DISCHARGE FROM ACUTE CARE

1
DISCHARGE FROM ACUTE CARE

• Patient medically stable
• Work up is complete
• Patient safe to go home

2
QUALITY MEASURES

• READMISSION TO HOSPITAL WITHIN 30 DAYS AFTER
  DISCHARGE
• REEVALUATION IN E.R. WITHIN 30 DAYS AFTER
  DISCHARGE

3
REASONS FOR READMISSIONS

• FALLS
• DEHYDRATION
• TAKING MEDICINES INCORRECTLY

4
LOS

• 2006
• GOAL OF 5.75 DAYS
• DISCHARGE PLANNING

5
ADMISSION

• SOCIAL HISTORY
• HOME SITUATION
• HOW INDEPENDENT DOES THE PATIENT NEED TO BE WHEN
  THEY GO HOME?

6
HOME SITUATION

• DO THEY LIVE
• ALONE?
• WITH FAMILY/ FRIENDS?

7
FAMILY / FRIENDS

• DO THEY ASSIST IN CARE
• DO THEY PROVIDE SUPERVISION
• IS IT 24/7
• DURING DAY
• DURING THE NIGHT

8
SAFE DISCHARGE HOME ALONE

• INDEPENDENCE IN
• HOUSEHOLD MOBILITY
• TOILETING
• MEAL PREP
• USING PHONE IN EMERGENCY
• TAKING MEDICINES

9
SERVICES IN THE HOME

• MEDICARE AND SOME PRIVATE INSURANCES PROVIDE IN
  HOME SERVICES
• P.T., O.T. , SPEECH THERAPY
• 3 TIMES PER WEEK
• NURSE TO MONITOR MEDICAL PROBLEMS
• AID FOR BATHING, HYGIENE WHILE GETTING HOME
  HEALTH NURSING, P.T. OR SPEECH THERAPY

10
CARELINK

• FOR LOW INCOME PATIENTS
• 65 OR OLDER

11
CARE LINK

• PROVIDES
• AID SERVICE
• UP TO 3 HOURS/DAY
• 2-5 DAYS/WK.
• MEALS ON WHEELS
• 6 WEEKS WAIT

12
MOBILITY EVALUATION

• P.T. EVALUATION
• IS THE PATIENT AT RISK FOR FALLS?
• LEVEL OF INDEPENDENCE IN MOBILITY
• WOULD FURTHER THERAPY IMPROVE INDEPENDENCE
  SAFETY?
• WOULD EQUIPMENT IMPROVE INDEPENDENCE SAFETY?

13
PHYSICAL THERAPY EVALUATION

• ABILITY TO PARTICIPATE IN THERAPY
• WHETHER PATIENT NEEDS
• HOME HEALTH THERAPY
• ACUTE INPATIENT REHAB
• SUBACUTE INPATIENT REHAB

14
P.T. EVALUATION

• BED MOBILITY
• SUPINE TO SIT
• SIT TO STAND
• TRANSFERS
• STANDING BALANCE
• AMBULATION

15
FIM SCORES

• INDEPENDENT - 7
• MODIFIED INDEPENDENT 6
• NEEDS A.D. OR MORE TIME
• SUPERVISION - 5
• MINIMAL ASSISTANCE - 4
• 25 ASSISTANCE NEEDED
• MODERATE ASSISTANCE - 3
• 50 ASSISTANCE NEEDED
• MAXIMAL ASSISTANCE - 2
• 75 ASSISTANCE NEEDED
• TOTAL ASSISTANCE - 1

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INDEPENDENCE IN SELF CARE

• O.T. EVALUATION
• INDEPENDENCE IN A.D.L.S

17
O.T. EVALUATION

• FEEDING
• GROOMING
• TOILETING
• U.E.DRESSING
• L.E.DRESSING
• BATHING

18
O.T.EVALUATION

• CAN THEY COOPERATE IN THERAPY DESPITE CONFUSION?
• CAN THEY COOPERATE WITH BOTH O.T. AND P.T.
  DESPITE POOR ENDURANCE ?
• WOULD ANY EQUIPMENT MAKE THEM SAFER OR MORE
  INDEPENDENT AT HOME?

19
FACTORS INTERFERING WITH P.T./O.T. EVALUATION

• HYPOTENSION
• ORTHOPEDIC/ NEUROSURGICAL PRECAUTIONS
• CONFUSION
• POOR ENDURANCE

20
OPTIONS FOR DISCHARGE

• HOME
• ALONE OR WITH FAMILY/FRIENDS
• HOME HEALTH THERAPY
• OUTPATIENT THERAPY

21
OPTIONS FOR DISCHARGE

• ACUTE INPATIENT REHABILITATION
• SUBACUTE INPATIENT REHABILITATION
• SPECIALTY HOSPITAL
• NURSING HOME

22
ACUTE INPATIENT REHABILITATION

• 3 HOURS / DAY THERAPY
• 5-6 DAYS / WEEK
• MULTIDISCIPLINARY THERAPY
• MEDICAL SUPERVISION 5-6 DAYS / WEEK

23
INSURANCE

• MEDICARE
• PRIVATE INSURANCE
• MAY OR MAY NOT HAVE REHAB. BENEFIT
• CHARITY IS SOMETIMES AN OPTION

24
ACUTE REHAB EVALUATION

• CAN THEY TOLERATE BID OT AND PT IN ACUTE CARE?
• CAN THEY COOPERATE AND PARTICIPATE IN THERAPY?
• DO THEY NEED MORE THAN ONE TYPE OF THERAPY?
• ARE THEY MEDICALLY STABLE?
• IS THE WORK UP COMPLETE?
• IS DISCHARGE HOME REALISTIC?

25
EVALUATION BY ACUTE REHABILIATION

• SW FIND FAMILY / PT. PREFERENCE
• REFERRAL MADE
• FACILITY REVIEWS
• PROGRESS NOTES
• THERAPY NOTES
• LAB X-RAYS
• LOOKS AT HOME SITUATION
• POSSIBLE P.M.R. CONSULT

26
REHABILITATION DIAGNOSIS

• 75/25 RULE
• SCI / TBI / CVA / AMPUTEE
• NEURO./ HIP FX./ BURN/ R.A.
• NON DIABETIC P.N/.MYOPATHY
• DONT COUNT OTHER FX.S
• CARDIAC/PULMONARY REHAB
• DIABETIC P.N./OSTEOARTHRITIS

27
ACUTE REHABILITATION

• MAY TAKE 1-2 DAYS TO GET PATIENT EVALUATED
• HAVE INSURANCE APPROVED
• THEN HAVE TO ARRANGE TRANSPORTATION TO FACILITY
• VAN TRANSPORTATION MAY NOT BE AVAILABLE ON
  WEEKENDS

28
SUBACUTE INPATIENT REHABILIATION

• HOSPITAL BASED RECUP. CARE
• T.C.U. IN SKILLED NURSING FACILITY

29
SUBACUTE INPATIENT REHABILIATION

• 1- 2.5 HOURS / DAY THERAPY
• 3 TIMES PER WEEK
• MEDICAL FOLLOWUP 3 DAYS WEEK
• 1-3 TYPES OF THERAPY
• DONT HAVE TO HAVE POTENTIAL TO GO HOME

30
SUBACUTE INPATIENT REHABILITATION

• COVERED BY MEDICARE
• NOT OFTEN COVERED BY PRIVATE INSURANCE
• NOT COVERED BY MEDICAID
• NO CHARITY ADMISSIONS

31
SUBACUTE REHAB. EVALUATION

• S.W. FINDS OUT PATIENT/ FAMILY PREFERENCE
• FAMILY OFTEN WANTS TO VISIT FACILITIES FIRST
• REFERRAL MADE TO FACILITY

32
SUBACUTE REHAB. EVALUATION

• FACILITY REVIEWS
• PROGRESS NOTES
• THERAPY NOTES
• INFORMATION ABOUT PATIENTS SKIN, NURSING CARE,
  AND INFECTIONS REQUIRING ISOLATION

33
SUBACUTE REHAB. EVALUATION

• EVALUATION MAY TAKE 1-2 DAYS
• FACILITY MAY COME TO SEE PATIENT
• FACILITY MAY ACCEPT BUT NOT HAVE A BED
• BEST FOR S.W. TO SEND REFERRALS TO MORE THAN ONE
  FACILITY

34
SPECIALTY HOSPITAL

• FOR PATIENTS NEEDING CONTINUED ACUTE CARE
• FOR
• VENT WEANING
• RENAL PROBLEMS
• WOUND CARE
• IV ANTIBIOTICS

35
SPECIALTY HOSPITAL

• COVERED BY
• MEDICARE
• SOME PRIVATE INSURANCE
• NOT BY MEDICAID
• NO CHARITY ADMISSIONS

36
NURSING HOME

• PATIENT UNABLE TO RETURN HOME
• NOT A CANDIDATE FOR INPATIENT ACUTE, SUBACUTE
  REHAB. OR SPECIALTY HOSPITAL

37
NURSING HOME

• COVERED BY MEDICAID
• PRIVATE PAY
• LONG TERM CARE INSURANCE MAY PAY A PART
• NOT COVERED BY
• MEDICARE
• PRIVATE HEALTH INSURANCE

38
DISCHARGE HOME

• COMPLICATED BY
• HOME SITUATION
• PATIENTS LEVEL OF INDEPENDENCE IN MOBILITY AND
  A.D.L.S
• INSURANCE COVERAGE

39
DISCHARGE HOME

• PLAN FOR DISCHARGE BY KNOWING HOME SITUATION AS
  EARLY AS POSSIBLE
• MOBILIZE PATIENT O.O.B. AS EARLY AS POSSIBLE
• START THERAPY AS SOON AS FEASIBLE
• WORK CLOSELY WITH S.W.