Therapy Functional Reassessment: It s a good thing. Objectives. Oasis-not just a requirement 3/19/2012. Vicki D. Gines PT DPT CEEAA

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1 Therapy Functional Reassessment: It s a good thing Missouri Alliance For Home Care Annual Conference 2012 Vicki D. Gines PT DPT CEEAA Objectives State how Oasis ties to Therapy evaluations State key components of therapy evaluations to support therapy need. State potential tests and measures therapists may use to support the need for therapy services State expected content of therapy goals and demonstrate ability to write a patient centered therapy goal State the time points for functional reassessments State expected content of therapy functional reassessments and demonstrate ability to suggest improvements to inadequate reassessment statements. Oasis-not just a requirement Assessment of WHAT the patient cannot do safely. Therapist evaluate to determine WHY the patient can t do it safely. 1

2 Oasis-not just a requirement Therapy Goals are about the WHAT Therapy Interventions will apply to the WHY Oasis Items M1610 M/1615 Urinary Incontinence M1800 Grooming M 1810 UE Dressing M 1820 LE Dressing M1830 Bathing M1840 Toilet Transfers M1845 Toilet Hygiene Oasis Items M1850 Transfers M1860 Ambulation M1870 Feeding or Eating M1880 Plan/Prepare meals M 1890 Telephone M2020/M2030 Management of Oral Medications 2

3 Oasis Items M Fall Risk Assessment M1240/M1242- Pain M1300 M 1350 Wounds M1400 Dyspnea M1700 M1740 Cognition M1720 Anxiety M1730 Depression M1740- M1745 Behavioral Components of therapy evaluations Home environment Prior level of function Current level of function Utilizing objective tests and measures Standardized Validated If you don t test it, you cannot write a goal about it Defining appropriate tests and measures Specific Objective Selected for the specific patient in front of you. Not all tests are appropriate for all patients Organizations cannot mandate specific tests-just that testing is done. 3

4 Tests and Measures Balance 4 Square step test Functional Reach Multi directional Reach One Leg Stand Tinetti Berg Activities Balance Confidence Scale Modified Best Tests and Measures Gait Dynamic Gait Index 4 meter gait speed Flexibility Back Scratch Posture Occiput to wall Rib to Pelvis Tests and Measures Strength Chair Rise 30 second/5x/10x Hip Extensor Strength MMT 1 Rep Max (1RM) 4

5 Tests and Measures Aerobic Capacity Vital Signs: Blood Pressure, Heart Rate, Respirations PRE and POST RPE 2 minute step test 6 Minute Walk Tests and Measures Combination TUG Dual Task TUG Motor and Cognitive Pain 0-10 Scale FACES FLACC Dyspnea Borg Breathlessness Scale MRC Breathlessness Scale Tests and Measures Cognition National Outcomes Measurement System (NOMS) Allen Cognitive Levels Test SLUMS Trails A/B Communication National Outcomes Measurement System (NOMS) Functional Assessment of communication Skills (FACS) (TBI and Left CVA) 5

6 Goals and interventions Goals Created road map to clinician and therapist Gauges progress Interventions Based on the deficits and what it will take to reach the goals This is the skill of the therapist Goal Writing Patient Specific-Meaningful Behavioral/Performance Based Using the terminology the patient will Based upon deficits seen in evaluations Objective and Measurable Standardized Quantitative Validated Reflective of norms Goal Writing Achievable Relevant Realistic within limitations of disease process Consider: Compensatory STG Rehabilitative (Restorative) LTG 6

7 Goal writing Impairment Measurement that will improve How it ties to function Goal writing Balance Deficits- Functional Reach 4 inches Increase functional reach to 10 inches To allow pt to obtain items from shelves without loss of balance or fall. Goal writing Gait Speed.5 m/s Increase safe gait speed to greater than 1 m/s To reach bathroom without incontinence 7

8 Goals-Physical Therapy PT will have improved TUG from 25 seconds to 15 seconds to demonstrate increased safety with mobility and a reduced risk of falls. Pt. will increase 30 second chair rises from 4 using UE to 10 without use of UE to increase ability to rise from the chair at the doctor s office without assist. Goals-Physical Therapy AROM L knee to 100 degrees to be able to negotiate steps with a reciprocal pattern up 12 steps to bathroom safely and independently using railing and straight cane. Goals-Occupational Therapy Pt will increase Functional Reach from 5 inches to 9 inches to increase safety in the kitchen when reaching for items in the overhead cabinets. Pt. will move items from overhead kitchen cabinets to the counter to reduce the reach distance required to increase safety due to impaired functional reach (FR 5 inches) 8

9 Goals-Occupational Therapy Pt will be independent with use of BSC for toileting and sponge bathing on lower level of home using alternate bathroom. Goals Speech Therapy Patient will demonstrate safe and efficient swallow on mechanical soft diet with 9/10 accuracy to meet nutrition needs without the risk for aspiration. Patient will demonstrate 8/10 accuracy with dysphagia exercises to increase the safety and efficiency to the swallow to prevent recurrence of pneumonia and subsequent rehospitalization. See handout Write Goal 9

10 Interventions General in care plans Specific in daily notes: Exercise programs: Actual Content of the HEP Changes (additions/deletions) to the HEP are stated Exercises sets/reps and assistance during visits are clearly stated Exercises all are tied to a specific goal and outcome Plan for next visit: Stair training to exit the home Bathing in shower using tub bench Swallow strengthening exercise program Therapy Reassessment Time points Calendar requirements Minimally every 30 days Each Therapy Discipline Crosses Certification periods Therapy Reassessment Time points Counting requirements: Single Therapy discipline: 13 th visit 19 th visit Multiple Therapy disciplines: Close to 13 th visit Close to 19 th visit 10

11 Functional Reassessments Identifying if the patient is making progress. Comparison from discipline evaluation to time point of reassessment visit Foundation Patient functional history Evaluation with appropriate tests and measures Goals that are measureable, meaningful Functional Reassessment Visit Review current goals Perform tests and measures from evaluation visit Review current interventions Provide treatment 11

12 Functional Reassessments Questions to ask.. Is the patient improving? If no, why not? Did I expect a change in this time frame? (ie 4 PT visits) Should I change the care plan? (ie goals or interventions) Should I d/c the patient? Functional Reassessments Questions to ask.. Is the patient improving? If yes do I need to update and advance goals? Should I advance the care plan (i.e. goals or interventions) Should I d/c because goals are met? Functional Reassessment Content Level of Function at evaluation Focus on the deficits and the tests that showed those deficits Level of Function at reassessment Compared to the deficits and tests that showed deficits at evaluation 12

13 Functional Reassessment Content Interventions that you provided What skilled service did the therapist do? What is the future plan? D/C old goals Add new goals D/C old interventions Add new interventions D/C old goal Functional Reassessments See Handouts Vicki D. Gines PT DPT CEEAA North Kansas City Hospital Home Health Clinical Systems Coordinator