Physical Therapy Archives - THE GRAND

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.

NeuroGym Sit-to-Stand Trainer

NeuroGym Sit-to-Stand Trainer

by Jeanne Seliskar, MA, CCC/SLP
Director of Rehabilitation

The GRAND of Dublin

With The GRAND’s focus on the best outcomes and discharge plans for our patients, the NeuroGym Sit-to-Stand Trainer has become an integral part of many of our therapy sessions at The GRAND.  With the action of coming to a fully upright standing posture being a significant  factor in returning  home, it is essential that this part of a patient’s mobility be prioritized and addressed effectively to achieve a functional level.

NeuroGymThe NeuroGym Sit-Stand Trainer uses a counter-weight mechanism to provide a safe and effective way to strengthen weight-bearing muscles and increase standing stability and endurance.  Unlike other tools that passively lift people to, or maintain them in, a standing position, the Sit-to-Stand Trainer enables an individual to actively initiate the motion of standing up, even with weakened or seemingly unsuccessful efforts.  Through continued training and gradually reducing the counter-weight, a patient can relearn the skill for standing up.  Equipped with a weight-stack and a locking pulley system, the counter-weight can be easily applied to the Sit-to-Stand Trainer.  Because it is mounted on wheels, early steps can be attempted in all directions.

NeuroGymThe Key Benefits of this equipment are:  1) early weight bearing and active mobilization at the hips and knees; 2) improvement of standing balance and stability; 3) Significant improvement of transfers; 4) improvement of patient rehabilitation with reduced physical strain to the therapist.

The GRAND is using this equipment routinely in many case to progress patients who would otherwise not ever leave the wheelchair to stand and walk leading to a significantly improved quality of life.

Answering Skilled Nursing and Nursing Home Admissions Questions

by Danielle Batdorff, BSHA/HIS
Director of Admissions
Jada Palm

Hospital Liaison
The GRAND of Dublin

If a person has never been through the process, the thought of entering a skilled nursing or rehab facility can be a little overwhelming. It’s natural to have several questions. We’ve put together a list of the most commonly asked questions to help you better understand what to expect.

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. Long term care is typically utilized for in-house placement for the duration of the patient’s life.

What social activities are offered?

Skilled 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 good 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?

Some 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 2018)
  • Days 21-100 – patient responsibility of $164.50 per day co-insurance
    (2018 co-insurance will be $167.50)

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 ration 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?

Therapy 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.

What 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 moved one. The GRAND does not have such restrictions and provides security 7 nights per week.

Utilizing The NeuroGym Sit-To Stand Trainer

neurogym

by Jeanne Seliskar, MA, CCC/SLP
Director of Rehabilitation

The GRAND of Dublin

The Rehab Department at The Grand of Dublin recently acquired a new piece of equipment to actively assist the standing motion while supporting the knees, trunk and arms to promote early mobility.  The NeuroGym Sit-To Stand Trainer uses a counter-weight mechanism to provide a safe and effective way to strengthen weight=bearing muscles and increase standing stability/balance and endurance.  Unlike other equipment used to passively lift people to a standing position or maintain them in a standing position, the Sit-To-Stand Trainer enables an individual to actively initiate the motion of standing up, even with weak musculature.  Through continued training and gradually reducing the counter-weight, a patient can increase target muscle strength and relearn the sit to stand skill.

neurogymThe keys to improved mobility and function in our rehab population that may exhibit considerable de-condition along with co-morbidities such as Stroke, Parkinson’s Disease and /or Dementia, are:  1) Safely enabling mobility practice and 2) ensuring sufficient intensity of training.  Mobility is a key not only to improved function and quality of life, but it is a critical predictor of health in general.  The sciences of rehabilitation and kinesiology have evolved and we now understand that, with the proper support, individuals can maintain greater fitness and mobility.  Our equipment will facilitate recovery and allow our patients to progress more rapidly and completely toward real changes in functional mobility and consequently improved functional independence.  Quality of life is of great importance in the rehabilitation process and leads to individuals attaining their maximum potential during the recovery period.

The GRAND of Dublin is currently premiering the use of this equipment with amazing first use results.  The Rehabilitation Team at The GRAND is excited to use this new concept equipment to enhance the rehabilitation process and increase positive outcomes for their patients and residents.   For further information on how our Rehab Department can utilize the NeuroGym Sit-To Stand Trainer for you or a loved one, please contact the Rehab Department at 614-889-8585.