Discharge planning for an accessible future

accessibility

• “of being able to be reached or entered”

• “of being easy to obtain or use”

• “of being easily understood or appreciated”

identity-first

descriptor before person

• grounded in medical model

person-first

person before descriptor

• grounded in social model

models of disability

• medical model

• social model

• right model

medical model

• there is somethig wrong with the patient that needs to be fixed

• Disability is a result of a person’s physical impairments and seeks
  to find a cure for those impairments even when they do not cause pain or illness

social model

• barriers to the environment around the person are the problem

• Disability is a result of the way society is organized rather than by a
  person’s impairment and seeks to remove barriers that restrict quality of life

rights model

Not about us, without us;” A shift from disability being seen as an individual medical problem to it instead being about community membership and fair access to social activities such as employment, education and recreation.

discharge locations

• Long Term Acute Care Hospital (LTACH)
• Inpatient Rehabilitation (IPR / IRF)
• Skilled Nursing Facility (SNF / Subacute)
• Day Rehab Program

Long term acute care hospital

• Complex medical condition(s) that require close observation and daily physician and nursing care / supervision

• Reasonable potential for improvement

• Examples include ventilator management and weaning, wound care, or severe deconditioning after a prolonged hospital stay

• so medically unstable that they can’t do rehab

• medicare Part A

inpatient rehab

• A medical condition requiring intensive rehabilitation, continued medical supervision (24 hour physician access), and coordinated care from doctors, other health care providers, and therapists

• Therapy for at least 3 hours per day, 5 days per week

• medical instability 

• medicare part A

SNF

• Qualifying IPR stay (at least 3 days)

• An ongoing condition that was also treated during the qualifying inpatient hospital stay

• Daily skilled care required
  • ie intravenous fluids/medications or physical therapy

• more medically stable

• medicare part A

Day rehab program

• Goal to effectively transition from an extended hospital stay to the homes while still receiving intensive therapeutic care

• Must be medically and behaviorally stable

• Have rehabilitation goals that require a community based program

• 6-8 hrs of therapy a day

• not covered by medicare

Discharge planning team

• Physician: Medical stability
• Case manager: Funding
• Social work: Community resources
• Therapy: Functional goals
• Family: Environment & caregiving feasibility
• And others!

Let’s Start From Discharge Day

• How are they transporting home?
• How are they entering the home?
• How are they going to go about their daily routine from waking up to going back to bed?
• How are they going to return to school/work/play?
• Who is helping them ...?

Family Training

• Positioning Program
  • Turning, orthotics, prone

• Level surface transfers

• Unlevel surface transfers
  • Toileting, bathing, car, couch, floor

• Home exercise program
  • Bed level, wheelchair level, advanced
  • Electrical stimulation, standing

• Equipment Use

big equipment

• Hospital Bed and Mattress
  • Fully electric? Semi electric? Mattress type?

• Lift with Slings
  • Fully electric? Manual?

• Wheelchair and Cushion
  • Tilt-in-Space? Power? Power assist? Sport?

• Orthotics
  • Positional? Functional?

• Bathing and Toileting
  • Rolling tilting shower commode chair

• Standers

“Small” Equipment

• Bed rails

• Transfer Board

• Bathing and Toileting
  • Elevated commode w cut-out, tub bench

• Ambulation
  • Rolling walker? Lofstrand? SPC?

• Miscellaneous
  • Electrical stimulation unit

General Equipment Rules

• Start planning and trialing from day 1
• Order big equipment no less than two weeks prior to discharge
• Order small equipment no less than one week prior to discharge

Altering Existing Room

• Doorways: 32” width

• Landings: minimum 5’ x 5’ width

• Ramps
  • 12” of ramp for every 1” rise
  • Direction change for every 30 feet of ramp

Emergecy Plan

• Special Needs Registry

• Local fire department: call to register, so can get 911 priority

• Home equipment
  • Life Alert vs Smart watch fall detection
  • Transport chair (worst case scenario)

Americans with Disabilities Act

“An individual with physical or mental impairment that substantially limits one or more major life activities”

Titles

• I: Employment
  • Prohibits discrimination and requires reasonable accommodation

• II: Local/state government
  • Cannot be denied any public service (i.e., transportation)

• III: Public accommodations
  • All new constructions or modified facilities must be accessible (i.e., stores, restaurants)