falls?
DEFINITION 20 Weakness Balance and/or gait deficit Impaired mobility or use of walking aid Functional impairment Visual impairment Use of antidepressants, sedative hypnotics Postural hypotension
Tests and Measures
aerobic capacity and endurance ROM muscle performance motor function self-care activities safety TERM 22
Aerobic capacity and endurance
tests
DEFINITION 22 Take vital signs at rest, during and after activity and Determine autonomic response to positional changes In order to interpret response to exercise, positional changes, the therapist must have a working knowledge about how specific disease states and medications can potentially impact the normal physiological response to external stimuli Functional tests of endurance Research findings: show 50% have 1 or more episode of orthostatic hypotension (> 20 mm Hg decline in SBP) 1 to 3 minutes after going from supine to standing TERM 23
ROM tests
DEFINITION 23 In general often limited In one study > 75% had unilateral knee flexion contractures > 5 Presence of knee flexion contractures associated with: Resistance to PROM Cognitive impairment Impaired ambulation c/o knee pain Flexion contractures > 20 associated with gait problems TERM 24
Muscle weakness often due to?
DEFINITION 24 Age-related changes History of hip fracture or arthritis Decreased activity levels Bedrest Disuse atrophy TERM 25
Motor function
testing
DEFINITION 25 Motor control & motor learning Must evaluate gait, locomotion, balance Best to use standardized performance tests if possible Gait speed correlates with functional ability and falls
Process of using physical restraints
Must have physicians order and justification must be documented Resident and family informed consent This includes explanation of possible side effects A schedule of use must be in the residents chart Specifics about when, where, how applied, for how long must be specified TERM 32
Adverse effects of physical restraints
DEFINITION 32 Behavioral changes like Agitation, Withdrawal and Depression Trauma/injury Falls Functional decline Decreased appetite Cognitive changes TERM 33
Chemical restraints
DEFINITION 33 The excessive control of behavior by the use of medication is becoming an epidemic Any drug used for discipline or convenience and not required to treat medical symptoms This does not single out psychiatric drugs TERM 34
What is "discipline"?
DEFINITION 34 Any action taken by the facility for the purposes of punishing or penalizing a resident TERM 35
What is
"convenience"?
DEFINITION 35 Actions taken by the facility to reduce its burdens rather than to promote the best interests of the resident
Adverse effects of chemical restraints
Agitation Gait disturbances Memory impairment Sedation Withdrawal Functional decline Increased fall risk Movement disorders Orthostatic/postural hypotension TERM 37
Process of using chemical restraints
DEFINITION 37 Must have physicians order along with consent from the patient and/or primary legal representative The order must specific the duration and circumstances under which the drug restraint is to be used Federal law does prohibit the use of unnecessary drugs TERM 38
What are "unnecessary" drugs?
DEFINITION 38 Excessive dosage (including duplicate drug therapy); For excessive duration; Without adequate monitoring; Without adequate indications for use; In the presence of adverse consequences which indicate the use of the drug should be reduced or discontinued; OR Any combination of the reasons above TERM 39
Common medications abused?
DEFINITION 39 Antidepressants Antipsychotics Mood stabilizers Sedative-hypnotics meds Antianxiety meds
