OTP 542 Final
LTC: reason for nursing home admission
Short-term: Rehab or skilled nursing care Long-term: Cognitive disorder Long-term: Health condition (chronic and disabling)
LTC: three categories of care
Skilled High-level care following a hospitalization Rehabilitative Expectation is improvement to move to a less restrictive environment Custodial care Long-term residential care
Impact
Skin integrity Functional status Medication reconciliation Incidence of falls Transfer of information Resource use Discharge to the community Risk of readmission
Accessible design home mod
Accessible Design: Both accessible and useable for individuals who have a disability Includes design recommendations for a person's disability to allow them to be a match for the disability Separate deign feature to match explicit disabilities Costly Stigmatizing Three categories of Accessible Design: Adaptable Design Transgenerational/Life-Span Design Universal Design Can come from a mix of categories Design may incorporate elements from one, two or all three categories
Rehab: Delivery Systems
Acute Care Transitional Care Facilities and Units Rehabilitation Units Day Hospital Care and Adult Day Care Facilities Home Health and Domiciliary Care Outpatient and Ambulatory Care
Vistability
A place where anyone can come/accessible for all (more so in person's residence) Three basic features of visitability: No-step entrance 32-inch-wide doorways First floor bathroom
Categories of accessible design
Adaptable Design: specific to individual's needs Modifications to a standard design for a specific individual Costly Stigmatizing Ex) providing 3 in 1 commode to someone with a hip replacement; tub bench for knee replacement/COPD Includes making adaptations to already existing item, such as adding a raised toilet seat to toilet Most stigmatizing - may look like "handicap accessible," doesn't look as user friendly Transgenerational Design/Life-Span Design: Considers changes with age Lack consideration of other potential barriers Make modifications that will be suitable for all individuals across the lifespan Does NOT take into considerations the needs of individual person Ex) adding grab bar into shower Universal Design: Universal Design: Design that takes into consideration the use of individuals with all abilities (disabilities) without adapting Least stigmatizing - no adaptation because the goal is to provide an environment that is suitable to everyone's needs 7 Principles of Universal Design: Equitable use - useful for all individuals for the same purposes, same means for all people using Flexibility in use - idea that design elements cover a wide variety of users Ex) accessed equally from someone who is right handed or left handed Simple and intuitive - no skill / preexisting knowledge needed to use Perceptible information - design itself/item itself should communicate what item is used for Tolerance for error - if someone doesn't use it exactly the right way, it should not explode/cause harm Ex) automatic shut off's - shouldn't have to need extreme precision Low physical effort - not a lot of force/energy needed to use it Size and space - should be able to be accessed by all individuals with different bodies Goal: Minimize adaptation needed to space Intended to be user friendly despite ability/disability
Home health
Aims of IMPACT, domains it looks at Better care Healthy communities Affordable care Specific domains of emphasis are Skin integrity Functional status (INCLUDING cognitive function) Medication reconciliation Incidence of falls Transfer of information and patient preferences during care transitions Resource use Discharge to community Risk of readmission
Rehab: Case management
Assists an individual in ensuring needed services are provided to assist in achieving goals
Consequences and factors
Consequences of Falls Bruises, contusions and lacerations Sprains Fractures Head trauma and brain injuries Factors Influencing Impact of Falls Height of the fall and impact surface Bed/standing height vs. toilet/chair Tile/wood/concrete vs. carpet Protective Reflexes Extend arms outward and quick shifting of feet to regain balance Slowed reflexes due to neuromuscular dysfunction or medications Shock Absorbers Fractures more likely in those with muscle atrophy and less fat Bone Strength Loss in bone strength is particularly prevalent in women (up to 50%)
Role of OT in urinary
Basic Interventions All OTs have the skills and training Assessment and training in self-care skills Interventions What skills may inhibit a persons ability to perform toileting tasks? Fine motor deficits, poor standing balance, lack of ROM to reach to wipe self, activity tolerance, sitting balance, issue finding bathroom in the first place Component skills that inhibit function Need for adaptive equipment - 3 in 1 commode, reacher, bidet insert, grab bars, modified clothing, button hook Training in adaptive techniques - positions, bed side commode Address functional incontinence Advanced Interventions Advanced training and knowledge-competency must be shown CEUs Clinical training with a mentor Certifications Assessment of bowel, bladder and sexual function Interventions Pelvic floor muscle re-education Bowel and bladder re-training Diet and fluid instruction Pain desensitization
Home Modifications Overview
Benefit individuals at all ages: Health conditions Sensory and movement impairments Cognitive Disorders Home modifications increase: Use Safety Security Independence Improve safety, increase security, improve independence Process: Evaluate the needs of the client Identify and implement the identified solutions Train the client to ensure understanding and safety Evaluate the outcomes of the modifications Recommendations include: Alterations - adjust seat height, make recommendation to alter furniture in house, change things from top cabinet to bottom Adjustments - recommend they move handrailing or make more steady Additions - things added on, like adding a grab bar or commode Client returns to home as is Recommendations are adhered to Client not safe to return to residence Determine best d/c plan We do NOT make modifications, only recommend - otherwise, we would be liable for them
What "type" of assessment is considered the norm for evaluating older adults in rehabilitation settings?
Comprehensive Geriatric Assessment, give areas for further evaluation or treatment
DME
Canes for mobility Commode Crutches Hospital Bed (other beds may be covered) Manual wheelchairs/Power mobility device Lift Walkers
Caregiving
Caregiving in the United States Who are the caregivers? Female (60%) - most likely mother or daughter Average age is 49 25% report difficulty with assisting in ADL tasks Who is the recipient? Female (65%) Average age is 69.4 (almost half are above 75) Long-term physical condition, Short term physical condition, memory problems, emotional problems, behavioral issues, and/or developmental disorder Context: Location-Home, Caregiver's home, Another persons residence, Nursing home, Assisted living, and Retirement community Most caregivers take care of one person 75% are in the role for less then 5 years Most caregivers assist the recipient with ADL tasks (transfers from beds and chairs are most frequently reported) Higher hour caregivers: care for 10+ years, recipient is most likely a spouse, caregiver is more likely to live with the recipient of services , more ADL tasks, increased difficulty assisting in ADL tasks Caregivers assist with IADL tasks (transportation being reported as most likely Caregiver Burden National Alliance for Caregiving and AARP- 32% of caregivers experience high caregiver burden and 19% experience medium caregiver burden Majority of caregivers are female who are taking care of a family member or friend Average time spent caregiving is 20.5 hours (20% spent over 40 hours in a week) Caregivers are often untrained and do not feel prepared for their responsibility Risk factors: Female, low education, increased hours caregiving, living with the recipient, depression, social isolation, and lack of choice Outcomes: Death, weight loss, loss of sleep, and lack of self-care, difficulty maintaining job, depression, anxiety and/or depression, and suicide *some risk factors and outcomes overlap Caregiver Burden National Alliance for Caregiving and AARP- 32% of caregivers experience high caregiver bur
Approaches in home mod
Change the individual Physical, psychological, and social functioning Change the environment Accessible Design Adaptable Design Transgenerational Design/Life-Span Design Universal Design Provide the individual with tools they can use Assistive Technology Device Low Tech Devices - cane, reacher, button hook, manual wheeelchair High Tech Devices - hoier lift, flashing doorbell, communication board, power wheelchair
Urinary case study
Client is an 83-year-old woman who presented to the ER with a fever and red area on her right shin. She reported catching her leg on a rose bush in the garden. Dx with cellulitis and treated with antibiotics. Admitted to BP-ECF for skilled services. Social Hx: working as an accountant, raising three children, playing tennis, playing the piano, gardening, and talking to her grandchildren by phone. She lives at home with her husband in 2 story house. Med Hx: mild stroke, mild CHF, mild cognitive impairment, and GERD. PLOF: I ambulation with cane. Mild memory problems. Urinary incontinence, wearing pads during the day and night. Evaluation results: Functional transfers and fxnal ambulation: Min A UB ADLs: Supervision LB ADLs: Min A Noted incontinent of urine in am. Client stated "I rang my bell but no one came." Bladder diary: # of incontinence episode over a 24 hour period: 6 What type of incontinence is this client most likely experiencing? Functional incontinence What would you recommend for interventions? Pelvic floor exercises, address mobility issues to access toilet, diet, fluid intake, bladder retraining, give access to safely transfer to bedside commode Make sure client is set up for success Write 2 goals for the client (1 involving urinary incontinence) In two weeks, client will demonstrate toileting with supervision in order to participate in leisure pursuits. In two weeks, client will decrease number of incontinence episodes to 2 per day in order to increase participation in leisure activities.
Models of integrating rehab professionals
Clinic: In office of MD, being more of supplemental service work within scope of OT but in more supplemental setting Outreach: not really huge in OT Ex) nurses go out to senior center to give flu shots w/c fitting, walker fitting Provide satellite services in a community that does not necessarily have access to services Self-management: help provide education and confidence in person's ability to manage own condition; can take place in clinic (ex. Diabetes management) Community-based rehabilitation: partner with other agencies/types of community partnerships Ex) SensiPlay for peds, Enfield/Manchester Holistic Case management: managing case Shared care: OT works with specialist (ex. Cardiologist, orthopedic surgeon), more generalized role
DME
Durable Used for a medical reason Not considered useful for an individual that is not sick/injured Used in a persons home Expected to last 3+ years
Community based services
Continuum of Care - what particular focus is Linear progression - some for those who are independent, moving down the line with more support for those dependent in ADL/IADL tasks We all do NOT progress in a linear fashion Independent -> Dependent Comprehensive assessment: Exploring physical abilities, intellectual abilities, emotional abilities, social abilities, financial, environmental Helps us to ensure services for client that are required and needed Essential to match services with individual needs Too much services: learned helplessness, lose abilities Not enough services: may not improve, pose safety risk Service needs may change overtime, thus requiring ongoing reassessment May require more services, may require less
Home Health Care
Criteria (two distinct "conditions") Eligibility Home Health Agency Person receiving services is a Medicare beneficiary The HHA participates in the Medicare Program The beneficiary qualifies for home health services The services provided are covered Medicare is the appropriate payer source Services are otherwise not excluded Medicare Beneficiaries Under a care of an MD An MD must certify the need for: Intermittent skilled nursing care (aside from blood draws) PT SLP *Continued OT An MD must certify that the client is homebound Cost No fee for the home health care services 20% co-pay for DME
Funding, Resources, and Partners
DME (Durable Medical equipment) AARP: HomeFit Rebuild Together
Urinary tx:
Electrical Stimulation Electrical stimulation: The client must show that therapeutic exercise alone has been found to be ineffective In order to bill Medicare for e-stim the client must have intact cognitive status and failed trial of the therapeutic exercises alone If client is making progress through pelvic floor retraining, insurance will NOT pay for e-stim When used in conjunction with therapeutic exercise it is used prior to implementing the exercisesy Goals In 2 weeks client will... decrease to # of incontinence episodes to ___ per day... decrease to # of soiled incontinence products to ___ per day... decrease to # of voiding episodes to ___ per day... demonstrate ability to manage incontinence products with ___ ... demonstrate ability to complete toileting with ___ increase length of time between episodes of incontinence to ___ ... ...in order to (relate to functional area, Occupation)
What is the general aim of rehabilitation?
Enabling people to maximize, restore and maintain their optimal physical, sensory, intellectual, psychological and social functional levels
Intervention
Enhance skills Create a supportive environment
What does the documentation need to include?
Evidence based practice Justify need for skilled therapy Show potential for improvement is possible Confirm homebound status Measurable/attainable goals Response to tx Assessments Comprehensive discharges
Fall facts
Falls are not a normal part of aging Falls are multifactorial Falls are costly Older age is associated with greater risk The older you get, the higher the chance of falling Fall Statistics Community dwelling older adults 65+: 1/3 (40%-50% have multiple falls) If someone has had a fall, it is more likely they will have another fall Reports show falls are more common in women More likely in adults living in LTC settings More likely in the winter - falls do happen in all seasons Location - Bedroom or bathroom bathroom is most likely Throw rug, slippery in bath tub and floor, more cluttered, not necessarily lighting in the evening, smaller space, may have to step a little higher into tub, may be barefoot, urgency (not always making best decision of speed, lights)
Balance and falls
Falls can imply an injury occurred, that a fall will occur again Near fall: fall could have happened but through righting reaction or grabbing something for balance Fall: going from higher surface to lower one (not able to catch self) Want to ask about near falls or losses of balance - gives us information Age-related changes Neuromusculoskeletal and Movement function Changes in posture Decreased strength and muscle power Changes to bone, cartilage and skeletal muscle mass Changes in balance and gait Decline in speed and initiation - takes a while to get started Axial Skeleton Forward head Rounded shoulders Kyphosis Increased knee flex angle Posterior hip posture Can also be problematic with sitting - may fall out of w/c Change person's COG, which contributes to a greater risk of falling Balance and Gait Visual and vestibular changes Slowing motor movements Decline in proprioception - difficulty on uneven terrain Decreased postural stability
Incontinence/Continence products
Female urinal, Foley catheter Briefs - for clients who can manage their own continence product, easier to remove Taped/dependent briefs - patient/family will have to bring own in May tape maxi pad if lighter flow, can dispose of that Can be ripped off if soiled MORE complicated to use - take off pants entirely Typical urinal - provided to male at bedside, sometimes females May work with client on positioning so no spilling occurs Leg bag - in place of Foley catheter bag, easier to manage clothes, do functional ambulation/transfers Condom/Texas catheter - external male catheter
Four stages of caregiving
Four Stages of Caregiving Stage 1: Anticipatory Caregiver Caregiving appears to be a possibility Watch relative begin to fail Good time to start gathering information Stage 2: Freshman Caregiver New to caregiving Caregiver for 6-9 months Often looking for help from others A good time to research what is available Stage 3: Entrenched Caregiver Care has been provided for some time Caregivers may be exhausted and/or overwhelmed May start to lack in their own self-care Fatigue may compromise the care they are able to provide Important to talk about self-care because they may feel burden of caring Good self-care can equate to proper caregiving Stage 4: Caregiver in Loss End of caregiving: no longer able to care for loved on or loved one passes away Maybe client needs hospice, inpatient setting Even if caregiver burden is associated, people still experience loss/grief because their role is changing Feelings of grief and loss often accompany this stage Support groups, counseling - GRIEF IS NORMAL WHEN LIFE ROLE IS CHANGING
need for therapy
Four dimensions Physical dimensions Control of symptoms: Pain and fatigue Functional decline: Mobility, endurance, body mechanics, loss of routines, ADLs, self-care, home management, and leisure Wont be able to improve all ADLs but at least help with meaningful tasks Psychological dimensions Fear and worry, anxiety, increased risk of depression, and loss of identity and self-worth Social dimensions Loss of prior social roles and networks, communication, interactions with family and caregivers, and living situation Existential dimensions Life crisis Awareness of the end of life Role of Occupational Therapy Role of occupational therapy: Value the remaining life a person has left Support individuals by optimizing their ability to engage and participate in activities that promote quality of life and preserve integrity while considering the needs and wants of the individual and Within the OT code of ethics and professional code of conduct, help an individual prepare for approaching death Intervention Accommodations: ECT - energy conservation, compensatory strategies Symptom management (ie. pain, dyspnea, and anxiety) Activity management strategies Considerations: Stage of the illness Early Late Terminal Context Home SNF Hospice facility Hospice takes over care if providing service in SNF
Rehab: Assessment Instruments
Functional Performance Participation in valued activities
Home bound
Generally, the requirement of being confined to one's home Considerable time and effort to leave house Leave on infrequent/inconsistent basis One of these qualifiers also must be met: Due to injury/illness, need special transportation or adaptive/assistive device for mobility MD stated leaving home is contraindicated
The Expanded chronic care model ECCM
Heavy focus on health and promotion/prevention of chronic conditions, expansion of previously identified model of health care
Home health
Home Health and Domiciliary Care - *Discussed in the previous chapter Outpatient and Ambulatory Care What settings provide outpatient services? Hospitals, free-standing clinics, private practice, CORFs
Reimbursement
Home health care therapy services (Part A) Three therapy thresholds Projected number of therapy visits is identified on the OASIS and then confirmed with submission of the final claim Outpatient services in the home (Part B)
Integration of OT services into primary care
How? improve individuals experience with their health care; improve health of the population; decrease costs Health prevention and promotion; advocate for profession
If a patient is covered by Medicare, what services are qualified to perform the initial visit and the start of care (SOC) comprehensive assessment?
If nursing is ordered at SOC, RN must perform comprehensive assessment Therapy only cases - PT or SLP can perform SOC comprehensive assessment upon admission of patient to an agency After the initial visit, can OT be the only service that stays in? YES
CBS Location
In-home care: community comes to individual in their home Homemaking, chore services, and meal services Outside-of-the-home assistance: requires person to be able to receive or perform self-transport Adult day care, congregate meals, and senior centers - some social or recreational activities/groups Housing modifications or options: to one's own home or an alternate residence Ramps, grab bars, and electric garage door openers Alternate residence that meets an individuals specific needs
Disability in older adults
Increased age=Increased chance of disability Chronic diseases, injuries, mental impairment, malnutrition, and communicable diseases Trauma and illness can potentially have catastrophic impacts on the individual experiencing them as well as their caregivers Older adults often have multiple comorbidities as well as normal age related changes
Documentation
Increasing need to show evidence based tx Justifies the need for skilled therapy Communication, effectiveness of services, response to tx, ongoing assessment Two recognized venues Rehabilitative Potential to improve Maintenance Need of skilled services to maintain current function or prevent/slow further decline Minimum standards Confirmation of homebound status, goals that are measurable and attainable, clients progress and response to tx, timely and complete reassessments, and comprehensive d/c summaries
Aging and Functional Performance
Individuals are living longer and healthier lives Along with living loner comes challenges Gradual decline in hearing, vision, mobility, and cognition Increased likelihood of chronic disease - Alzheimer's, visual pathologies, diabetes, arthritis Individuals choose to live at home when alternate living arrangements are made
CBS Linkage
Information and referral: from formal and informal means; friend gives info, MD tells you place is available Case management: set up services, work with people in any population that help facilitate and find resources/manage care person receives Outreach: works in community services, reach out to individuals about beneficial services Service guides: lists of available services, organized by specific needs or location Educational programs: lectures and workshops that provide information
Caregiver intervention
Intervention: Education and information on diagnosis Care needs, progression of caregiver role Use of technology (reduce physical burden - lift system, use/availability of life line) Respite care - temporary care by SNF where care is able to be provided for little bit of time Certain amount of beds allotted for custodial care 1 - 2 weeks until caregiver takes client home Outside assistance and/or care Encourage self-care - people need to hear roles/responsibility is taken care for Encourage participation on the team Not billing for caregiver burden, bill in relation to client Participate in caregiving more effectively MED A: patient MUST be present Legislation September 2001: Medicare Memorandum A dx of dementia cannot be sole reason for denial of therapy services for Medicare beneficiaries January 2013 Jimmo vs. Sebelius (CMS, 2014) Vermont, claims were denied due to the "improvement standard" Regulation 42 CFR 409.32 = The level of care criteria for SNF coverage specify that the "... restoration potential of a patient is not the deciding factor in determining whether skilled services are needed. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities" (pg. 1). What that means for OT OTs can work with clients with chronic, progressive, and terminal diseases. Services cannot be denied based solely on diagnosis. Even when restoring function is unlikely, OTs can create maintenance programs aimed to maintain, preserve, and/or maximize functional abilities, and to prevent or slow decline. It is appropriate and necessary for OTs to train caregivers during treatment.
Fall interventions, EBI & EB fall prevention programs
Interventions Falls often occur as the result of more then one etiology, requiring various intervention strategies Exercise Assistive and Adaptive Devices Fear of Falling Interventions Environment and Community: Prevention and Intervention Others - Urinary incontinence Endurance, bone health promotion, strengthening, education on adaptive devices Evidence-Based Interventions Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults Chase, Mann, Wasek, & Arbesman (2012): Multifactorial Interventions Included a variations of the following: Home modifications, education on health and safety, medication management, vision management, gait and balance training, and exercise Take the approach of what is best for client, what makes them feel comfortable Physical Activity Included group and individual sessions: Balance retraining, walking, general exercise in sitting and standing, lower-extremity strengthening, use of a workstation format, or tai chi. Home Assessment and Home Modifications Included: Hazard identification, structural changes to the inside and outside of the home, and provision of assistive technology and assistive device Evidence-Based Fall Prevention Programs A Matter of Balance, CAPABLE, Enhance Fitness, FallsTalk, FallScape, Fit & Strong, Healthy Steps for Older Adults, The Otago Exercise Program, Stay Active and Independent for Life (SAIL), Stepping On, Tai Ji Quan: Moving for Better Balance, YMCA Moving for Better Balance
Risk factors and roles of OT
Intrinsic Medical conditions Vision and hearing Changes related to aging Extrinsic Medications Hazards to environment Improper use of AD - intended to help maximize a person's independence but if used improperly, can increase risk for a fall Role of Occupational Therapy Occupational Therapy Practitioners have the skills to address fall prevention Falls are multifactorial Interaction-Individual and environment Address Fear of Falling Address Risk Factors Intrinsic verses Extrinsic Use language of concern - do you have any concerns about falling when you do this activity? People tend to respond more to this than using the word fear Work with them to participate in activity they have fear about, offer adaptations, work with them to continually do task until they feel confident "use it or lose it" - gives more motivation to allow them to participate in things again
Life threatening illness
Kubler-Ross Stages of dying: 1) denial: news of diagnosis, don't want to admit truth Often at beginning but happen later as well 2) anger: "why me?" 3) bargaining: "if im able to live, ill do this" Bargaining with disease 4) depression: when people can no longer deny illness is happening Replace anger with grief and loss 5) acceptance: no longer angry, accept destiny Not necessarily a linear progression Common emotions Fear Uncertainty A Good Death Kellehear identifies features of good death: Awareness of dying by the individual and others Social adjustments and personal preparations for death Delegation of care, comfort and responsibilities Control of symptoms Preparations for death Closure and completion Farewells to others Access to both spiritual and religious support Public preparation - everything ready and set for process (house sold, let people know what they want with their assets)
What is the focus of intervention in home-care?
Maintenance and rehabilitation Supporting the individual's return to the best possible function in his or her environment, or minimizing additional functional loss
OASIS
Mandatory for clients who receive reimbursement from Medicare or Medicaid Group of standard data elements Designed to allow for a systematic comparison between two time points Assessment points are required to be collected at different time points SOC, Resumption of care after inpatient stay, recert: within 5 days of the 60 day recert period, follow-up, transfer to an inpatient facility, d/c, and death All expected to be assessed while with the client through direct observation/interaction (with the exception of transfer to inpatient or death) Data address reimbursement and function
Assessments
Many facilities create their own Home Safety Assessment Tool (HSSAT) Version 5.0: Home Safety Assessment: SAFER tool Cougar Home Safety Assessment 4.0:
Rehabilitation
Maximize, restore, or maintain Physical, sensory, intellectual, psychological, and social function
Illness and disability
Medical conditions as well as normal age-related changes can impact performance skills, body structures and body functions. An individual need for intimacy, excitement and pleasure continue through later life. Below are some of the illnesses and disabilities that can impact a person's ability to have and/or enjoy sex. What can we do as occupational therapy practitioners to address the following conditions? Arthritis - pain, stiffness Recommendations: warm bath prior, change positions to not bear weight on painful joints, times of day are least painful for individual, schedule times Chronic pain Dementia - tricky, able to provide informed consent to engage, client may think someone is their spouse who is still living Strategies: staff intervention (make everyone feel more comfortable), education Diabetes Heart disease - may fear they will have another event with strenuous activities (including sex) If client can climb 2 flights of stairs briskly without pain in chest or breathlessness, client is able to resume sexual activity 300 yards on a flat surface without pain or breathlessness Incontinence - uncomfortable topic of conversation to have with spouse/partner (esp. if newer partner) Education on positioning to apply less pressure on bladder, scheduling to lower risk of episode, educate to urinate prior to activity, incontinence protocol with client Stroke Depression COPD Surgery
LTC: Evolution of the nursing home
Medicare and Medicaid (1965) Quality care, quality of life, resident rights, and development of a standardized assessment tool Numerous federal and state guidelines
Pharmacology and OT
Medication Management (IADL) Negotiation with the provider to obtain the prescription Fill the prescription Interpret the information required about the prescription Take the medications as prescribed Maintain ability to continue to manage ongoing use of the prescription Medication Adherence Taking medications as prescribed 100% means perfect adherence (as opposed to overdose or underdose-both which can lead to negative effects) Role of OT in Medication management Evaluation Assess the ability an individual has to manage their medications Interview Observation Assessment of specific aspects *Numerous skills may cause dysfunction in medication management Intervention Management of medications within the client's daily life through habits and routines What are things you do every day to help remind you to take your medication? Remediate impairments - FM skills, cognitive rehab Compensate for impairments - automatic pill dispenser, ways to identify different meds b/c visual impairment Advocate for a change in the medication regimen If we feel client isnt taking meds, talk to pharmacist/doctor to reduce times per day or less medications *Best evidence supports the role of occupational therapy in addressing medication management
Fear of falling
Modified falls efficacy scale - really easy way to find info on what client is uneasy with, structured goals around Viscous cycle - directly correlated with higher risk of fall Fear of falling Decreased participation in activities Reduced physical abilities Additional decreased participation in activities More impaired physical function (And back to the top!) Can be VERY disabling to have a fear of falling
Rehabilitation team
Multidisciplinary Interdisciplinary Transdisciplinary
What is the difference between a Multidisciplinary, Interdisciplinary, and Transdisciplinary team; SNF
Multidisciplinary: discipline oriented, each member has their spot; Interdisciplinary: involved in problems outside their scope, treat within their scope Transdisciplinary: 1 team member chosen to be leader, depending on needs of client Common in early intervention
Within the different types of rehabilitation delivery systems, what areas should assessments measure?
Not only measure an individual's performance in functioning domains, but also evaluate the extent to which older adults participate in valued life activities, medical, psychosocial and environmental resources
Role of OT in home mod
Occupational Therapy Evaluations: OTs look at how a person interacts with the environment to successfully perform tasks Goal is to maximize safety and independence within the clients home environment Provide services to those who currently require the modifications or for those planning for possible future needs Work as part of a team Want proper fit between person, environment and occupation Recommendations made to make sure client is safe
Interventions for urinary
Occupational therapy practitioners take a holistic approach Physical Environmental Behavioral The OT should work with other professionals PT's trained in incontinence programs nursing, CNA's, doctor consultation Dietitian - acidic/spicy foods, alcohol irritate bladder Advise they drink water more throughout the day A diagnosis of urinary incontinence needs to be provided by the MD Determining a therapeutic approach Biomechanical approach Assess cognitive abilities - sequencing, follow instructions Determines how we work with our clients Creating a plan Symptoms - identify Dietary review - common day's worth of meals, Previous interventions - if so, determine if they have been effective or for the same reasons If they are no longer effective Bladder diary - gives baseline info to get goals off of Behavior strategies Make sure individuals when they first get to location, they find where bathroom is Changing strategies of toileting schedule Make sure they use bathroom before long car ride Management of diet and food intake If dietary staff are on board, they will take on this roll Bladder diary - go through trends Talk to them about decaffinated tea, half-caff to decrease irritation of bladder Scheduled voiding vs. bladder retraining Scheduled voiding: set time intervals a person will be urinating CNA staff goes in every 2 hours to take patient to toilet Bladder retraining: strengthen bladder and increase time intervals between trips to bathroom Typical goal is 2 hours between trips
Common conditions and falls
Older adults may have normal age related conditions or those that are pathological in nature which contribute to falls Pathological conditions Dementia, Parkinson's, Depression, or Stroke Attentional deficits, executive dysfunction, and visual changes can be contributors OA - most common joint disorder, most disabling Provide education on dx, information on pain management (joint protection, respect pain, exercise programs, medication adherence) OP - compromises bone structure, a lot more common in women from hormonal changes (menopause) Increased risk for fractures - hip is one of the more common Take multidisciplinary approach - fall prevention program, body mechanic and posture education, exercises Parkinson's Disease Shuffling gait - increased fall risk Voluntary and involuntary movement dysfunction - resting tremor (primarily UE), rigidity Difficulty with initiation and termination of movement Slow, progressive movement disorder, 2nd most common neurodegenerative disorder (to Alzheimer's) Non-motor symptoms: pain, depression, sleep disturbances, memory impairment Stroke - occurs a lot in older population, heavily tied to fall risk
Access to health care
Opportunities and constraints to health-care-seeking Domains of access Acceptability: understanding if people are going to access services, they want someone understanding of their needs. Good fit between person and provider Affordability: can be HUGE constraint, copays/deductibles higher than a person's able pay Availability: places have to be available and more convenient, or it will limit access
Regulations that impact therapists in home health
POC (performed by all appropriate disciplines) - *Different than the individual POC identified by each discipline If POC includes therapy provisions the following must be included: After consult, the course of tx must be established by the MD Plan must include: Measurable goals pertaining to the clients illness or injury, expected duration, and course of tx consistent with the assessment Therapy Services: Must be in accordance with the POC Initial Visit and Comprehensive Assessment (OASIS items) Performed within 48 hours of referral If nursing is nursing services, the nurse must perform the initial assessment visit (Under the Medicare Law) In therapy only cases the PT or SLP can open the case OTs cannot open a case All involved discipline should contribute to the to the comprehensive to show a clear picture of the client Updated Comprehensive Assessment (any qualified discipline involved in care can perform the updated comprehensive assessment) The last 5 of every 60 days, within 48 hours after returning from a an inpatient stay, after a patient elected transfer or dc and readmit within the 60 day episode of care, within 48 hours of d/c or transfer to inpatient or death at home Assessment of medications and management of medications is a requirement for all clients regardless of the disciplines working with the client or the clients payer source OASIS - questions that are added into comprehensive assessments so data can be tracked across HHA HHA's have to report data So agencies can be compared HAS TO BE OBSERVED DIRECTLY BY THERAPIST
CBS Role of occupational therapy
Performance skills: provide education and safety regarding available resources, work to enhance a person's abilities so they can maintain roles that are meaningful Enhanced contexts: perform safety evaluations, assist older adults in getting needed services/resources to age in place within their community Expanded or sustained quality of life: helping individuals to stay engaged in meaningful occupations even when they have diminished capacity; can be due to pathological or normal age related changes Either enhance current occupation or exploring new interests and ways to engage Enhance function in settings that are meaningful Comprehensive assessment to identify current barriers and future barriers Able to help client in context they live, work, perform leisure in this setting - most natural, really in their real life
Rehab: Personal and Enviornmental Factors
Personal Frailty, motivation, Depression, Cognitive status, and comorbidities Environmental Caregivers, Living arrangements, and interaction of the client-therapist
What personal and environmental factors may influence the rehabilitation process?
Personal: frailty, motivation, depression, cognitive status, comorbidities Environmental: family members / caregivers, living arrangements, therapist-client interaction
End of life care
Philosophy End of life: Describes all of the conditions surrounding a person who has a life threatening illness End-of-life care: Care that is intended to promote quality of life for those with advanced, progressive, or terminal illnesses until the end Supportive care: Care that is intended to assist in the coping process for both the individual and their family Palliative care: The total care of a person who has not responded to curative treatment Person can receive care while getting treated even if prognosis states person will be cured of illness Often added as supplement - concurrent service Most common diagnosis for referral - cancer Ex) may have chemo appointment at one point during the week, palliative appointment later on Hospice: A comprehensive and interdisciplinary care system for individuals with a terminal illness and their families Identified by TWO physicians to live less than 6 months
What areas, generally speaking, are typically addressed?
Physical, sensory, intellectual, psychological, social
Primary Care
Primary Care (PC) vs. Primary Health Care (PHC) Primary health care: how finances, income, housing, education, environment impact health Primary care: health-based center, looks at health promotion, prevention of injury, diagnosis/treatment
LTC: Role of OT
Promote function and quality of life Focus on the functional problems and their primary concern Guidelines and regulations identify the need to ensure activities provided to clients match their interest, age, gender, and level of cognitive functioning CNAs are often the individuals who implement many aspects of a plan Interventions specific to dementia Spaced retrieval Montessori-based activities
Health service utilization
Societal and individual determinants of utilization Four major components Societal Determinants: norms, whether it is in accepted societal norms to seek out services Health Services System: access to actual health care system Individual Determinants: if person has behaviors/attitudes toward seeking medical attention, if family is facilitator or not advising Health Services Utilization: type of services that gets utilized; hospital vs. clinic
OT Process
Referral MD or other health care professional Assessment Client-centered approach OT needs to establish a relationship to ensure dialog with the patient to select appropriate assessments AMPS, COPM, IPPA, ADL-I, time diary, interview, and *QOL assessments (QOL is the ultimate outcome) Performance will change over time Family members, caregivers and the professional team can provide important information Goals Goal setting requires an individualized approach (problems, needs, and wishes) Range from goals about life-sustaining tx, communication about prognosis to family, to wishes for the future Interventions Prioritizing resources: help establish routine and care that can be provided to them Compensatory strategies: reduce pain, help increase function in meaningful tasks, be successful and comfortable ADL training Fatigue management Leisure and enjoyment Opportunities for creative and symbolic engagement though meaningful activities Routine establishment
Restraints
Restraints defined "Physical restraints are any manual method or physical or mechanical device, material, or equipment attached to or near your body so that you can't remove the restraint easily. Physical restraints prevent freedom of movement or normal access to one's own body." "A chemical restraint is a drug that's used for discipline or convenience and isn't needed to treat your medical symptoms." Is it a restraint or not? If a client does not have skills to manipulate (like a belt), or if it prevents client from doing something (like a seat cushion preventing a client from standing easily), then it is a restraint There can become a fine line from helping and hindering a client - just be careful and aware! Alternatives to Restraints https://video.search.yahoo.com/search/video?fr=mcafee&p=restraints+in+nursing+homes#id=3&vid=6a5e01164d08ec40de2a55fce7caee5f&action=click What problems occur as a result of restraints? Pressure injuries/rashes, anger, increased aggression, lack of freedom, inappropriate use of antipsychotics (can increase symptoms, premature death), anxiety, dehumanizing, noncompliance, safety for workers Restraints do not necessarily increase fall risk, but may cause a more severe injury What strategies were used in the video that appeared successful? Recovery model - recover person, get to know client and what is meaningful Child care, baby doll, stuffed animals Sensory tubes, sensory integration-based rooms Wind down time Ethical considerations with restraints Risk vs. benefit - benefit should outweigh the risk Not shown to decrease falls Impact on client's cognition and physical being What impact may the restraints have on "loved ones"? May look dehumanizing, give them anxiety/anger Considerations: Dignity Autonomy Wellbeing Self-reliance Benefit needs to outweigh the risk Decisions should b
Measuring self-care
Self-care performance Best practice, utilize: Standardized assessments Measure that are sensitive to change Performance-based measures - don't just rely on reports, need to see for ourselves Assessments in the natural setting Assessment of IADLs Assessment of the clients living area Needs, lifestyle, and living setting to determine the goals Assessing contributing factors - other things going on that hinder performance Sensory and Sensorimotor components Cognitive impairments Assessing IADLs: Home-based assessments Assessing Environmental Factors: Safety Interventions ADLs Skill Training - one handed dressing, eccentric viewing, scanning technique Environmental Modifications Assistive Devices for Self-care Task Modifications - simplify, make easier to participation
Role of OT in primary care
Self-management of chronic conditions - ex. Managing diabetes Help promote/prevent secondary complications Health promotion Self-management of psychiatric conditions: Coping strategies Management of musculoskeletal conditions: pain management, joint protection techniques Safety and fall prevention: integrating balance strategies, exercise programs; fit person appropriately to w/c or walker Promoting and ensuring community access Palliative and end-of-life care Driving and community mobility resources Environmental redesign Family and caregiver assistance and support: REALLY important to integrate family and caregiver into training of support for clients; support THEIR needs as well - burden and burnout are HUGE
Sexuality, pharmacology, restraints and older adult
Sexuality and the Elderly Sexually Transmitted Disease - Elderly are at high risk for STDs - less monogamy, not using contraception (menopause done), not a lot of education/platform for older adults Women may be at higher risk with an increase in age Less lubrication Not worried about pregnancy HIV progresses more rapidly in older adults - progresses to AIDs quicker Sexuality in Nursing Homes Recognize residents right to sexual expression but there are concerns - safety, litigation, supervision concerns Myths Older adults do not have sex New drugs have greatly enhanced the sex lives of older adults - NOT A MYTH There are drugs available People find each other less attractive over time Sexuality What is sex? Sexual Activity: "Engaging in activities that result in sexual satisfaction and/or meet relational or reproductive needs" (American Occupational Therapy Association, 2014) Sex can be alone or with a partner There are different way to have sex and/or be intimate Sexuality can identify arrange of sexual behaviors as well as celibacy It is necessary to maintain a broad sense of the term sexuality Because we have a closer relationship with clients, we may initiate conversation Age related changes Female: Changes to the vagina that my result in pain during penetration or if a woman is on hormones sex may be more desirable Decreased levels of estrogen post menopause Male: Increased likelihood that erectile dysfunction will occur Decrease in the production of testosterone As is true with working with any population, acceptance is necessary in regard to a person's sexual choices Expressions of Sexuality Personal Appearance PDA: Holding Hands, Kissing, Touching Masculine and feminine demeanor Friendship and Companionship Walking Together Intimate Conversation Mutual or solitary sexual activity Factors Preventing
CBS Function
Something to do Working - find work related to skill set they have, meaningful to them Learning - formal or informal Giving - volunteering Experiencing Senior centers Congregate meal programs Adult day services Someone to care any kind of support service Adult protective services Participants in visiting friends program Emergency response systems Counseling services Someplace to live Public housing, Assisted living, shared housing etc. Some community based have combinations of these functions
What types of evidence-based interventions can be employed for individuals with dementia residing in a long-term care facility?
Spaced retrieval: giving person with memory deficits practice at successfully remembering information over increasingly long periods of time Montessori-based activities: moderate to advanced dementia; based on idea that there may be a developmental progression to loss of abilities in dementia, roughly following "first-in, last-out" model of cognitive deterioration labeled by Reisberg as retrogenesis Meyers-Memorah Park/Montessori-based Assessment System: 7 Montessori-based activities, yields more relevant information than more standard assessments of cognition in late-stage dementia Minimizing dysfunction, capitalizing on strengths
Rehab: Evaluation
Standardized and comprehensive assessment Ensure systematic evaluation Assists in identifying problems that require further investigation and tx Facilitates care planning Collection of data to ensure quality improvement and research
Common causes of incontinence
Stress incontinence Anything putting pressure on bladder Benefit from exercise protocol: Kegel exercises "pinch a penny between butt cheeks" - clinch internal muscles Timed toileting program - goal is to increase intervals of time between urinating Goal is to strengthen internal muscles Urge incontinence Cause: UTI, detrusor muscle is overactive Work on relaxation techniques with them, calm those muscles (breathing exercises) Timed regular voiding - increase intervals Functional incontinence Typical things we do to address toileting - all the time as OT's Toilet transfers, functional ambulation to toilet, clothing management, access to toilet, functional modifications/adaptive techniques, provide commode Overflow incontinence May work on double voiding - sit for prolonged period of time, stand up and sit back down, try to pee again Crede maneuver - massage technique, SPECIAL training Facilitate movement in bladder to push toward sphincter muscles to assist in urination Straight cath - catheter to drain urine and then remove it If more significant issue, may need Foley catheter put in for a longer period of time Pessary insertion - sling cup inserted into woman's vaginal area to help hold up uterus (prolapsed uterus - hanging lower than normal) Mixed incontinence Treat same way as both urge and stress incontinence - combo of both Transient incontinence Work on dietary schedule/menu, medication management, address anxiety/depression
Regulations
Survey Process HIPPA POC (performed by all appropriate disciplines)*Different than the individual POC identified by each discipline If POC includes therapy provisions the following must be included: After consult, the course of tx must be established by the MD Plan must include: Measurable goals pertaining to the clients illness or injury, expected duration, and course of tx consistent with the assessment Therapy Services Must be in accordance with the POC Initial Visit and Comprehensive Assessment (OASIS items) Performed within 48 hours If nursing is nursing services, the nurse must perform the initial assessment visit (Under the Medicare Law) In therapy only cases the PT or SLP can open the case OTs cannot open a case All involved discipline should contribute to the to the comprehensive to show a clear picture of the client Updated Comprehensive Assessment (any qualified discipline involved in care can perform the updated comprehensive assessment) The last 5 of every 60 days, within 48 hours after returning from a an inpatient stay, after a patient elected transfer or dc and readmit within the 60 day episode of care, within 48 hours of d/c or transfer to inpatient or death at home Assessment of medications and management of medications is a requirement for all clients regardless of the disciplines working with the client or the clients payer source
CBS Barriers
System-level: policy making, what types of things are available in terms of things being set up and can be sustained Agency-level: hard to keep staffing consistent, funding for actual agency itself Individual-level: pride issues, beliefs that a place isn't for them, not wanting to identify themselves as "old" *Group-level: cultural beliefs, not having belief you should go out to family for help, language barriers, financial means, fear discrimination because of sexual orientation Group membership, identity and larger social norm NOT identified in first 3 barriers
Interaction between the occupational therapist and the client
The Intentional Relationship Model (IRM) Skills-based conceptualization of the therapist-client relationship Therapeutic use of self-foster client engagement and support positive outcomes Client is the focal point Six therapeutic modes: Advocating: for client's needs, set up connections Make sure client's needs are being met Collaborating: expect clients will be active participants in therapy process Empathizing: understand from their perspective Important to approach with client-centered mind set Encouraging: instill hope in them Instructing: don't do things for our client, we set up opportunities for client to help improve their performance Problem-solving: make their own decision and work through task Ask posing questions, but want them to think things out for themselves Pharmacology What risk factors put an older adult at an increased risk for adverse effects from medication? Or decreased safety in regards to medication? Slower metabolism, hormones, eat/drink, cognition (not remember, not take correctly), memory, fine motor, executive skills, vision, health literacy, beliefs about meds, may not be able to afford meds, lack of transportation to pharmacy/doctor's office What are the risks of an individual not taking their medication correctly? over or under medicating, fall risk, lose effectiveness Why is adherence to medications important? What is the role of occupational therapy in medication management? Pharmacology There are 700,000+ ED visits annually due to adverse medication events Individuals 65+ are twice as likely to have an adverse event from medication Individuals 65+ are 7 times more likely to become hospitalized due to adverse medication events NCHS: 90% of older adults take medication 50% of individuals do not correctly take their medications Beers list http://www.healthinaging.org/medicat
self care
The normal aging process and chronic conditions Declining function in self care skills Sensory limitations Cognitive declines Reduced strength and agility Restricted mobility Self-care defined Duties and chores Personal care and personal business ADLs and IADLs Survival and participation in the community Significance of Self-care Contributes to healthy aging, longevity, and quality of life Necessary for survival, safety, and general health Necessary for self-esteem, social acceptance, and social well-being Performance in self-care facilitates participation in leisure and social activities Older adults (75 years and older) 12% required assistance for ADL tasks 20% required assistance for IADL tasks - often require combo of several different client factors for client to perform independently Medical conditions impacting self-care Stroke - deficits in vision (neglect), strength, ROM, memory, cognitive abilities, aphasia, hemiparesis, sensation Impacts ADLs/IADLs Strategies to work on: compensatory strategies (Lighthouse, memory aids, 1 handed dressing techniques, ambulation aids), constraint-induced movement therapy, ROM, strengthening, FM, balance, mirror therapy, energy conservation Cardiovascular disease - decreased endurance, strength, edema, mobility, increased pain Intervention: energy conservation, pain management, home exercise programs, positioning to decrease edema, breathing techniques, posture, increase activity tolerance Dementia and other cognitive deficits - memory, judgement, safety awareness, impulsivity, anything that initiates/progresses through, depression, anxiety, decreased strength, balance and coordination impairment Strategies: visual cues, home exercise, simulate tasks, ambulation devices, picture cards, sequencing charts, leisure and social participation, sensory stuff, timers, ADL
Who is the most important member of the rehabilitation team?
The older adult/client
Home health: Criteria
The person is an eligible Medicare beneficiary HHA that is providing services has in effect a valid agreement to participate in Medicare program Beneficiary qualifies for coverage of home health services as described in 30 (Conditions Patient Must Meet to Qualify for Coverage of Home Health Services) Services for which payment is claimed are covered as described in 40 (Covered Services Under a Qualifying Home Health Plan of Care) and 50 (Coverage of Other Home Health Services) Medicare is appropriate payer Services for which payment is claimed are not otherwise excluded from payment Criteria must a Medicare beneficiary meet to qualify for home health service Be confined to the home Be under the care of a physician Be receiving services under a plan of care established and periodically reviewed by a physician Be in the need of skilled nursing care of an intermittent basis of physical therapy or speech-language pathology Have continuing need for occupational therapy
Types of incontinence
Transient Sudden onset, resolves after cause is identified and treated D-I-A-P-P-E-R-S (delirium, infection, atrophic urethritis, pharmaceuticals, psychological, excessive excretion, restricted mobility, stool impaction) Chronic Urge: large amounts of urine leak unexpectedly (sometimes small amount) Stress: Occurs as a result of activities putting increased pressure on the bladder and pelvic floor Flatulence, coughing, laughing, sit to stand transition, pregnancy Overflow: Occurs as a result of an individual's inability to empty the bladder during toileting, causing an overfill of urine in the bladder Caused by underactive transducer muscle, blockage, most commonly MEN (inflamed prostate) May have issue initiating Functional: Occurs as a result of a disability or other hindrance preventing a person from getting to the toilet Difficulty managing clothing, bathroom cannot be found, cannot alert caregiver in time, unable to access bathroom Mixed: individual has both stress and urge incontinence
Patient-centeredness
Triple Aim: goals to - improve individuals experience with their health care; improve health of the population; decrease costs Focus on primary care and interprofessional teams
Primary care core principles
Universal access to care and coverage based on need Commitment to health equity as part of development oriented to social justice Community participation in defining and implementing health agendas Intersectional approaches to health care
Urinary incontinence and self care
Urinary Incontinence: Why OT? Listed under the description of toileting and toilet hygiene in OTPF-3 Incontinence can effect a person's quality of life, function, and social participation OT practitioners are holistic in their approach to practice Urinary incontinence can impact other occupations Individuals with urinary incontinence are at risk for secondary factors The goal of OT is to facilitate occupational engagement and independence Defined Continence - a state in which a person possesses and exercises the ability to store urine and micturate at a socially acceptable place and time Incontinence - The loss of continence, Involuntary or unwanted leakage of urine Prevalence of Urinary Incontinence by population Nursing Home Residents: 36.7% of short-term residents and 70.3% of long-term residents did not have complete bladder control Home-health: 40.2% clients did not have complete control of their bladder Hospice: 36% of hospice clients did not have complete control of their bladder Noninstitutionalized: 43.8%reported urinary leakage
What qualifies equipment as durable medical equipment (DME)?
Used for medical reason Withstand repeated use Not considered useable for someone without injury/illness Used in person's home for 3+ years
What types of Durable Medical Equipment are covered under Medicare Part B?
Walkers, shower benches, Canes for mobility, Commode, Crutches, Hospital Bed (other beds may be covered), Manual wheelchairs/Power mobility device, Lift *Some may be harder to get, require MD to prescribe
Demographics
What are the demographics of a "typical" nursing home resident? 65-74 years old, female, no spouse, 1/3 have dementia, poor family support, low rate Hispanic population, functional or mental difficulties What are the categories of care in long-term care? Skilled: High-level care following a hospitalization Rehabilitative: Expectation is improvement to move to a less restrictive environment Custodial care: Long-term residential care What are the 3 common reasons that an older adult is admitted to a nursing home? Short term needs for skilled nursing/rehab Long term for cognitive disorder Long term for chronic disabling health condition What staff member within a long-term care facility often assists most in providing quality of life to the residents? CNAs What is the primary role of the OT in a long-term care facility? Address individual's ability to complete daily activities If they can function
LTC
What are the demographics of a "typical" nursing home resident? 65-74 years old, female, no spouse, 1/3 have dementia, poor family support, low rate Hispanic population, functional or mental difficulties What are the categories of care in long-term care? Skilled: High-level care following a hospitalization Rehabilitative: Expectation is improvement to move to a less restrictive environment Custodial care: Long-term residential care What are the 3 common reasons that an older adult is admitted to a nursing home? Short term needs for skilled nursing/rehab Long term for cognitive disorder Long term for chronic disabling health condition What staff member within a long-term care facility often assists most in providing quality of life to the residents? CNAs What is the primary role of the OT in a long-term care facility? Address individual's ability to complete daily activities If they can function
Rehab units
What is the difference between a geriatric rehabilitation unit (GRU) and a geriatric assessment unit (GAU)? GRU: distinct unit housed within common hospital, staffed by multidisciplinary teams (rehab focus) GAU: emphasis on medical treatment (emphasis on being medically stable, assess current medical status) What are the rehabilitation requirements of a GRU? Medically stable Able to tolerate at least 3 hours of therapy per day, 5-6 times per week Measurable progress What are two common settings a client may be discharged to upon discharge from a GRU? Home or long-term care facility Can an individual be transferred to a GRU from a long-term care facility? YES
Day Hospital Care and Adult Day Care Facilities
What is the main focus of a day hospital? Offer an alternative to institutionalization for newly chronically disabled Rehab & maintenance Who may benefit from attendance at an adult day care? Individuals with physical limitations and cognitive impairments Don't need 24/7 hour services, just services during the day What types of services are available through the Program of All-Inclusive Care for the Elderly (PACE)? Distribution of drugs, physician services, rehabilitation services, personal care, socialization, leisure, hospital, nursing home care, ADL care
Acute care
What percentage of older adults experience a functional decline as a result of an acute hospitalization? 60% What percentage have a decline in ADL function? 1/3 or 33% Many may NOT return to premorbid function What is the role of a therapist in acute care settings? Assist in identifying appropriate discharge plans
Interventions and Recommendations
What recommendations may be appropriate? Mobility Impairments - walker, cane, ramp (permanent or temporary), remove throw rug, walking seated shower, walk in shower, shoe recommendation, hallway railing Visual Impairments - sticker, larger print Hearing Impairments, - vibrating alarm, TTYL phone system, flashing alarm Cognitive Impairments - schedule, timers, visuals, baby monitor, sequencing chart
Transitional care facilities and units
What type of care is provided on a transitional care unit? Intermediate and post-acute care What types of settings are classified as transitional care? SNFs, subacute, transitional care unit
Role of OT in sexuality restraints.. etc
Why would an OT address sexual activity? Sexual activity is an ADL Both acute and chronic conditions can impact a persons ability to participate What clients should an OT address sexuality with? Clients who are: middle-aged, old, men, women, transgender, gay, lesbian, straight, bisexual, physically disabled, developmentally disabled (*and any other client that is appropriate) What setting may an OT practitioner address sexuality in? Any setting that an OT works with clients identified above: homes, skilled nursing facilities, senior centers, hospitals, group homes, community settings, rehab centers, etc. What types of interventions are used to address sexuality? Health Promotion Remediation Modification
