Discharge Planning

accessibility definitions

of being able to reach or entered, of being easy to obtain or use, of being easily understood or appreciated

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

medical model of disability

disability is a result of the way society is organized rather than a person’s impairment and seeks to remove barriers that restrict QOL

social model of disability

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

Rights Model of disability

Consideration for language use

use patient first language

discharge location options if a patient is not ready to return home

long term acute care hospital (LTACH), inpatient rehab, SNF, day rehab program

examples of reasons for a long term acute care hospital (LTACH) stay

ventilator management/weaning, wound care, severe deconditioning

what is an LTACH?

discharge location for complex medical conditions that require close observation and daily physician/nursing care/supervision (too medically unstable for rehab)

what is inpatient rehab?

discharge locaiton for medical conditions requiring intensive rehab, continued medical supervision, and coordinated care’ therapy at least 3hrs/day 5 days/week

what is a SNF?

discharge location where daily skilled care is required but more medically stable and do not need 24/7 physician access, qualifying IPR stay or ongoing condition

Are day rehab programs covered by medicare?

no

What is a day rehab program?

goal to effectively transition b/w extended hospital stay and the home while still receiving intensive therapeutic care, must be medically and behaviorally stable w/ rehab goals that reqire a community based program

big distinction factor when deciding discharge location

medically stable (home/SNF) vs. unstable ( LTACH/Rehab)

considerations for discharge home

transportation, how will they enter home, daily routine, return to school/work/play, who is helping

elements of family training for discharge

positioning program, level surface transfers, unlevel surface transfers, HEP, equipment use

what “big” equipment may be needed for successful discharge home

hospital bed/mattress, lift w/ swings, wheelchair w/ cushion, orthotics, bathing and toileting equipment, standers

what “small” equipment may be needed for successful discharge home

bed rails, transfer board, bathing/toileting, ambulation devices, other

general equipment rules for discharge planning

start planning/trialing from day 1, order big equipment no less than 2 weeks prior to discharge and small no less than 1 week prior to discharge

ADA requirements for doorway width

32” minimum

ADA requirements for landings (any area where someone needs to turn including accessible restrooms)

5’ by 5’ minimum

ADA requirements for ramps

12” ramp for every 1” rise, direction change every 30 feet of ramp

when do ADA requirements apply

new builds and renovations

who does the Americans with disabilities act cover?

Any individual w/ physical or mental impairment that substantially limits 1 or more major life activities

Examples of some main sections of the Americans w/ disabilities act

employment, local/state government, public accommodations

what is universal design?

made to be dully inclusive to any mobility/ability