Complex pt management Week 11

Home health requirements

must be homebound/require considerable effort to leave home

normal inability to leave the home

this may occur because of an illness, injury, or medical condition that restricts the patient's ability to leave their residence without assistance.

What is the definition of being homebound for Medicare home health services?

Patients must have a normal inability to leave home due to illness, injury, or medical condition, requiring considerable effort to leave.

What are some activities that do not disqualify a patient from being considered homebound?

-Medical appointments.

-Religious services.

-Family gatherings.

-Funerals.

-Graduations.

-Other infrequent or short-duration activities.

What are the responsibilities of a home health physical therapist?

-Promote independence in essential activities of daily living.

-Promote reintegration into the community.

-Minimize recurrent hospitalizations and nursing home admissions.

If a patient is hospitalized during an episode of care and subsequently returns home, the therapist must complete the

resumption of care assessment

Resumption of Care (ROC) purpose

reassess the patient's current condition and determine whether the existing plan of care remains appropriate.

What is OASIS in home health care?

A standardized assessment instrument used to collect information on patient health and functional status.

OASIS is used for

-Comprehensive patient assessment.

-Quality measurement.

-Patient classification.

-Medicare payment calculations.

-Monitoring changes in patient outcomes.

OASIS Assesses

-risk of re/hospitalization

-Demographics

-Living arrangements

-Supportive assistance

-Sensory status

-Integ status

-Respiratory and neurological status

-ADLs

-Meds

-equipment

What is the home health certification period under Medicare?

60 days, with a recent shift to a 30-day period of care.

Frailty is defined as

multidimensional state of increased vulnerability that develops as an individual loses physiologic reserves and the ability to respond to stressors.

What characterizes frailty?

-Decreased physiologic reserves.

-Reduced ability to respond to stressors.

-Increased vulnerability to adverse health outcomes.

-Declining physical function and independence.

What are the five major characteristics of the Fried frailty phenotype?

-Unintentional weight loss.

-Muscle weakness.

-Slow walking speed.

-Self-reported exhaustion.

-Low physical activity.

What biological factors contribute to frailty?

-Loss of muscle mass and strength.

-Decreased cardiovascular capacity.

-Chronic diseases.

-Reduced physiologic reserve.

What psychological factors can contribute to frailty?

-Depression.

-Fear of falling.

-Cognitive impairment.

-Reduced motivation.

What are some social factors that contribute to frailty?

-Limited family support.

-Social isolation.

-Financial limitations.

-Reduced access to healthcare.

What environmental factors can contribute to frailty?

Unsafe home environments, limited accessibility, and barriers to community participation.

What are important physical therapy priorities for frailty?

-Progressive resistance exercise.

-Balance training.

-Gait training.

-Functional mobility training.

-Improving endurance.

-Maintaining independence with ADLs.

-Addressing environmental barriers.

-Encouraging participation in meaningful activities.

What does the FRAIL scale evaluate?

-Fatigue.

-Resistance (difficulty climbing stairs).

-Ambulation (difficulty walking one block).

-Illnesses.

-Loss of weight.

What is sarcopenia?

Progressive loss of skeletal muscle mass, strength, and physical performance.

Sarcopenia SMI

Defined a SMI >2 SDs below young adult sex specific mean

Groningen Activity Restriction Scale (GARS)

-measures sarcopenia

-≥19 indicates disability

causes of sarcopenia

-changes in hormonal levels

-sedentery lifestyle

-increased inflammation

-altered proteostasis (way of maintaining protein levels)

-mitochondrial dysfunction

-altered satellite cell number / function

-decrease in motor unit number

What is sarcopenic obesity?

A condition where an individual has both reduced skeletal muscle mass and increased adipose tissue.

What are the causes of sarcopenia?

Aging, hormonal changes, inactivity, inflammation, and poor nutrition.

What are recommended treatments for sarcopenia?

-PRE

-High-velocity resistance training

-Combined exercise programs

-Nutritional management

-Vitamin D supplementation

-Medication management

-Osteoporosis management

What are major fall risk factors related to physical health?

Muscle weakness, balance impairments, gait abnormalities, decreased mobility, impaired proprioception, and reduced sensation.

What medical conditions increase fall risk?

Polypharmacy, diabetes, cardiovascular disease, orthostatic hypotension, and neurological impairment.

What psychological factors contribute to fall risk?

Depression, cognitive impairment, and fear of falling.

What environmental hazards increase fall risk?

Poor lighting, loose rugs, clutter, uneven surfaces, and unsafe footwear.

What types of medications are associated with increased fall risk?

-Psychoactive medications.

-Sedatives.

-Antipsychotics.

-Antidepressants.

-Anticonvulsants.

-Antihypertensives

-Taking more than four medications is also identified as a potential risk factor

What is the recommended dosage for fall prevention interventions?

At least 50 hours of balance-focused exercise.

fall prevention interventions

-Strength training postural and LE muscles

-Balance training

-Gait training

-Dual task training

-Environmental modifications

What is the maximum score for the Fullerton Advanced Balance Scale (FAB)?

40

What FAB score indicates a concerning fall risk?

≤25

What walking speed warrants further assessment for fall risk?

Walking speed <10 m/s

MoCA normal score

26-30

What is the MOCA score range for mild cognitive decline?

18-25

MoCA moderate cognitive impairment

10-17

What is the MOCA score range for severe cognitive decline?

≤10

What are the two criteria for home health eligibility?

-Criteria 1: Patient must either need the aid of supportive devices, assistance of another person to leave or have a condition that means leaving the home is contraindicated

-Criteria 2: Must have a normal inability to leave home and leaving home requires a considerable and taxing effort

What does 'homebound status' mean?

Condition does not allow leaving home without help or requires considerable effort.

What is the significance of documentation in home health?

It should convey the reason for homebound status and support it with tests and measures.

What is the OASIS in home health care?

A standardized assessment used for planning care, determining reimbursement, and measuring quality.

What does Medicare Part A cover regarding home health?

-coverage after you are in a hospital or SNF for at least 3 consecutive days as a hospital inpatient or have a Medicare-covered SNF stay

-must receive home health services within 14 days of discharge

-Covers first 100 days of home health care per spell of illness

-Part B covers home health care after the 100 days

Medicare part B regarding home health

-No hospital stay requirement o No deductible, coinsurance, or copayment

-Durable medical equipment DME requires 20% coinsurance

-Unlimited coverage of home health visits if the patient meet criteria

What is the Home Health Prospective Payment System?

A payment model that covers a 30-day episode of care instead of 60 days.

30 day episode of care includes

-Includes all covered home health services: nursing and therapy services routine & non-routine medical supplies, home health care aide, and medical social services

-Excludes DME

-Geographic differences in wages

-Adjusts for beneficiaries with most expensive needs

-No limits on number of episodes of care

Patient placement for home health payment system is based on

-Admission source

-Primary Diagnosis

-Functional Impairment Level

-Comorbidity Adjustment

HHRG

Home Health Resource Group: A type of PPS (Prospective Payment System) that pays a fixed amount for all services provided in a 30 day period

Patient's Can have multiple 30-day episodes

-1st episode is "Early" episode

-Subsequent episodes are "Late"

OASIS is completed every

Admission, discharge, transfer in agency, every 30 days, and change in condition

who can complete the initial OASIS

Only PTs, SLPs and Nurses

Qualifying for hospice

-Duration of life expectancy must be 6 months of less

-Pt must be terminally ill

-Care provided is for comfort not cure

routine home care

The beneficiary has elected to receive hospice care at his/her residence, which can include a private residence, assisted living facility or nursing facility

continuous home care

Care provided between 8-24 hours/day only during periods of crisis to maintain the beneficiary at home to manage pain and other acute medical symptoms

What is the difference between home health vs an inpatient or an outpatient care?

-Clinician must be more sensitive to boundaries of the person and their home

-Different cultural dynamics may be encountered

-Many unexpected barriers can be present (throw rugs, fall risks, clutter, pets

-Less availability of tools to be able to be used

-Less tests and measures available to conduct

-Use of the OASIS instrument

What is the Low Utilization Payment Adjustment (LUPA)?

Payment per visit when the number of visits is low.

What is required for a PTA to treat a patient in Florida for home health

The supervising PT must be readily and physically available for direct supervision.

What is the definition of 'home' in the context of home health?

The residence that the patient makes as home; institutions like hospitals are not considered homes.

What is the purpose of the Quality of Care Outcome Indicators?

To monitor home health agency performance and improve practices.

What is the significance of the patient's ability to leave home for home health eligibility?

Leaving home must require considerable and taxing effort or be contraindicated.

What is the role of balance tests in home health documentation?

To support the assessment of homebound status and safety with tasks.

What is the importance of the patient's condition in determining home health eligibility?

The condition must restrict the ability to leave home or require assistance.

What is the initial assessment requirement for a PTA in home health?

The supervising PT must perform the initial assessment.

What is the purpose of the Home Health Resource Group (HHRG)?

To determine how much the home health agency gets paid based on patient needs.

What services can a PTA provide to a patient in an inpatient facility?

The PTA can provide services as long as the PT is available for consultation, including assigned interventions, monitoring vitals, and reporting changes in medical status.

What is the mechanism of action of Lasix?

Lasix is a diuretic that inhibits the cotransport of sodium, potassium, and chloride, reducing fluid excess and relieving congestion.

What should be monitored when a patient is on Lasix?

Hypokalemia.

What is the function of Altace?

Altace is an ACE inhibitor that inhibits the conversion of angiotensin, decreasing excess intravascular volume due to sodium and water retention, and is used to decrease afterload and preload.

What side effects should be monitored when a patient is on Altace?

Hypotension and dry cough.

What is the purpose of Aldactone?

Aldactone is a weak diuretic used for aldosterone suppression, decreasing the effects of the renin-angiotensin-aldosterone system (RAAS).

What should be monitored when a patient is on Aldactone?

Hyperkalemia.

What is the role of Aspirin in Mr. Lopez's treatment?

Aspirin is used for preventing pericardial effusion.

What characterizes Type 2 Diabetes Mellitus (DM)?

Type 2 DM is characterized by insulin resistance and a decrease in beta cell function over time, typically leading to hyperglycemia.

Symptoms of Type 2 DM

unusual weight loss or gain, polyuria, polydipsia, blurred vision, N/V, polyneuropathy

How does exercise benefit individuals with Type 2 DM?

Aerobic exercise increases glucose uptake, while resistance training increases glucose sensitivity.

What risks are associated with exercise in patients with Type 2 DM?

Hypoglycemia, worsening hyperglycemia, hypertensive problems, musculoskeletal injury.

What is the action of Metformin?

Metformin reduces the amount of glucose released by the liver.

What side effects should be monitored when a patient is on Metformin?

GI distress and hypoglycemia.

What is presbycusis?

Presbycusis is a gradual age-related loss of hearing in both ears.

What strategies should be used when working with a patient who has presbycusis?

Sit in front of the patient, speak clearly but not loudly, reduce background noise, and use visual aids instead of verbal directions.

What cognitive impairments are commonly seen in the elderly?

Delirium, confusion, depression, anxiety, sleep disorders, distractibility, memory loss, and medication side effects.

What strategies should be used when working with geriatric patients with cognitive impairments?

Use short instructions, minimize distractions, provide sensory cues, memory aids, random practice, and errorless learning.