Upload
tahq2012
View
234
Download
0
Tags:
Embed Size (px)
Citation preview
Presentation by
Graciela Lange
Copyright March 2011
• Nursing• Physical therapy• Occupational therapy• Speech therapy• Social work
Skilled Home Care: In home services provided by qualified personnel:
What do these disciplines provide?
• Clinical assessment• Treatment planning• Treatment provision• Patient and/or family education• Health status monitoring• Reassessment, referral, and follow-up
Home care agencies will not accept
• Patients unwilling to participate in home plan of care (non compliant or refuse care).
• Patients without an address or phone number• Patients w/ hx active drug use - violence • Patients whose scope of care exceeds what
VNS can safely provide and support.
Nursing
• Medication management• Disease management (symptom management
etc.)• Access line care e.g. PICC • Patient/caregiver education related to disease
process • Wound care • Labs related to referral diagnosis
Occupational Therapist
• Functional assessment ADLs and iADLs• Evaluation for adaptive equipment• Evaluation for home safety modification• Patient/caregiver teaching related to
equipment etc.
Physical Therapist
• Strengthening- conditioning • Range of motion • Gait-mobility training (balance, transfers) • Evaluation of assistive mobility aids • Home safety evaluation • In-home rehab
Speech Therapist
• Cognitive evaluation• Speech rehab • Dysphagia evaluation
Medical Social Worker
• Patient-caregiver support• Assist w/ fiscal – community resources• Stress management• Grief support • Long range care planning
Goal:
• To support in restoring, improving their health status and maintaining their independence
• Provide short term intermittent skilled care• Individual disciplines (not interdisciplinary • RN or PT or ST is identified case manager• OT and MSW can’t open a referral – Agencies are state-licensed or– CMS-certified for the level of care provided (SHC,
H/HHA), – Must be in good standing with the state.
Home Care Agencies
Home Care Agencies
• Agencies have catchment areas• Not all agencies offer same disciplines e.g.
speech• Not all agencies offer same services e.g.
Wound care specialist or falls prevention program
• Some agencies have better outcomes with specific skilled needs (Refer to OASIS Medicare data – Medicare website (compare home health agencies)
• Some agencies provide earlier start of care dates • Not all offer weekend home visits for routine care • Patient preference should be considered when
selecting the home care agency
Quality Oversight – Monitoring
• Service quality complaints should be reviewed by referring agency –hospital.
• Create process for customer feedback• Report suspected neglect- abuse involving
caregiver, family etc. (mandated reporting)• Sustain and cultivate partnerships with home
care agencies - staff
Questions?
- Thank You
Graciela Lange | Presentation © 2011