503 Midterm
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| Disablement process | show 🗑
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| show | 1. Disability is viewed differently in various cultures and societies
2. Disabled may be included or excluded depending on these views
3. Changes within cultural/societal areas impact directly on how the disabled are cared for and treated
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| show | 1.Emphasis is on pathology; cause of the disability lies within the individual
2.Has objective and standardized measurements to define and characterize the condition
3.Goal of treatment is to eliminate illness/ disease/ disability
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| show | ignores the indiv's role and fx within the broader context of society and the env
disability not only the result of condition itself, but of limitations, barriers PWD encounter in their social and physical env.
client has little/no say in their own tx
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| show | International standard for describing and measuring health and disability
Universal classification of functional status related to numerous health conditions
Tool for measuring efficiency and effectiveness of rehabilitation services
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| show | Focus is on health not on the conseq. of illness
Uses the health continuum dealing with PWD and Pw/o D's
Promotes the concept of the disability as a result of assets or barriers found within the social or physical environment instead of as a “problem”
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| show | Function and Disability:
1.Body function: physiological funct. (mental, sensory, funct. of immune system)/ body structure:anatomical components; structure of nervous system, or cardiovasc. system.)
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| ICF Structure and parts: | show 🗑
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| ICF Part II of structure | show 🗑
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| show | 2. Personal factors: gender, race, education, occupation, human factors( past experience, temperament, and other intrinsic characteristics; state of mind)
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| ICF "Experience" of disability | show 🗑
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| show | Health- components of health and components of well being
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| Function | show 🗑
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| show | Disability – any impairment, activity limitation, or participation restrictions resulting from a health condition or personal societal, or environmental factors
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| Inpairment | show 🗑
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| Functional capacity | show 🗑
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| TR and reconceptualizing disability | show 🗑
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| show | How we get paid for services
Help clients/ pt.s navigate system
Maintain health literacy
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| show | In 2005 the United States spent approximately $2 trillion on health care (16% of GDP)
By 2015 the cost is projected to
rise to $4 trillion (20% of GDP)
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| show | Public financing regulated by Center for Medicare & Medicaid Services (CMS)
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| show | Private financing through private insurers (traditional insurers & managed care orgs)
Out of pocket
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| show | Centers for Medicare & Medicaid Services (CMS):Federal agency
Facility Administrators
Allied Health Professionals
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| show | 7 Screening Criteria for IRF
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| show | Close medical supervision
24 hour rehabilitation nursing
“3-hour Rule” relatively intense level of rehabilitation services (per day)
Multidisciplinary team
Coordinated care program
Significant practical improvement
Realistic treatment goals & object
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| What is the 3-hour rule in a rehab setting? | show 🗑
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| show | Are primarily concerned with:
Generating dollars
Protecting dollars
Complying with regulations
Keeping their job
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| show | Medicare:Hospital insurance: in-patient care, short-term skilled nursing, skilled rehab care, some home health, hospice
Room/board
Medically necessary care (physician’s order) and “active treatment”
Must be pre-approved by CMS (3 hour rule)
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| show | Any intervention which:
Restores
Remediates
Rehabilitates
Reduces
Eliminates
*Specific to functional improvement
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| What Settings Require Active Treatment? | show 🗑
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| show | will NOT pay or cover…
Recreation
Diversion
Maintenance
Comfort
We need to make sure our interventions are framed in funct. terms in language and doc.
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| what services are covered and what are not/ why? | show 🗑
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| show | Become familiar with state and federal regulations
Familiarize self with Professional Standards of Practice
Know your 3rd Party Payers
Get administrative support at the facility level
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| show | Physician’s Orders
Assessment
Goals & Objectives
Treatment Plan
Delivery of Services or Interventions
Documentation of Provision of Services/Interventions
Reevaluation
Discharge Recommendations & Summary
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| show | Medicare Part A:
Hospital insurance: in-patient care, short-term skilled nursing, skilled rehab care, some home health, hospice
Room/board
Medically necessary care (physician’s order) and “active treatment”
Must be pre-approved by CMS (3 hour rule)
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| Medicare part B | show 🗑
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| show | Medicare Part C:
Blends Part A & B
Services are provided by MCO
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| Medicare part D | show 🗑
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| Public Funding: Medicaid; State administered | show 🗑
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| show | Selected group of physicians and hospitals that provide comprehensive services to individuals enrolled in specific healthcare plans
Goal is to control healthcare costs while providing high-quality medical care
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| show | Limited access to the universal providers
Payment mechanisms that reward efficiency
Enhanced quality through improved monitoring
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| show | Managed Care Organizations (MCO):
Focus is prevention so routine visits are encouraged
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| HMO's | show 🗑
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| POS | show 🗑
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| show | Fee for service payment (FFS):
pay specific amount for each type of service or unit of time; goal for provider is to maximize delivery of care in order to get the $
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| show | Per visit payment:
Fixed amount regardless of amount of time or the services provided: no $ incentive for provider--get pt out quickly (SuperCuts)
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| Methods of Payment | show 🗑
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| show | Capitation:
Applies to a group of individuals who are within the network. Provider is given a regular payment (monthly or yearly) to provide all services
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| Impact of Managed Care on Individuals with Disabilities | show 🗑
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| Limitations of Managed Care for PWD | show 🗑
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| show | (from med. model) refers to changes in structure and function of the body systems
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| Illness: | show 🗑
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| show | sudden onset of symptoms that are short term
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| show | symptoms that last indefinitely and are attributed to a cause that may or may not be identified
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| trajectory: | show 🗑
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| show | nature or stages of the chronic illness or disability
-stable: managed condition, symptoms not progressing
-episodic: sympts not always present but flare occasionally
-degenerative: continuing breakdown of structure or funct.
-exacerbations: sympts wo
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| show | A state in which unusual or excessive demands threaten a person's well-being or integrity
-body integ (physical)
-independence
-self-concept
-future(goals, $status)
-relationships
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| Stress reactions | show 🗑
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| coping strategies | show 🗑
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| coping behaviors (2) | show 🗑
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| Emotional reactions to disability/ loss | show 🗑
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| Emotional reactions to disability/ loss | show 🗑
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| show | infancy/childhood
school-aged
young adult
middle age
older adult
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| Injury as a result of violence: | show 🗑
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| show | PTSD, poor coping skills, anger, helplessness, fear, anxiety, take out feelings on rehab staff (don't trust you, authority figure, have problem c structure of prgm)
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| suggestions for dealing with angry pt's | show 🗑
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| show | how one perceives themselves; an assessment of their own worth, strengths and weaknesses
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| Self-esteem: | show 🗑
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| show | Mental view of one's body with regard to appearance, sexually, and ability to perform physical tasks
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| show | individual feelings of shame due to disapproval of others and guilt resulting from being discredited or devalued by others
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| Uncertainty: | show 🗑
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| show | refers to conditions that have no outward signs that alert casual observers to an individual's condition
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| show | Family adaptation: all fam members experience loss, fear, frustration, anger
-common stressors: altered roles/ role reversal, $$, dependency, child care, change in pace, intimacy
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| Stages of Adaptation and adjustment | show 🗑
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| Stages of Adaptation: | show 🗑
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| show | an expression of one's self as a woman or man
commonly expressed through phys and emotional closeness
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| show | sexual exploration: concerns about giving/receiving phys. pleasure, exploration of their bodies hypersensitive areas
Sexual reintegration: the ability to communicate and be open about one's own sexual needs or desires c a sex partner
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| show | cog-genital dissociation: conscious awareness of "shutting down" or "shutting out" sexuality as a result of focusing on other aspects of managing daily living
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| 4 categories of sexual adjustment: | show 🗑
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| gender differences: | show 🗑
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| barriers to providing sexuality info | show 🗑
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| show | Autonomic Dysreflexia
Verbal and Physical Abuse
Sexual Dysfunction
Aging
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| What is Rehab: | show 🗑
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| show | Physical disability as a result of traumatic or atraumatic injury/illness
Exs: SCI, TBI/ABI, CVA, Orthopedic, Neurological, Med-surgical
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| show | Spina bifida, multiple sclerosis, muscular dystrophy, ALS, post-polio syndrome, chronic pain
Rehab can be beneficial
Congenital disabilities--rehab provided by school system (IDEA, 1975)
Problem: transition to adulthood
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| show | Private: HMO's, Self-pay)
workers comp
Gov: VA, Medicare/ medicaid
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| show | Acute
Nursing facilities
Local rehab clinics
Large regional facilities
Specialty hospitals
Veteran’s Administration
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| show | Centers that work together to demonstrate improved care, maintain a national database, participate in research & provide continuing education relating to SCI or TBI.
Applied for & awarded for 5-year periods of time
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| show | Rehab centers that are committed to innovative projects for the delivery, demonstration, and evaluation of comprehensive medical, vocational, and other rehab services to meet needs of individuals with SCI
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| show | Purpose is to advance medical rehabilitation by increasing the rigor & efficiency of scientific efforts to assess the longitudinal experience of individuals with TBI.
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| Continuum of Care | show 🗑
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| show | Urban centers vs. rural centers
Where injury happens can make big difference in recovery and rehab
Regional insurance differences
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| show | Tells public that hospital has met stringent set of standards
Stamp of approval on facility or program
Not guarantee of perfection
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| Why do rehab’s want accreditation? | show 🗑
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| show | JCA: Joint Commission on Accreditation (formerly JCAHO)
CARF: Commission on Accreditation of Rehab Facilities
Certifies programs not whole facilities
For example, a rehab can have a CARF accredited SCI program
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| rehab team | show 🗑
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| show | 1st contact with patient & family
Coordinates benefits, insurance coverage
Communicates with insurance co.
Progress towards goals
Length of stay
D/C logistics
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| show | Strengthening & Stretching (ROM)
Developing balance
Wheelchair skills
Transfer training
Bed mobility
Standing programs
Gait training
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| show | Self care: grooming, bathing, dressing, feeding
Occupation
Housekeeping Tasks
ECU’s
Driving
Orthotics
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| show | Optimize strength & skills via recreation activity
Explore recreation options
Keep active
Community re-entry outings
Fun, enjoyment
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| show | Respiratory therapy
Speech therapy
Psychologists
Vocational Rehab Counselors
Sex Counselors
Education dept. (family training, pt ed)
Peer supporters
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| show | Dictate short lengths of stay
Per diem rates & patient unit billing
Show insurance co. that person is continuing to make gains to keep him/her longer
Restrictions on medical tests, limited funds for equipment
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| Short Length of Stay | show 🗑
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| show | PPE: Personal protective equipment; gloves, gowns, shoe/head covers, masks/ respirators, face+eye protection
hand washing
needle sticks
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| Assistive technology | show 🗑
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| what does AT enable people to do? | show 🗑
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| High tech | show 🗑
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| low tech | show 🗑
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| Types of assistive devices: | show 🗑
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| types of AD's | show 🗑
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| show | Need to ensure that the device truly meets the needs of the individual and for whom they are intended
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| Manual w/c basic functions: | show 🗑
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| show | foam, gel, air, honey comb, alternating pressure
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