Home Evaluation

Home Evaluation

Home Evaluation
By Jeanne R. Seliskar, MA, CCC/SLP
Corporate Director of Rehabilitation
Vrable Healthcare Inc

Home Evaluation completed by a Physical Therapist or Occupational Therapist is a necessary component of the treatment plan of care in a Skilled Facility.  It is essential to ensuring a safe and successful return to the patient’s prior living situation.  A home evaluation is usually scheduled 1-2 weeks prior to discharge and can easily be misunderstood by the patient and family as a signal that we are discharging.  Careful education about the timeline and how goals can develop from seeing the person function at home, need to be reviewed.  It is offered to everyone within a reasonable distance from the facility and helps to dispel the misconception that “when I go home, I will be able to things”.  It presents a realistic picture of current levels of functioning.

Evaluation Areas

The therapist covers various areas which can be divided into the following areas with the patient performing tasks and mobility in each part of the home:

Exterior and Access to the Home:  This section covers lighting, steps, handrails, locking/unlocking doors, opening/closing doors, getting the mail and other outside obstacles, tasks or barriers. This allows the therapist to assess the patient’s ability to enter/exit the home and manage assistive device in case of an emergency. Recommendations may be made regarding the addition of handrails or other safety features such as a ramp.

Foyer and Hallways: This particular part of the evaluation assesses lighting, throw rugs, width of the hallways for walker/wheelchair, managing switches and other possible trip hazards.

Kitchen:  In this area, the flooring condition, accessibility of items to cook or eat with, storage/counter space, operation of the faucets/garbage disposal, dining space, retrieval of items from the stove, oven, microwave and refrigerator are examined. Therapists may recommend that items be placed between knee and shoulder level to improve safety and decrease risk of falls during kitchen tasks/IADLs. Additional equipment such as a walker tray or basket may be recommended at this time.

Living Areas:  the condition of the carpeting, any throw rugs present, sturdiness of the furniture as well as the height of seating for transfers are the foci of this part of the visit.

Interior Stairs or Steps:  Important factors include height of the step, presence of handrails, clutter on the steps, and carrying items when navigating the stairs.

Bedroom:  The therapist notes the condition of the carpeting or flooring, stability of the bed and other furniture, transfers on/off the bed, accessibility of clothing from drawers and the closet and the use of the blinds or window coverings.

Bathroom:  Components include lighting/presence of a night light, throw rugs, presence of grab bars, availability of supplies and ability to safely navigate throughout bathroom with reduced risk of falls. Therapists will assess ability to get on and off the toilet and into/out of tub or shower, recommending equipment as necessary.

Basement/Laundry Area: Lighting, throw rugs, flooring and tripping hazards are assessed. Therapists observe the patients ability to reach and transport laundry items, retrieve clothing from washer/dryer and safely operate machinery.

Telephone: The therapist will assess the availability of telephones and other emergency devices to assure that the patient can get help from emergency response personnel if needed.

Fire Safety: During this portion of the home assessment, alternate exit routes are examined, fire sources are observed and smoke detectors are located. Recommendations are made to facilitate safety in case of a fire or other need to evacuate the home.

The importance of the home evaluation should not be taken lightly or dismissed.  It can be the difference between a successful, happy and safe return to home life for a long period of time or possible re-hospitalization from a fall or inability to manage essential components around the house.

Drug Class Series: Analgesics and NSAIDs Medications

Opioid - analgesics-medications
Andrea Hartley, CPhT
Pharmacy Technician/Central Supply Manager
The GRAND of Dublin

This month I’ll begin a series of articles focusing on some of the common classes of medications. I chose analgesics for this article.  Analgesics are one of, if not the most common class of medications around the world.  This class includes both prescription and over-the-counter medications, and opioids.  Some references list NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) as a separate class, but for our purposes NSAIDs will be included with analgesics.

Please note that some medications are in multiple drug classes because they have multiple/different uses.

Analgesics are medications that relieve pain, also called pain killers. They are distinctly different from anesthetics, which temporarily affect, and in some instances completely eliminate, sensation.  Below are the medications in the analgesic class along with the most noteworthy facts about them.

Acetaminophen (aka Tylenol; APAP) is sold over-the counter both alone and in formulations such as Nyquil.  It is also sold as a prescription with codeine, hydrocodone and oxycodone. Over dosing on this medication can cause serious liver disease.  Acetaminophen works by changing the way the body senses pain.  Adults with healthy livers should take no more than 4gm (4,000mg) from all sources in a 24-hour period.  People with liver problems should take even less.

Aspirin (aka Ecotrin; Bayer) is sold over-the counter.  Some also consider it to be in the NSAID class.  Upset stomach is common when taking aspirin.  Children shouldn’t take aspirin or any related medications (pink bismuth, loperamide etc.) because it is thought to play a role in causing a serious condition known as Reye’s syndrome.

Opioids (narcotics), such as Avinza, Kadian, or MS Contin (morphine),  Ultram (tramadol), Oxycontin (oxycodone), Dolophine or Methadose (methadone), Dilaudid (hydromorphone), codeine, Demerol (meperidine), Duragesic or Actiq (fentanyl), Lortab or Norco (hydrocodone),  and others. Opioids reduce the pain signals sent by the nervous system and the brain’s reaction to those pain signals.  If you take an opioid for a long time, you could develop dependence as your body gets used to the drug. Some people also become addicted to opioids. Talk to your doctor if this is a concern.  One of the most common side effects when taking a narcotic is constipation.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (Ibuprofen), Aleve or Naprosyn (naproxen), Cataflam or Voltaren (diclofenac), Celebrex (celecoib) and others. NSAIDs are available as OTC and prescriptions, oral and topical. 

At The Grand we will make sure you have all of your medications available to you as quickly as we can; especially pain medications.  It’s important to use them wisely to maximize your recovery time here!

What Is BIMS?

BIMS – Brief Interview for Mental Status

Catherine Denlinger, MSW, LSW
Director of Social Services
The GRAND of Dublin

BIMS stands for Brief Interview for Mental Status.  It is a screen used to assist with identifying a resident’s current cognition and to help determine if any interventions need to occur. BIMS is a mandatory interviewing tool for skilled nursing centers.  A social worker is usually the one that would be administering the BIMS.  There is a series of questions that are asked to the resident.  These questions have a score value attached to them.  The total score of all the questions range from 0-15.   The numeric value falls into one of three cognitive categories: Intact, Moderate or Severe.  The BIMS is another tool used to assist with providing the best possible holistic well-being to a resident. 

BIMS

BIMS is administered shortly upon admission to a skilled nursing center.  If a resident is in a skilled nursing center for long term care, then the BIMS would be administered at least quarterly.  If an improvement, decline or significant change occurs with a resident, then another BIMS would need to be administered.   If a resident is at a skilled nursing center for a short period of time, then the BIMS would be administered more often.  A resident would typically be asked these questions shortly upon admission, after 14 days, 30 days and so forth.  The objective of this interview is not to diagnose, but to assist with recognizing a resident’s possible need for further evaluation.  It provides a baseline for a resident’s cognitive functioning.  BIMS is divided into three sections.  The first section looks at a resident’s immediate recall.  The second section looks at a resident’s orientation.  The third and last section looks at a resident’s short-term memory. 

BIMS can present as intimidating and/or invasive toward some residents.  Since it is mandated that skilled nursing centers administer this, it is important to note that it is just one component of a resident’s MDS (Minimum Data Set) which is a combination of many assessments to develop an overall picture of a resident’s functioning.  The MDS helps to determine a resident’s plan of care so that he/she receives the best possible care.  BIMS is one part of the whole in determining the best possible treatment during a resident’s stay in a skilled nursing center.  Here at The Grand, we strive to develop a cohesive treatment plan to maximize a resident’s strengths and assist with a resident’s weaknesses to provide the best quality of care.

Please go to the following link for a sample BIMS and instructions:

http://www.foundationsgroup.net/files/126558935.pdf

What You Need To Know About Skilled Nursing

What You Need To Know About Skilled Nursing

Danielle Batdorff
Director of Admissions
The GRAND of Dublin

What is skilled nursing?

Skilled nursing is a type of intermediate care in which the patient or resident needs more assistance than usual. This setting is designated for physical, occupational, and speech therapies, to aide in strengthening the patient who has a goal of returning to their home at baseline. Skilled nursing services are offered to patients who need IV medications administered, who may have wound care needs, or who may need teaching on medication management, an example of this would be newly diagnosed diabetics.

What is the difference between short-term care and long-term care?

Short term care is a temporary solution that may last from a few days to a few months and is typically provided for rehabilitation and allow for recovery outside of a hospital. Long term care is typically utilized for in-house placement for the duration of the patient’s life, providing permanent custodial assistance.

What social activities are offered?

The GRAND Skilled Nursing ActivitiesSkilled nursing facilities offer a full calendar of social events and activities. Residents are encouraged to join in as many activities and social events as they like. Some examples include; art classes, ice cream socials, bingo and cards, game and movie night, quest performers and church services.

In addition, they offer wellness programs, exercise classes, beauty salons, small dining areas, café and restaurant style dining rooms, and outdoor sitting and walking areas.

 What should I bring with me?

It is recommended that you bring comfortable clothing for working out in therapy along with well-fitting shoes. Personal hygiene items (all labeled with your name), photo ID, insurance cards, advanced directive paperwork (Power of Attorney and Living Will paperwork).

What are the rooms like?

The GRAND of Dublin Skilled Nursing RoomSome facilities offer both single and double occupancy rooms. Each facility has its own characteristics which make it unique and sets it apart from the other down the street. An example; The GRAND offers single occupancy rooms with walk-in showers, individual heating/cooling units, refrigerators, Wi-Fi and cable. Patient’s medications are locked securely in each patient room and we strive to provide a home like atmosphere.

What does Medicare cover?

Medicare part A covers skilled nursing care under certain conditions for a limited time.

* You must have a qualifying hospital stay. This means you meet the minimum 3 night inpatient hospitalization requirement.

* You have part A and days left in your benefit period.

* Your doctor has ordered skilled services due to a medical condition which requires the need for 24/7 nursing care and therapy services offered 5 to 6 days a week.

Medicare covered services include:

  • A semi-private room
  • Meals
  • Skilled nursing care
  • Physical and Occupational Therapy
  • Speech-Language Pathology Services
  • Medical Social Services
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers ones health) to the nearest supplier of needed services that aren’t available at the SNF
  • Dietary Counseling

Medicare part A will pay as follows:

  • Days 1-20 – pays at 100% with no patient responsibility  (Remains $0 co-insurance for 2019)
  • Days 21-100 – patient responsibility of $167.50 per day co-insurance  (2019 co-insurance will be $170.50)

Additional information can be obtained through Medicare.gov

How do I find out what my insurance will cover?

Insurance benefits and eligibility will be checked prior to admission to the building, but you may also call the member services number on your card and a customer service representative will provide you with details of your coverage options.

What is the next step and what can I expect once I select a facility?

Once you have selected a facility you will notify your hospital social worker and he/she will send the referral to the building for review. You may choose to tour the building. Your clinical is then reviewed by the admissions and nursing team to make ensure the facility can clinically manage your stay, and then the hospital liaison will visit you in the hospital to answer any questions you may have. If you need an authorization from your insurance to admit, the facility will then start that process. Once authorization has been received the facility will communicate with the hospital social worker.

What are your staffing ratios?

At The GRAND skilled setting, our ratio is 1:12 or 1:13, with an STNA on each hall. Our staffing ratios are significantly above average.

How often is therapy provided and will I have a schedule?

The GRAND of Dublin TherapyTherapy is provided at the discretion of your ordering physician, the therapy team, and your needs. You can ask for a specific schedule if that works better for you. At The GRAND, the therapy team will meet with you either the day of your arrival or the next day.  An example, some prefer mornings, some prefer afternoons and some prefer to have their therapies separated. Meaning occupational therapy may be planned for the afternoon and physical therapy planned for the mornings.

What sets your facility apart from the others?

The GRAND offers several amenities that set us apart from our competitor’s. We have Digger and Finch pub, our ice cream parlor, Movie Theater, beauty salon, pharmacy, chapel, licensed in-house therapy team and team of dedicated nurses and STNA’s and low patient/staff ratios, we offer outstanding service to our residents.

The GRAND of DublinWhat are your visitation hours and/or restrictions?

Each facility will have set hours of operation. The most common hours of operation most facilities follow are 8am to 8pm, 7 days per week. The GRAND’s hours are 8:30am to 8pm, Monday through Friday and 9am to 8pm, Saturday and Sunday. There may or may not be restrictions on when visitors can be with their loved one. The GRAND does not have such restrictions and provides security 7 nights per week.

December 2018 Activity Calendars

December 2018 Activity Calendars

Skilled Nursing Activity Calendar

Grand of Dublin December 2018 Activity Calendar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Assisted Living Calendar

GRAND of Dublin December 2018 Assisted Living Activity Calendar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Memory Care Activity Calendar 

GRAND of Dublin December 2018 Memory Care Activity Calendar

 

Executive Functions

Executive Functions

Jeanne R. Seliskar, MA, CCC-CLP
Corporate Director of Rehabilitation
Vrable Healthcare, Inc.

Executive FunctionsIf you have ever had a hospitalization, the whole process can make you feel “a little off”.  Most of us can fairly quickly return to our normal selves, but for many others something has changed with the ability to think clearly, concentrate or remember.  Speech Pathologists at The GRAND of Dublin have been focusing on helping patients with Executive Functioning skills.  These are skills which involve high level thinking, allowing individuals to function independently with all the specifics and decisions of daily living.  Executive functions include:  attention, concentration, memory, problem solving, sequencing, organizational skills and judgment.  These areas can be easily affected by multiple medical situations, such as strokes, head injuries, poor oxygen levels, chemical imbalances in the body or anesthesia.

At The GRAND on of the challenging ways, to improve these high level thinking skills is through multi-tasking and bilateral integration.  Patients are asked to complete exercises that combine cognitive-verbal and motoric tasks in alternating physical and verbal patterns while crossing over the midline of their bodies.  These tasks stimulate the brain to integrate movement and thoughts from both the left and right sides of the brain.  When this takes place, gains are made across the board in all executive function areas, impacting the improved ability to think insightfully, problem solve complex tasks, improve memory and concentration and make sound judgments.  These are the components necessary for an independent and safe return to the patient’s home environment.  That is the goal for patients and families in Rehab at The GRAND of Dublin, and addressed by our expert, experienced Speech Pathologists are trained in the specifics of remediating these impairments.

To learn more please contact the therapy department at The GRAND of Dublin by calling 614-889-8585 today.

The Flu: From 1918 to 2018

The Flu: From 1918 to 2018

Andrea Hartley CPhT
Pharmacy Technician / Central Supply Manager
The GRAND of Dublin

fluWe all know the flu virus can be deadly to vulnerable populations, but did you know that in 1918 a worldwide flu outbreak caused illness and deaths in many young and healthy people, as well as those at high risk? This particular strain of the flu became known as the Spanish flu because it was well known that Spain was hit particularly hard, but before the end of the 1918 flu season the virus had spread to every corner of the globe and killed up to 50 million people. The particular strain that caused the 1918 pandemic was of avian origin, as were many of the most deadly flu outbreaks.

The first flu vaccine in America was released in 1940, so at the time of the Spanish flu there was nothing to stop its spread except good hygiene disinfectants and isolation those who fell ill.  Today we not only have a vaccine for the flu, we have diagnostic tests and we have prescription medications to help treat the virus, as well as lessen the symptoms and duration of the illness; some can even be taken to prevent the flu in people who have been exposed to the virus: we have Tamiflu (Oseltamivir) oral capsules and liquid, Relenza (zanamivir) inhalation powder and Rapivab (peravimir) injection.

In 1960 the U.S. Public Health Service first recommended annual flu vaccination for high risk groups. This year the Centers for Disease Control recommend flu vaccination for everyone 6 months or older who do not have contraindications.

So much has changed in the prevention and treatment of the flu in the last 100 years!  At The GRAND of Dublin we offer flu vaccines to all of our employees and residents every autumn, and we still have plenty left this year if you need one during your stay with us.

For more information on the 2018 / 2019 flu season Centers for Disease Control and Prevention website.

Commercial and Managed Medicare Coverage

Commercial and Managed Medicare Coverage

Stefanie Villasante
Business Office Coordinator
The GRAND of Dublin

What does your Commercial or Managed Medicare insurance mean for your rehabilitation stay? It important that you understand how your coverage effects a variety of areas of your stay in a short term rehab facility, from admission, to type of room, to amount of therapy you receive to per day/week, how much it will cost you out of pocket, up to your prospective discharge date.  If you are looking for Skilled Rehab for yourself or a loved one it is important that you educate yourself on what coverage you have.  A lot of times the Business Office at your prospective Facility has access to this information and can help you understand your coverage.

Most Insurance providers require precertification for you to even come to a Skilled Nursing Facility.  This is done by the facility, with the paperwork provided to them from the hospital.  Some insurance companies will only authorize a Semi-Private room (you’re bunking up with a stranger for your rehabilitation stay).  A request is submitted to the insurance company and they generally take 24-48 hours to respond (they don’t always say yes).  You cannot transfer to the facility until the service is authorized.  Once the hospital and facility are notified of authorization, the hospital will then arrange transportation to the rehab center.

Medicaid CoverageMany Insurance companies cover 100% for the first twenty days, following a more Medicare-like guideline. The will have a set amount or percentage due per days for days twenty one on.  Other insurance plans have a deductible due up front and a daily coinsurance starting on day one of admission.  Almost all Insurances have an amount that you have to reach paying privately before they pay your services at 100% with no Out of Pocket cost.  This is known as your annual Out of Pocket Max.

Some Insurance companies have a “Level” that they assess your rehab need at.  This level dictates the amount of nursing care and therapy the facility will provide to you on a daily/weekly basis.  (Example: Anthem Level 2 covers 90 minutes of Therapy no less than 3 days per week, where Anthem Level 3 states 90 minutes of Therapy no less than 5 days per week).  So you might come into your Rehab stay thinking that you will have therapy 5-7 days per week, and might only be seen 3 times a week because that is all your insurance has authorized the facility to treat.

On a regular basis your Insurance Company will ask for updates from the facility.  These updates include nursing and therapy notes documenting your progress (or sometimes lack of progress).  At any point that insurance company can decide that you are ready to go home, or no longer meet skilled criteria and are in need of Long Term Care which is not covered by the insurance.  Managed Medicare Insurance plans will issue a “Notice of Medicare Non-Coverage” giving you AT LEAST a two day notice.  They are not required to give you any more notice than 2 days that you will no longer be covered your skilled stay.  If you have a commercial insurance plan, they do not have to follow Medicare guidelines and do not need to give you any notice.  A commercial plan might review your update, and say we are going to stop paying effect the previous day.  It is on you to discharge or pay privately at the facility if you stay.

With all of the different types of Insurances and Plans out there it is important to do your research before selecting one for yourself.  If you do find yourself in a situation where you don’t know your coverage or have questions, call your insurance company, talk to your hospital social worker, or the Business Office at the Rehab facility.  We all have a plan in mind of how everything will work out perfectly.  Unfortunately your insurance company (and life) doesn’t always follow that perfect plan.  Make sure you are doing your homework, so things don’t come up and leave you so shaken that is sets you back in your progression to home.

 

RESIDENT RIGHTS Continuation

Catherine Denlinger, MSW, LSW
Director of Social Services
The GRAND of Dublin

RESIDENT RIGHTS

This SSS (Social Services Series) will be the continuation and completion of Ohio & Federal Nursing Home Residents’ Bill of Rights. During our last series we looked at the first five resident rights. We will resume summarizing the resident rights continuing with number twenty-five.

25. Residents have the right to be informed in writing of the basic rate charged by the center, services available and any additional charges related to such services. The basic rate of the center shall not be changed unless a 30 day notice is provided to the resident and/or the resident’s responsible party.

26. Residents have the right to receive their bill on a monthly basis for any charges not included in the basic rate.

27. Residents have the right to be free from financial exploitation. Residents have the right to manage their own financial affairs and/or the right to quarterly accounting statements if the center is delegated this responsibility. Residents have the right to review a complete record of their funds, transactions, bills, etc.

28. Residents have the right to access their valuables/property that are on deposit at the center at reasonable hours.

29. Residents have the right to receive notice prior to a room change and/or having a roommate as well as an explanation to the fact. The Grand has all private rooms.

30. Residents have the right not to be discharged or transferred from the center unless for the following reasons: for the safety of other residents in the center, the health of residents in center would be endangered, the resident’s health has improved and he/she no longer meets the criteria for services provided in the center, and/or the welfare/needs of the resident cannot be met in the home. Other reasons may be that the resident has failed to pay for the services provided in the home, the center’s license has been revoked and/or the home is being closed, the resident receives Medicaid and the center is terminating the Medicaid program w/in the center, the resident receives Medicare and the center is terminating the Medicare program w/in the center.

31. Residents have the right to voice grievances and recommend changes to the center’s employees, to The Department of Health, or to any other person not associated with the center (Ombudsman, Legal Rights, family, friends, etc.). Residents are able to do this per their choice, free from restraint, interference, coercion, discrimination or reprisal.

32. Residents have the right to be informed of any significant change in their health status as well as their responsible party/emergency contact. The center shall make every reasonable effort to notify the resident and/or their responsible party/emergency contact as soon as the significant change is noted.

Swallowing is a basic function that we all take for granted

Jeanne R. Seliskar, MA, CCC-SLP
Corporate Director of Rehabilitation
Vrable Healthcare Companies

Swallowing is a basic function that we all take for granted

Swallowing VitalStim PlusOnce it becomes difficult to swallow or a person is at risk for aspiration, then the speech pathologist becomes an important expert in remediation of this process.  At The GRAND of Dublin, our speech pathologists have the expertise and the latest technology at hand to treat even the most difficult cases.  VitalStim Plus is an electrotherapy and sEMG Biofeedback System designed for interactive therapy dynamics allowing patients to receive visual and audible feedback leading to enhanced patient engagement during swallowing exercises.  Supplementing a standard therapy program with sEMG biofeedback facilitates functional swallowing recovery.

This device allows the speech pathologist to guide patients through personalized targeted swallowing exercises.  Programs allow the clinician to truly customize treatments while biofeedback and visuals create a patient-focused experience that encourages participation and achievement of goals.

VitalStim Plus neuromuscular electrical stimulation helps recruit and re-educate the muscles critical in the process of swallowing.  The muscle strengthening, targeted in this process, rehabilitates swallowing, leading to increased effort and duration of the swallowing attempts as well as improved coordination.  Improvements in swallowing lead to upgrades in diet resulting in improved nutrition and quality of life for our patients.

About The GRAND of Dublin

THE GRAND offers luxury accommodations in a premier resort style community. Our Clinical Professionals provide first-class healthcare inspired to elevate the quality of life in a country-club style environment. THE GRAND defines the art of luxury living, coupled with the security of Post Acute Care and Rehabilitation Services with the ambience of a resort hotel.

Your skilled nursing and post-hospital medical and rehabilitation services are an important part of your recovery. Our interdisciplinary team of trained medical professionals treat each person holistically in order to provide the greatest opportunity for you to achieve your discharge goals. Working together, the team creates a customized plan of care to deliver the necessary support for a successful discharge back home. Your quality of life is important to us. It is our goal to ensure everyone feels at home and is being provided the highest quality of care and services.