Counseling in the Post-Acute setting

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Counseling in thePost-Acute setting

• Aaron Reese, EdD, CCC-SLP
• November 15, 2012

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SPHP 219 class

• Any slides with asterisks are NOT on the exam ?

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Working with Adults

• Geriatrics vs Pediatrics?
• Does the setting in which adults are being
  treated make a difference?

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Post-Acute Settings

• Long Term Acute Care (LTAC)
• Skilled Nursing Facility (SNF)
• Assisted Living Facilities
• Home Health

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LTAC

• Post-Acute, but patient required intensive
  medical care
• Tracheostomy Ventilator Needs
• Severe CVAs with global effects
• Rehab (PT, OT, SLP) often a main focus
• Select Specialty Hospitals
• NPO, PEG Tubes, AAC, very limited language

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Assisted Living Facilities
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Assisted Living Facilities
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Assisted Living Facilities

• For residents who maintain some level of safety
  at an independent level
• Non-acute residents who need little nursing or
  rehab care
• Typically one-bedroom apartments with private
  bathrooms and kitchenette
• Nursing staff available on-call, or ONE nurse
  overnight on staff.

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Home Health
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Home Health
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Home Health

• Provides in-home healthcare services typically
  after an acute-care stay
• Nursing, Social Work, Physical Therapy,
  Occupational Therapy
• AndSpeech Therapists.
• Give up on Speech Pathologistlol.

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Skilled Nursing Facility

• Nursing Home
• Split between long-term care (e.g., dementia
  units) and short-term rehabilitation.
• Medicare and MediCAL funded.
• Rehab Driven

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SNFs

• Patients who need 24-hour care, but no longer
  need acute care.
• Specific Rehabilitation needs
• CVAs, post-orthotic surgery, Parkinsons
• Patients admitted on short-term basis typically
  leave facility after completion of therapy.
• Combination of hospital and home (?)

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Factors Working Against SLPs

• Multiple health problems
• Depression due to illness and current placement
• Surrounding can be difficult to deal with.
• Hopelessness, whats going to happen next?
• Dreaded word NURSING HOME

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Factors Working Against SLPs and Service Delivery

• Children VS Adults
• Similar family dynamics
• Making a case for SLP servicespeople like to eat
  and talk
• SLP required to screen EVERY patient
• Engage the patient, find about them and
  incorporate that into therapy.

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What Not to Say

• Dysphagia, Phonology, Morphology
• Mortuary
• Diarrhea
• Jaws of Life
• Bring it down a notch

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How would you explain this to a family or
patient?

• Your father has severe pharyngeal dysphagia and
  may need a j-tube or g-tube.
• What if he doesnt get better?
• What if you get a patient whose looked of
  strokes online and knows everything about
  strokes now?
• How do you explain to a family that you just
  evaluated their 98 old mother and you are
  recommending NPO?