The Role of a Physical Therapist July August ... - Fox Rehabilitation by pengxiang


									The Interdisciplinary Team
The Role of a Physical Therapist
Mimi Jacobs, PT, OCS, CSCS

        hysical therapy (PT) services    Medicare Part B, the resident does         modes, canes, walkers, and wheel-

P       strive to maximize functional
        independence in the assisted
living (AL) environment and com-
                                         not have to be homebound. The
                                         goals of this type of PT are to max-
                                         imize the daily function of the resi-
                                                                                    chairs. Such equipment can help
                                                                                    maximize a new, independent, and
                                                                                    safe functional level for a resident.
munity by restoring functional mo-       dent in their own environment and             Staff education, especially of di-
bility and preventing disability. The    the community. Companies that              rect caregivers, about residents’ ca-
role of a PT in AL is two-fold. For      provide Medicare Part B outpatient         pabilities, safety issues, and new
the resident, the provision of PT        PT in the home are not as common           functional levels is an integral part
services is an extension of tradition-   as VNA companies, but may be               of PT services. This interdisciplinary
al home care medical services. For       worthwhile investigating.                  approach to resident care maxi-
the interdisciplinary team, consist-                                                mizes carry-over throughout the re-
ing of administrative, medical, and      Restoration of                             habilitation process and encourages
caregiver staff, the PT brings ex-       Functional Mobility                        residents to achieve their functional
pertise and insight to the functional    A common reason for referral to PT         goals.
level of each resident, as well as to    is the functional decline of a resi-
facility-wide programs, including        dent after the occurrence of an ad-        The Proactive Approach:
fall prevention, group exercise          verse event, a fall, or hospitaliza-       Preclude Disability
classes, and staff education.            tion. A PT is able to design a             The interdisciplinary team has the
    An AL residence is considered        progressive therapeutic exercise           opportunity to be proactive in the
the resident’s home. Medicare ac-        program to improve mobility,               care of their residents. In the ab-
knowledges 2 types of home care          strength, balance, and cardiovascu-        sence of an adverse event or hos-
PT services. First, traditional home     lar endurance. The PT can also pro-        pitalization, the team should ac-
care services through a visiting         vide training to improve a resident’s      tively screen for risk factors that
nurse association (VNA) company          abilities in the areas of bed mobili-      may result in a resident’s function-
can be billed under Medicare Part        ty, transfers, and ambulation in or-       al decline.
                                                            der to facilitate           A PT can play a key role in fall
                                                            their return to         prevention, providing a fall risk as-
                                                            leisure activities in   sessment that includes an extensive
                                                            the AL home and         balance evaluation with objective
                                                            community. For ex-      tests to quantify a resident’s fall
                                                            ample, instruction      risk. A PT is then able to develop
                                                            in safe and efficient   an individualized therapeutic exer-
                                                            gait patterns to pro-   cise program to improve strength
                                                            mote dependable         and balance and reduce the resi-
                                                            mobility and im-        dent’s risk and fear of falls. For a
                                                            proved gait en-         resident with an unsteady gait, a PT
                                                            durance may help        may recommend the introduction of
                                                            a resident achieve      an assistive device and proper gait
                                                            their functional        training to further reduce the risk of
                                                            goal, whether it be     falling.
                                                            ambulating to the           In collaboration with the inter-
A. The goals of this type of PT are      dining room or going out to lunch          disciplinary team, a PT can design
to maximize function and safety in       with family and friends.                   a group exercise program that
the home only, and the resident              If a resident does not demon-          includes strength, flexibility, and
must be homebound. Second, un-           strate the potential to return to their    balance exercises to maintain a safe
der Medicare Part B, the resident        prior level of function, a PT can          functional level in all residents.
can receive PT services on an out-       recommend and assist with the pro-         Furthermore, PT interventions can
patient basis, with the site of serv-    curement of adaptive equipment,            be utilized in pain management to
ice being their AL home. Under           including transfer benches, com-                          (continued on page 43)

                                                                             July/August 2006   Assisted Living Consult   39
                                       The Interdisciplinary Team                manage challenging behaviors.
 Roundtable                            (continued from page 39)
                                                                                 Severe Cognitive Impairment
 Update                                reduce the functional decline and
                                       disability in AL residents with
                                                                                 When a resident demonstrates se-
                                                                                 vere cognitive impairment and can
                                       chronic pain. Lastly, education of        no longer ambulate safely, a PT can
Medco Removes                          individual residents, as well as staff,   recommend and assist with the pro-
Prior Authorization for                on safety, fall prevention, transfer      curement of a custom wheelchair
Alzheimer’s Drugs                      techniques, joint and energy conser-      and seating system. A resident is of-
In response to a June 12, 2006         vation, general health and wellness,
Alzheimer’s Association letter to      and the effects of immobility is also
the Centers for Medicare and           within the scope of PT services.
Medicaid Services (CMS), Admin-
istrator, Dr. Mark B. McClellan,       PT for Residents with                     A PT can teach residents
Medco removed its prior authori-       Cognitive Impairment
                                                                                   with mild cognitive
zation policy for Alzheimer’s          As the disease process progresses,
drugs for Medicare Part D benefi-      the functional needs of a resident        impairment strategies to
ciaries over age 65. As of July 15,    will change. Consequently, the role        maintain their level of
2006, Medco no longer requires         of the PT and the goals of therapy
prior authorization for all FDA-ap-    will also change to reflect the pro-
proved drugs to treat Alzheimer’s      gression of the disease process. Fre-
disease.                               quent interdisciplinary communica-
    The Alzheimer’s Association ap-    tion and education of the direct
plauds Medco for making this im-       caregivers are essential aspects of       ten able to safely self-propel when
portant change to its formulary        PT interventions for cognitively im-      properly fitted in a wheelchair. As
policy. With Medco’s policy            paired residents.                         the disease progresses to its end
change, only 2 national plans still                                              stage, a custom wheelchair can en-
require prior authorization: RxAm-     Mild Cognitive Impairment                 courage proper posture, resulting in
erica and Silverscript (Caremark).     In residents with mild cognitive im-      improved breathing, feeding, and
However, Silverscript (Caremark)       pairment, a PT can provide a fall         socialization. Pressure relief and
is in the process of developing a      prevention assessment, including a        wound prevention are also poten-
modification to its prior authoriza-   balance evaluation, and initiate an       tial benefits of a custom wheelchair
tion requirements and is in dis-       exercise program to maintain mo-          and seating system.
cussion with CMS.                      bility, strength, balance, and gait. A
    The Medco policy reversal is a     PT can also teach residents with          Final Thoughts
significant advocacy victory. It is    mild cognitive impairment strate-         PTs are experts in safe functional
the Alzheimer’s Association’s posi-    gies, including verbal and visual         mobility and its components, includ-
tion that the doctor-patient rela-     memory cues, to maintain their lev-       ing gait, balance, fall prevention/
tionship should be at the core of      el of independence during function-       management, transfers, cardiovascu-
medical treatment, and that only       al activities.                            lar endurance, strength, flexibility,
the clinical judgment of the treat-                                              wheelchair mobility, and therapeutic
ing physician in conjunction with      Moderate Cognitive Impairment             exercise. The utilization of PT serv-
the patient/family should deter-       As a resident’s mental status pro-        ices by residents and interdiscipli-
mine the appropriateness of a          gresses to a level of moderate cog-       nary teams can be beneficial in
drug for a patient and how long it     nitive impairment, repeated fall pre-     maintaining safe functional inde-
should be used.                        vention assessments are indicated.        pendence and maximizing the quali-
    For more information about this    Balance and gait training that in-        ty of life for AL residents.        ALC
topic, access the Alzheimer’s Asso-    cludes the use of an assistive de-
ciation Fact Sheet, “Important         vice, additional caregiver education,     Mimi Jacobs, PT, OCS, CSCS is a physi-
Things to Consider When Choos-         and modifications to the environ-         cal therapist and the Director of Re-
ing a Medicare Drug Plan for Peo-      ment may be warranted. A PT can           search and Presentations for Fox Reha-
ple With Alzheimer’s Disease,”         educate the caregiver staff on how        bilitation, providing rehabilitation
available at:             to best assist the resident with          services to multiple AL facilities in the
Resources/FactSheets/MedicareRX_       functional activities, as well as rec-    New York, New Jersey, Pennsylvania
PWDChooseplan.pdf.               ALC   ommend strategies to prevent and          tri-state area.

                                                                          July/August 2006    Assisted Living Consult   43

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