California Physical Therapy Ebook Continuing Eduction - PTC…

disoriented, in an attempt to differentiate between patients who have intermittent confusion and patients who continually have cognitive difficulties. Question M1720 attempts to determine whether the patient has anxiety and, if so, how disruptive the anxiety is to learning and coping and if the frequency of the condition could indicate that the patient has an anxiety disorder that should be addressed. Question M1730 asks if the patient has been screened for depression using a standardized validated tool and, if so, whether the screening tool indicates that the patient is at risk and should be further evaluated. The PHQ-2 screening tool is even embedded in the item to facilitate “best practice” screening. Depression is a prevalent condition affecting many home care patients, and although it may not be a primary

psychiatric diagnosis, it is a complicating factor for many common diagnoses affecting home care patients. Depression is associated with chronic illnesses or conditions such as heart failure, chronic obstructive pulmonary disease, diabetes, and urinary incontinence and often results in poorer self- care management. For these reasons, CMS believes that home health therapists should identify and facilitate treatment for patients with depression. Question M1740 identifies patient behaviors that indicate significant neurological, developmental, behavioral, or psychiatric disorders. Patients with diagnoses such as Alzheimer’s disease, developmental disorders, schizophrenia, and many other cognitive and psychiatric disorders will require responses indicating behavioral symptoms. fifty-percent rule applies to the patient’s ability over most of the time over the past 24 hours. Figure 2: Conventions Specific to ADL/IADL Items 1. Report the patient’s physical and cognitive ability to perform a task. Do not report on the patient’s preference or willingness to perform a specified task. 2. The level of ability refers to the level of assistance (if any) that the patient requires to safely complete a specified task. 3. Although the presence or absence of a caregiver may affect the way a patient carries out an activity, it does not affect the assessing clinician’s ability to assess the patient in order to determine and report the level of assistance that the patient requires to safely complete a task. 4. Understand what tasks are included and excluded in each item and select the OASIS response based only on included tasks. 5. If the patient’s ability varies among the different tasks included in a multi-task item, report what is true in a majority of the included tasks, giving more weight to tasks that are more frequently performed. 6. Consider medical restrictions when determining ability. For example, if the physician has ordered activity restrictions, consider this when selecting the best response to functional items related to ambulation, transferring, bathing, etc. Note . From Centers for Medicare and Medicaid Services. (2019). Outcome and assessment information set OASIS-D guidance manual . Effective January 1, 2019. Retrieved from https://www. cms.gov/Medicare/Quality- Patient-Assessment-Instruments/ HomeHealthQualityInits/Downloads/OASIS-D-Guidance-Manual-final. pdf Other items complete the Functional Assessment. Question M1910 asks if a multifactor fall risk-assessment tool was used to identify the patient’s risk for falls. In other words, the therapist is asked if the patient was assessed for factors known to put the patient at risk for falls. Most agencies have identified the tool the therapist should use to conduct this OASIS-encouraged best practice assessment. As stated earlier, the IMPACT Act of 2014 is gaining traction in OASIS completion in order to track patient status across post-acute care settings. Further items introduced in OASIS-D are GG0100, asking about the patient’s prior functioning with self-care, ambulation indoors, stairs performance, and functional cognition. GG0110 is for the reporting of prior device usage including wheelchairs, lifts, walkers, etc. GG0130 is also new, solely about self-care, with the reporting of the patient’s current status and a projected performance goal. Finally, GG0170 was expanded to include twenty subassessment questions to report the current mobility status and projected performance goal of the patient in a variety of situations, including wheelchair mobility. Consideration of safety and assistance needed from another person are crucial for the proper scoring of these items.

Activities of daily living and instrumental activities of daily living OASIS’s ADL/IADL assessment consists of 9 items, and certain additional guidelines and conventions govern how they are assessed and coded (see Figure 2). Almost all of these items are measured at admission and again at discharge to determine whether the patient has become more functionally independent or more dependent while under the agency’s care or if the home care services did not make any difference in the patient’s functional abilities. The CMS is very interested in promoting beneficiaries’ functional independence. Further, most of them contribute to points earned toward the PDGM payment system via the Functional Impairment Level category. Therefore, it is crucial the therapist respond accurately to the ADL items to gain appropriate reimbursement.

The education of physical and occupational therapists makes them experts in – among other competencies – conducting functional assessments. Speech-language pathologists in home care, unlike speech-language pathologists in many other settings, must be able to perform a skilled functional assessment – that is, the therapist must be able to competently assess the patient’s ability to perform each of the ADLs and IADLs. The first step for performing an accurate functional assessment is to actually get patients to demonstrate how they perform each of the activities. The therapist should ask patients to “walk through their” daily activities, such as taking shoes off and putting them back on again and demonstrating transferring on and off the bathroom commode. The therapist should also ask patients to get in and out of the shower or bathtub (with clothes on) and ask them to demonstrate how they reach the faucets, soap, towels, etc. In other words, therapists need to ask patients to show how they perform each ADL and IADL. While observing patients demonstrating their ability to perform ADLs and IADLs, the therapist needs to keep in mind that multiple patient factors can interfere with a patient’s ability to perform these activities, such as problems with endurance, strength, balance, range of motion, vision, pain, fatigue, memory, orientation, and depression. There are also numerous environmental factors that impair the patient’s ability to perform ADLs and IADLs. If a patient’s bathroom is upstairs and the patient cannot climb stairs or the house is so cluttered that the bathtub or shower cannot be used because it serves as a storage bin, then the patient cannot perform toileting and bathing as described in the OASIS item. Also, medical contraindications can impair a patient’s functional ability to perform an activity. If the patient is advised not to get a dressing wet, precluding showers or tub baths, then patients cannot perform bathing as described in the OASIS item and should be scored according to their current inability to perform the activity. When evaluating the patient’s ability to perform activities, the therapist needs to keep in mind the fifty-percent rule. For instance, many of the items consist of multiple tasks. Grooming (M1800) consists of six tasks. If the patient can do some tasks but needs assistance in performing other tasks, the therapist identifies the patient’s functional level based on the patient’s ability to perform most (more than 50%) of the tasks. Also, the

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Book Code: PTCA2622B

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