1 Rehabilitation for Stroke: Inpatient Acute Care Gary Stillman, MS, OTR Carl V. Granger, M.D. Chetan Malik, MBBS Uniform Data System for Medical Rehabilitation Amherst, New York Department of Rehabilitation Medicine University at Buffalo The State University of New York Buffalo, New York 2006 Uniform Data System for Medical Rehabilitation (UDSMR), a division of UB Foundation Activities, Inc. (UBFA). All rights reserved. All marks associated with AlphaFIM, FIM, LIFEware, and UDSMR are owned by UBFA.
2 Healing is a matter of time, but sometimes it is also a matter of opportunity. - Hippocrates
3 Problem Identification Counting rehabilitation cost mean lifetime cost of ischemic stroke estimated at $145, percent, or just over $23,000 will be used for rehabilitation
4 Rehabilitation Outcome percent ischemic or hemorrhagic stroke survivors will regain functional independence percent will be permanently disabled 20 percent will require institutionalized care
5 Epidemiology of Stroke in Buffalo-Niagara Region
6 Epidemiology of Stroke in Buffalo-Niagara Region
7 The Rehabilitation Specialists: PT, OT, Speech, and Swallowing Roles Defined: Physical Therapist: Engages the patient in the active/passive restoration of movement in critical areas such as gait and strength. Occupational Therapist: Facilitates practical applications of movement. (ADL, IADL) Speech/ Swallowing Therapist: Treats deficits and disorders of voice and swallowing.
8 Kalieda Health Kaleida Health was formed in 1998 through the merger of 4 acute hospitals and a children s hospital. It is comprised of over 950 acute care beds, 2 inpatient medical rehabilitation units, 3 sub-acute rehabilitation units, and 5 outpatient rehabilitation sites.
9 Kalieda Health stroke center at Millard Fillmore Hospital First JCAHO and NYSDOH certified stroke center (2004, 2005) in the Western New York region. Total Stroke Discharges 2003: : : : 512
10 Kalieda Health s Stroke Path of Care
11 Early Inclusion of Rehabilitation Services Often, only hours after admission Not necessarily for remediation of stroke deficits Early intervention provides a starting point to the next level of care
12 Early Rehabilitation Intervention Primary purpose of which is to provide the physician and discharge planner early guidance in triaging the stroke patient to the next level of care.
13 Description of Post Acute Services after Stroke Most Frequent Discharge Destinations Inpatient medical rehabilitation units (MRU) - Since PPS in 2002 designated by CMS as IRFs Home with in-home or outpatient services Sub-acute rehabilitation (SNF rehabilitation)
14 Key Point Getting the right patient to the right setting at the right time. This is facilitated using the AlphaFIM Instrument
15 The AlphaFIM Instrument for Adult Inpatient Acute Care Carl V. Granger, M.D. Chetan Malik, MBBS Gary Stillman, MS, OTR Uniform Data System for Medical Rehabilitation Amherst, New York Department of Rehabilitation Medicine University at Buffalo The State University of New York Buffalo, New York 2006 Uniform Data System for Medical Rehabilitation (UDSMR), a division of UB Foundation Activities, Inc. (UBFA). All rights reserved. All marks associated with AlphaFIM, FIM, LIFEware, and UDSMR are owned by UBFA.
16 AlphaFIM Instrument Is a Short Version of the FIM Instrument and Represents the Beginning of Tracking the Continuum of Care Created for the acute care hospital to measure function during stay and determine next care placement Uses familiar rating and language of the widely used 18-item FIM instrument for inpatient medical rehabilitation AlphaFIM instrument has four motor and two cognition items: eating, grooming, bowel management, toilet transfer, expression, memory Tested on more than 2,000 stroke and orthopedic cases over three years
17 AlphaFIM Instrument Is a Short Version of the FIM Instrument and Represents the Beginning of the Continuum of Care Developed using Rasch analysis, such that hierarchical rating expectations are used to estimate the level of dependence in personal care (burden of care) in the acute care setting The program estimates ratings of unobserved items in order to predict the full 18-item FIM instrument rating Now it is possible for patients to be assessed in all venues of care and functional status linked into the continuum of care
18 UDSMR ADULT REHABILITATION INPATIENT INSTRUMENTS AlphaFIM INSTRUMENT FOR ACUTE CARE INPATIENTS LINK TO THE FIM INSTRUMENT LINKED FIM INSTRUMENT FOR MEDICAL REHABILITATION INPATIENTS 4 motor and 2 cognition items: Eating Grooming Bowel management Transfers-toilet Expression Memory Patients rated by clinicians on 7-point scale: 1 = Total assistance needed from helper; 7 = Complete independence Ratings in between = various levels of dependence or independence Maximum rating = motor and cognition items in these sub-domains: Self-care Sphincter control Transfers Locomotion Communication Social cognition Patients rated by clinicians on 7-point scale: 1 = Total assistance needed from helper; 7 = Complete independence Ratings in between = various levels of dependence or independence Maximum rating = 126 points
19 UDSMR s CONTINUUM OF CARE One picture is created of a patient s functional history through inpatient and outpatient settings, including adult day care. Assessments are converted to a common scale: (100 = better function). Longitudinal record highlights functional deficits for clinicians to address. Item ratings are expressed as above expected and below expected in relation to pre-specified levels of clinical significance. These classifications are based on thousands of assessments in the database. Only items below expected appear on the longitudinal record as an alert for clinical attention.
20 How Does Medicare Define Continuity of Care? Continuous flow of care in a timely and appropriate manner. We are adding flow of information about care across the continuum Linkages between primary and specialty care Coordination among specialists Appropriate combinations of prescribed medications Coordinated use of ancillary services Appropriate discharge planning Timely placement at different levels of care including hospital, skilled nursing, and home health care
21 UDSMR ADULT REHABILITATION INSTRUMENTS/SYSTEMS FIM INSTRUMENT FOR MEDICAL REHABILITATION INPATIENTS 18 motor and cognition items in these sub-domains: Self-care Sphincter control Transfers Locomotion Communication Social cognition Patients rated by clinicians on 7-point scale: 1 = Total assistance needed from helper; 7 = Complete independence Ratings in between = various levels of dependence or independence Maximum rating = 126 points LIFEware SM SYSTEM FOR MEDICAL REHABILITATION OUTPATIENTS, INCLUDING ADULT DAY CARE Self-reporting in these domains: Physical functioning Affective sense of well-being or mood state Experience with pain Community role in terms of work/social roles Overall satisfaction with life Satisfaction with treatment Measures are derived using the Rasch measurement model Rated on scale, with 100 indicating better function
22 UDSMR ADULT REHABILITATION INSTRUMENTS/SYSTEMS FIM INSTRUMENT FOR MEDICAL REHABILITATION INPATIENTS 18 motor and cognition items in these sub-domains: Self-care Sphincter control Transfers Locomotion Communication Social cognition Patients rated by clinicians on 7-point scale: 1 = Total assistance needed from helper; 7 = Complete independence Ratings in between = various levels of dependence or independence Maximum rating = 126 points COMBINED BOTH ON SCALE AND IN ONE REPORT LIFEware SM SYSTEM FOR MEDICAL REHABILITATION OUTPATIENTS Self-reporting in these domains: Physical functioning Affective sense of well-being or mood state Experience with pain Community role in terms of work/social roles Overall satisfaction with life Satisfaction with treatment Measures are derived using the Rasch measurement model Rated on scale, with 100 indicating better function
23 Links Across the Continuum of Care Acute Hospital Care Rehabilitation Program Outpatient Assessment or Program Tying the Present to the Future Making the continuum Understandable Meaningful Cost-effective Manageable
24 Accountability for Outcomes Fundamental to clinical accountability is accountability for outcomes, not just processes Accountability and management, whether it be of a program or of a case, cannot be accomplished without measurement Accountability rests on the notion that clinicians take ownership of the goals of achieving healthy functioning of patients in their care
25 AlphaFIM Instrument Items 4 Motor: Eating, Grooming, Bowel Management. Transfers-Toilet 2 Cognition: Expression, Memory Inferring Probable 18-Item (13 Motor, 5 Cognition) FIM Instrument Rating Models based on Rasch analysis identify expected rating relationship between the two instruments. Hierarchy of item difficulty: some items easy to perform independently, some not. Hierarchy as a staircase: patient progresses upward from easier to more difficult items, achieving functional independence. Hierarchy of rating expectancy estimates dependence in personal care (burden of care) of patient in acute care setting and level of function in terms of the full 18-item FIM instrument rating. All 6 items must be completed to derive benefit from the measure.
26 Staircase from Dependence to Independence Stairs The patient is trained for Trnsfr Tub independence with Walking progressively more difficult tasks. Bathing Dressing - Lower Toileting Trnsfr Toilet FIM Trnsfr Bed Hierarchy Dress - Upper Bladder Control Bowel Control Grooming Eating Easy Difficult
27 Clinicians Uses of the AlphaFIM Instrument Used primarily to facilitate triage in discharge planning, thus assessment must be timed to occur in order that AlphaFIM information contributes to the discharge plan May be used to track changes from acute admission to discharge, if desired Records actual performance, not capacity Lowest rating recorded Best available information used: observation or from reports Patients rated from 1 to 7, complete dependence to independence
28 AlphaFIM Instrument Levels of Function and Rating EATING Includes use of suitable utensils to bring food to mouth, chewing and swallowing, once the meal is presented in the customary manner on a table or tray. Performs safely. NO HELPER 7 Complete Independence Patient eats from a dish while managing a variety of consistencies of food and drinks from a cup or glass with the meal presented in the customary manner on a table or tray. Patient opens containers, butters bread, cuts meat, pours liquids, uses a spoon or fork to bring food to the mouth, and chews and swallows the food. Performs safely. 6 Modified Independence Patient requires an adaptive or assistive device (e.g., long straw, spork, or rocking knife), requires more than a reasonable time to eat, requires modified food consistency or blenderized food, or there are safety considerations. If the patient relies on other means of alimentation, such as parenteral or gastrostomy feedings, then the patient self-administers the feedings. REQUIRES HELPER 5 Supervision or Setup Patient requires supervision (e.g., standing by, cueing, or coaxing) or setup (application of orthoses or assistive/adaptive devices); or another person is required to open containers, butter bread, cut meat, or pour liquids. 4 Minimal Contact Assistance Patient performs 75% or more of eating tasks. 3 Moderate Assistance Patient performs 50% to 74% of eating tasks. 2 Maximal Assistance Patient performs 25% to 49% of eating tasks. 1 Total Assistance Patient performs less than 25% of eating tasks or the patient relies on parenteral or gastrostomy feedings and does not self-administer the feedings.
29 AlphaFIM Instrument Levels of Function and Rating GROOMING Includes oral care, hair grooming (combing or brushing hair), washing hands/face, shaving/applying make-up, or first four tasks only. NO HELPER 7 Complete Independence Patient cleans teeth or dentures, combs or brushes hair, washes hands, washes face, either shaves face or applies make-up, including all preparations. Performs safely. 6 Modified Independence Patient requires specialized equipment (including prosthesis or orthosis) to perform grooming activities, or takes more than a reasonable time, or there are safety considerations. REQUIRES HELPER 5 Supervision or Setup Patient requires supervision (e.g., standing by, cueing, or coaxing) or setup (e.g., applying orthoses or assistive/adaptive devices, setting out grooming equipment, and initial preparation such as applying toothpaste to toothbrush and opening make-up containers). 4 Minimal Contact Assistance Patient performs 75% or more of grooming tasks. 3 Moderate Assistance Patient performs 50% to 74% of grooming tasks. 2 Maximal Assistance Patient performs 25% to 49% of grooming tasks. 1 Total Assistance Patient performs less than 25% of grooming tasks.
30 AlphaFIM Instrument Levels of Function and Rating BOWEL MANAGEMENT Includes complete intentional control of bowel movements and, if necessary, use of equipment or agents for bowel control. NO HELPER 7 Complete Independence Patient controls bowels completely and intentionally and is never incontinent. 6 Modified Independence Patient requires a bedpan, digital stimulation or stool softeners, suppositories, laxatives (other than natural laxatives, e.g., prunes), or enemas on a regular basis, or uses other medications for control. If the patient has a colostomy, the patient maintains it. No accidents. REQUIRES HELPER 5 Supervision or Setup Patient requires supervision (e.g., standing by, cueing, or coaxing) or setup of equipment necessary for the patient to maintain a satisfactory excretory pattern or to maintain an ostomy device; or the patient may have occasional bowel accidents, but less often than every two weeks. REQUIRES HELPER 4 Minimal Contact Assistance Patient requires minimal contact assistance to maintain a satisfactory excretory pattern by using suppositories or enemas or an external device; patient performs 75% or more of bowel management tasks; or patient may have occasional bowel accidents, but less often than weekly. 3 Moderate Assistance Patient requires moderate assistance to maintain a satisfactory excretory pattern by using suppositories or enemas or an external device; patient performs 50% to 74% of bowel management tasks; or patient may have occasional bowel accidents, but less often than daily. 2 Maximal Assistance Despite assistance, patient is soiled on a frequent or almost daily basis, necessitating wearing diapers or other absorbent pads, whether or not an ostomy device is in place. Patient performs 25% to 49% of bowel management tasks. 1 Total Assistance Despite assistance, patient is soiled on a frequent or almost daily basis, necessitating wearing diapers or other absorbent pads, whether or not an ostomy device is in place. Patient performs less than 25% of bowel management tasks.
31 AlphaFIM Instrument Levels of Function and Rating TRANSFERS-TOILET Includes getting on and off a toilet. Performs safely. NO HELPER 7 Complete Independence If walking, patient approaches, sits down on, and gets up from a standard toilet. Performs safely. If in a wheelchair, patient approaches toilet, locks brakes, lifts footrests, removes armrests (if necessary), does either a standing pivot or sliding transfer (without a board), and returns. Performs safely. 6 Modified Independence Patient requires an adaptive or assistive device (e.g., sliding board, lift, grab bars, or special seat), takes more than reasonable time, or there are safety considerations. In this case, a prosthesis or orthosis is considered an assistive device if used for the transfer. REQUIRES HELPER 5 Supervision or Setup Patient requires supervision (e.g., standing by, cueing, or coaxing) or setup (positioning sliding board, moving foot rests, etc.). 4 Minimal Contact Assistance Patient performs 75% or more of transferring tasks. 3 Moderate Assistance Patient performs 50% to 74% of transferring tasks. 2 Maximal Assistance Patient performs 25% to 49% of transferring tasks. 1 Total Assistance Patient performs less than 25% of transferring tasks or does not transfer onto a toilet.
32 AlphaFIM Instrument Levels of Function and Rating EXPRESSION Includes clear vocal or non-vocal expression of language; either intelligible speech or clear expression of language using writing or a communication device. Evaluate and indicate the more usual mode of expression, whether vocal or non-vocal. If both modes used equally, code Both. Complex or abstract ideas include (but are not limited to) current events, religion, and relationships with others. Basic daily needs and ideas refer to daily activities such as nutrition, fluids, elimination, hygiene, and sleep (i.e., physiological needs). NO HELPER 7 Complete Independence Patient expresses complex or abstract ideas clearly and fluently (not necessarily in English). 6 Modified Independence In most situations, patient expresses complex or abstract ideas relatively clearly or with only mild difficulty. No prompting needed. May require an augmentative communication device or system. REQUIRES HELPER 5 Standby Prompting Patient expresses basic daily needs and ideas more than 90% of the time. Requires prompting (frequent repetition) less than 10% of time to be understood. REQUIRES HELPER 4 Minimal Prompting Patient expresses basic daily needs and ideas 75% to 90% of time. 3 Moderate Prompting Patient expresses basic daily needs and ideas 50% to 74% of time. 2 Maximal Prompting Patient expresses basic daily needs and ideas 25% to 49% of the time. Uses only single words or gestures. Needs prompting more than half the time. 1 Total Assistance Patient expresses basic daily needs and ideas less than 25% of the time or does not express basic needs appropriately or consistently despite prompting.
33 AlphaFIM Instrument Levels of Function and Rating MEMORY Includes skills related to recognizing and remembering while performing daily activities in an institutional or community setting. Includes ability to store and retrieve information, particularly verbal and visual. Includes recognizing people frequently encountered, remembering daily routines, and executing requests without being reminded. A deficit in memory impairs learning as well as performance of tasks. NO HELPER 7 Complete Independence Patient recognizes people frequently encountered, remembers daily routines, and executes requests of others without need for repetition. 6 Modified Independence Patient appears to have only mild difficulty recognizing people frequently encountered, remembering daily routines, and responding to requests from others. May use self-initiated or environmental cues, prompts, or aids. REQUIRES HELPER 5 Supervision Patient requires prompting (e.g., cueing, repetition, reminders) only under stressful or unfamiliar conditions, but no more than 10% of time. 4 Minimal Prompting Patient recognized and remembers 75% to 90% of the time. 3 Moderate Prompting Patient recognizes and remembers 50% to 74% of the time. 2 Maximal Prompting Patient recognizes and remembers 25% to 49% of the time. Needs prompting more than half the time. 1 Total Assistance Patient recognizes and remembers less than 25% of the time or does not effectively recognize and remember.
34 AlphaFIM Instrument Calculations Projection of the patient s likely FIM Instrument Ratings FIM-13 Raw Motor Rating: Best approximation of FIM Instrument Motor Rating FIM-13 Rasch Motor Rating: transformation of the FIM-13 Raw Motor Rating FIM-5 Raw Cognition Rating: Best approximation of FIM Instrument Cognition Rating FIM-5 Rasch Cognition Rating: transformation of the FIM-5 Raw Cognition Rating FIM Motor Range: Best approximation of level of assistance FIM Cognition Range: Best approximation of level of assistance FIM Walking Range: Best approximation of assistance needed by patient to walk at least 150 feet Help Needed: Best approximation of daily number of hours of care required from another person to perform personal care tasks of daily living
35 Transforming Raw Scores to Rasch Measures Approximately 1=2 2=30 3=40 4=50 5=60 6=70 7=100
36 Acute Inpatient Rehab Acute Care Hospital Subacute Rehab Homecare Rehab Outpatient Rehab AlphaFIM Instrument Facilitates Triage of Patients from Acute Care to the Next Care Setting
37 Acute Inpatient Rehab FIM instrument Acute Care Hospital AlphaFIM instrument Subacute Rehab Homecare Rehab Outpatient Rehab FIM instrument FIM instrument + LIFEware SM System FIM instrument + LIFEware SM System UDSMR Instruments Are Used in Different Settings and the Continuum of Care Links Inpatient to Outpatient Settings
38 Stroke Patients Study Projecting Rehabilitation Admission FIM Instrument Rating Using the AlphaFIM Instrument Objective Examine validity and applicability of the AlphaFIM instrument ratings obtained in an acute care hospital setting for predicting admission FIM instrument ratings in the comprehensive medical rehabilitation unit.
39 Stroke Patients Study Projecting Rehabilitation Admission FIM Instrument Rating Using the AlphaFIM Instrument Design Retrospective analysis of data from Uniform Data System for Medical Rehabilitation (UDSMR) using information from 77 patients who were admitted to one stroke center for an ischemic or hemorrhagic stroke, and subsequently transferred to two comprehensive medical rehabilitation units.
40 Stroke Patients Study Projecting Rehabilitation Admission FIM Instrument Rating Using the AlphaFIM Instrument Results Mean age (± standard deviation) of patients was (±13.41), age range 31 to 91 years old 55.8% female; 44.20% male Mean AlphaFIM instrument total rating: (SD 21.48) Mean admission-fim instrument total rating (SD 18.67)
41 Stroke Patients Study Projecting Rehabilitation Admission FIM Instrument Rating Using the AlphaFIM Instrument Results (continued) Pearson correlation coefficients: Positive linear relationship was found between AlphaFIM instrument ratings obtained in the acute care setting and admission-fim instrument ratings obtained in the medical rehabilitation unit. Between AlphaFIM total and total-fim admission: (p=0.01)
42 Stroke Patients Study Projecting Rehabilitation Admission FIM Instrument Rating Using the AlphaFIM Instrument Conclusion AlphaFIM instrument ratings obtained in the acute care hospital setting predict the FIM instrument rating in the medical rehabilitation unit and may assist in triaging patients from the acute care hospital into appropriate settings, such as the medical rehabilitation unit, skilled nursing facilitysubacute rehabilitation, long-term nursing home, or home with or without services.
43 Stroke Patients Study Projecting Rehabilitation Admission FIM Instrument Rating Using the AlphaFIM Instrument Discussion The results of this study are applicable only to stroke patients. Additional study would be needed to determine if patient s length of stay can be reduced while maintaining quality of care. Use of the AlphaFIM instrument requires training and testing of raters.
44 Actual and Projected AlphaFIM Instrument Ratings for Stroke AlphaFIM Motor Rating 22/28 FIM Motor Rating 59/91 Walking AlphaFIM Cog Rating 4/7 7/14 FIM Cog Rating 20/ Actual Projected
45 Translation of Total FIM TM Rating into Burden of Care: Raw or Rasch Score Measure = Approx. 4 hours of assistance = Approx. 2 hours of assistance = Approx. 1 hour of assistance = Minimal or no assistance = No assistance
49 Summary The AlphaFIM instrument: Is used in the acute care hospital Is a shortened version of FIM instrument, using 6 items Is the beginning functional assessment through the inpatient and outpatient venues of the continuum of care Is highly correlated with the FIM instrument Translates into motor and cognitive domains as well as full FIM instrument ratings Predicts burden of care Facilitates triage to the next level of care Ties the present to the future by linking acute hospital care, the rehabilitation program, and outpatient care
Rehab Criteria The patient must have a physical impairment requiring rehabilitation OR have a known cognitive impairment requiring ongoing rehabilitation support or services. The patient is medically stable:
Acute Care to Rehab & Complex Identify Referral Destination: Referral to Rehab Referral to Complex Continuing Care (CCC) If Faxed Include Number of Pages (Including Cover): Pages Estimated Date of Rehab/CCC
(Identify Referral Destination) Rehabilitation Program Requested: CCC Program Requested: Restorative Medically Complex Medically Complex Ventilator Behavioural Health End of Life Medically Complex - Bariatric
COLLABORATIVE NURSING DOCUMENTATION The following section is designed to assist the clinician in providing information to the nursing staff in effort to facilitate collaborative nursing documentation regarding
Slide 1 Slide 2 Slide 3 Maintaining independence in ADLs and mobility is very important to most of us. In fact, functional decline can lead to depression, withdrawal, social isolation, and complications
Importance of Integrating Stroke Rehabilitation Across the Continuum of Care Dori Tooke, MHA, PT, CSCS Manager-Inpatient Rehab Program St. Luke s Medical Center Milwaukee, WI Disclosure Nothing to disclose
PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY/PROCEDURE Policy Number: MCUP3003 (previously UP100303) Reviewing Entities: Credentialing IQI P & T QUAC Approving Entities: BOARD CEO COMPLIANCE FINANCE PAC
Inpatient Rehabilitation Guidebook Welcome to Alta Bates Summit Medical Center s Regional Rehabilitation Program Our experienced and caring team will provide you with outstanding care as you begin your
Rehabilitation Nurses: Champions for Optimizing Stroke Rehabilitation Across the Continuum of Care Presenters Sandra Melchiorre RN, MN, ACNP, CNN (c) Regional Stroke Acute Care Advanced Practice Nurse,
National Stroke Association s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you: Re-learn basic skills
Office of Licensing and Regulatory Oversight Resident information Resident s name: Resident s current address: Resident s current living situation: Resident s current primary caregiver: Adult Foster Home
Types of Home Health Care Services You Need You may receive one type or many depending on your needs. Care may be provided by one source or by several sources. Work with your physician, clinic staff, or
Profile: Kessler Patients 65 Breakthrough Years Kessler Institute has pioneered the course of medical rehabilitation since 1948. Today, as the nation s largest single rehabilitation hospital, we continue
Medical Rehabilitation Rehabilitation Unit Medical Rehabilitation The purpose of this handout is to give you information about University Hospital s Rehabilitation Unit (2 North or 2N). It will explain:
CLINICAL PRACTICE GUIDELINE PROFESSIONAL PRACTICE TITLE: Stroke Care Rehabilitation Unit DATE OF ISSUE: 2005, 05 PAGE 1 OF 7 NUMBER: CPG 20-3 SUPERCEDES: New ISSUED BY: TITLE: Chief of Medical Staff ISSUED
Provincial Rehabilitation Unit Patient Handbook ONE ISLAND FUTURE ONE ISLAND HEALTH SYSTEM Welcome to Unit 7, the Provincial Rehabilitation Unit. This specialized 20 bed unit is staffed by an interdisciplinary
Recovery After Stroke: Bladder & Bowel Function Problems with bladder and bowel function are common but distressing for stroke survivors. Going to the bathroom after suffering a stroke may be complicated
Inpatient Rehabilitation Patient Handbook 2601 Electric Avenue, Port Huron, MI 48060 810-985-1500 mymercy.us SJMPH 12-12 300 My Rehabilitation Team Physician Nurse Case Manager Physical Therapist Occupational
PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium May 31, 2013 2 DEFINITION: INPATIENT REHABILITATION FACILITY
Certified Nursing Assistant Essential curriculum- Maryland Board of Nursing Module I Orientation/Introduction A. Identify general information pertaining to the nursing assistant course B. List requirements
2/2006 1 Objectives Activities of Daily Living F 311 Minnesota Department of Health Use To determine if the facility is providing maintenance and restorative programs that will not only maintain, but improve,
Rehabilitation After Debilitation James Inzerillo MD Physiatrist What Happens to Me If I m I m Not Able to Take Care of Myself? Rehabilitation Options Self-Rehabilitation Outpatient Rehab At Home Rehab
Rhode Island Hospital Inpatient Rehab Unit (IRU) We are located on the 7 th floor of the Main Building. The unit phone number is (401) 444-2217 Within this packet, you will find answers to some commonly
October 29, 2014 DAL: DAL 14-01 SUBJECT: Individualized Service Plan (ISP) with an EHP addendum to meet the requirements for the EHP functional assessment Dear Administrator: The purpose of this letter
Acute Care for Elders (ACE) Providing Excellence in Care for Older Patients/Families Vancouver General Hospital 899 West 12th Avenue Vancouver BC V5Z 1M9 Tel: 604-875-4111 Our Purpose The Phyllis Howard
12 High Dose Radioactive Iodine (I-131) Therapy for Treatment of Thyroid Cancer Please arrive 15 minutes early to allow for parking and registration. If you have questions or need to cancel your appointment
Rehabilitation Where You Recover Inpatient Rehabilitation Services at Albany Medical Center You're Here and So Are We As the region s only academic medical center, Albany Medical Center offers a number
Hamilton Health Sciences Integrated Stroke Model of Care Rhonda Whiteman, Stroke Best Practices Coordinator, Hamilton Health Sciences Integrated Stroke Model of Care Goals To provide a more comprehensive
Behaviour Management: Partnering To Bridge The Continuum Presented by: Nancy Boaro, MN, CNN(C), CRN(C) Karey-Anne Fannon, BA, BST, RRP Objectives Review some of the behaviours exhibited by patients with
Using Objective Measures to Facilitate Rehabilitation Referral Mark Bayley MD, FRCPC Medical Director, Neuro Rehabilitation Program, Toronto Rehabilitation Institute Associate Professor, Division of Physiatry,
Recommended time for assessment: Basic Intermediate Advanced FIMTM: (see attachment 1) - Entry to rehab - Discharge rehab - 1 month post injury - 3 months post injury NSI: (see attachment 2) - Entry to
RESTORATIVE Yvonne Russell RN Long Term Care Nursing Coalition of Mississippi-1 st Teleconference Restorative Nursing OVERVIEW Restorative Nursing is not a new concept Techniques have been taught in nursing
REHABILITATION begins right here Select Rehabilitation Hospital of Denton offers you a new direction in medical rehabilitation. Our 44-bed, state-of-the-science hospital offers unparalleled treatment to
Family Caregiver Guide Admission to Inpatient Rehabilitation (Rehab) Services What Is Rehab? Your family member may have been referred to rehab after being in a hospital due to acute (current) illness,
Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals: Timely access to geographically located acute stroke unit care with a dedicated interprofessional team
TORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Guide (updated January 23, 2014) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals:
MDS Part 1: Section GG What You Need to Know about Coding the New Section GG Presented by: Amy Franklin, RN, RAC-MT, AHIMA approved ICD-10CM & PCS Trainer, Curriculum Development Specialist 1 Faculty Disclosure
June 27, 2014 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1605-P Room 445-G Hubert H. Humphrey Building 200 Independence
DISCHARGE PLANNING GUIDELINES FOR INPATIENT REHABILITATION The Discharge Planning Guidelines for Inpatient Rehabilitation have been developed by the GTA Rehab Network s Patient Access and Flow Committee
I n t e r n a t i o n a l C l i n i c a l E d u c a t o r s, i n c. Functional Treatment Ideas and Strategies In Adult Hemiplegia s e c o n d e d i t i o n By Jan Davis, MS, OTR/L Video Registration No.
Printed in USA Arcadia Home Care & Staffing www.arcadiahomecare.com Home Care: What does it mean to you? For some people it may mean having only occasional help with the laundry, grocery shopping, or simple
Activities of Daily Living About this domain ADLs To identify the need for support in completing basic daily activities including eating, bathing, dressing, personal hygiene/grooming, toileting, mobility,
Acute Rehabilitation Center Acute Rehabilitation Courtyard Our Center Community Westview Hospital's Acute Rehabilitation Center and programs are specially designed to meet the needs of our patients and
SAM KARAS ACUTE REHABILITATION CENTER 1 MEDICAL CARE Sam Karas Acute Rehabilitation The Sam Karas Acute Rehabilitation Center is a comprehensive and interdisciplinary inpatient unit. Medical care is directed
Family Caregiver Guide Rehab-to-Home Discharge Guide In Rehab: Planning for Discharge The best time to start planning for discharge is just after your family member is admitted. While it may seem too soon
APPENDIX D GLOSSARY OF COMMON LONG-TERM CARE TERMINOLOGY Activities of Daily Living (ADLs) Everyday functions and activities individuals usually do without help. ADL functions include bathing, continence,
Patient and Family Education Comprehensive Acute Rehabilitation Unit THOMAS JEFFERSON UNIVERSITY HOSPITALS Redefining Healthcare Contents Introduction...3 Mission Statement...3 Mission Statement Of The
Long Term Care Insurance Claims Processes Presented by Randy Moses South Dakota Division of Insurance Long Term Care Insurance Benefit Standards Tax Qualified/Partnership ADL triggers Plan of Care Chronically
Mount Sinai Rehabilitation Center 2014 Outcomes Mount Sinai Rehabilitation Center 2014 Outcomes TABLE OF CONTENTS A Message from the Chair... 3 About Our Programs. 4-5 Inpatient Rehabilitation. 6-12 Outpatient
CONSUMER INFORMATION GUIDE: ASSISTED LIVING RESIDENCE 1 TABLE OF CONTENTS Introduction 3 What is an Assisted Living Residence? 3 Who Operates ALRs? 4 Paying for an ALR 4 Types of ALRs and Resident Qualifications
Stroke Rehab Across the Continuum of Care in Quinte Region Adrienne Bell Smith Manager of Rehab Therapies QHC Karen Brown Manger Client Services, Hospital Access South East CCAC Disclosure of Potential
PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB
Discharge planning with Case Managers Paul Kelsey R.N., C.C.M Joan Wilson R.N.,C.R.R.N.,C.C.M Rehabilitation Center at Scripps Memorial Hospital Encinitas Discharge Planning There are no EASY rehab patients
Presented by: Nadine Olness, RN Marci Martinson, RN February 212 Participants will be able to: State where the requirements for coding Restorative Nursing Programs can be found in the RAI Manual. Write
Family Caregiver Guide For Family Caregivers: Leaving the Hospital and Going Where? Planning for care after a discharge is often stressful. A thoughtful discussion with a knowledgeable professional can
Session: T32 A True Person Centered Restorative Nursing Program- Individualized Care at it s Best! Presented By: Sue LaGrange, RN, BSN, NHA Director of Education Pathway Health (651) 964-4946 Objectives
Maintenance Therapy in Home Health Cindy Krafft PT, MS Director of Rehabilitation Consulting Services President Home Health Section APTA Objectives Define the medical necessity of maintenance therapy Understand
Mrs. M. Care Plan (Post Significant Change) Mrs. Cynthia M is a 90-year-old, Caucasian female, born June 22, 1920 in Germany and immigrated to the United States when she was seven years old. Mrs. M speaks
Recovery and Rehabilitation after Stroke NICK WARD UCL INSTITUTE OF NEUROLOGY QUEEN SQUARE email@example.com Follow us on Twitter @WardLab For more information go to http://www.ucl.ac.uk/ion/departments/sobell/research/nward
SAN DIEGO CONTINUING CARE SERVICES DEPARTMENT TRANSFERRING TO A NURSING FACILITY FOR KAISER MEMBERS You are going to a skilled nursing facility for further care. This booklet gives you information about
Outpatient & Community I n p a t I e n t Stroke Rehab Definition Framework Institutional Setting Inpatient Rehab in Acute Care or Rehab Hospitals* Acute Care Integrated Specialized Units Transitional Care
Sun Retirement Health Assist product FEATURE SHEET Sun Retirement Health Assist provides an income-style benefit if you become unable to care for yourself due to aging, an accident, illness or deteriorated
APPLICATION FOR ADMISSION Adult Care Facility/Assisted Living Program The Fairport Baptist Homes (FBH) is very pleased to be able to offer an Adult Care Facility (ACF) and Assisted Living Program (ALP)
Office of the Assisted Living Registrar Personal Assistance Services Self-assessment Worksheet Purpose The purpose of this worksheet is to help you assess the extent to which you offer personal assistance
LEVEL OF CARE ASSESSMENT NAME: TDCJ-ID#: FACILITY: I. CURRENT DIAGNOSIS A. B. C. D. E. F. II. FUNCTIONAL ASSESSMENT CHECK THE APPROPRIATE CATEGORY INDEPENDENT SUPERVISED ASSISTANCE (SPECIFY DEGREE) MOBILITY
Career Options for Direct Service Workers in Maine Maine s Career Options in the field of Direct Service Work (Specialized Content) Homemaker Homemakers assist individuals with household or personal care
THE INPATIENT REHABILITATION FACILITY-PATIENT ASSESSMENT INSTRUMENT (IRF-PAI) TRAINING MANUAL: EFFECTIVE 10/01/2014 Copyright 2001-2003 UB Foundation Activities, Inc. (UBFA, Inc.) for compilation rights;
Rehab Outcomes Measure (ROM) reach your potential! www.accu-med.com 800.777.9141 Outcomes Trend Analysis Time is Critical Information is power Nowhere is this statement more accurate than in the achievement
UW MEDICINE PATIENT EDUCATION Your Care Team Helpful information In this section: You: The Patient Medical Staff Nursing Staff Allied Health Professionals Support Staff Peer Mentors for People with Spinal
Shepherd Center is a world-renowned provider of comprehensive, specialized rehabilitation for people with spinal cord injury, brain injury or stroke. Table of Contents 1 HOPE is HERE 2 Why choose Shepherd
Rehabilitation Nursing Criteria for Determination and Documentation of Medical Necessity in an Inpatient Rehabilitation Facility An ARN Position Statement The objective of this Position Statement is to