Renee Kinder
Renee Kinder

With the New Year upon us we often find ourselves with a restored energy and enthusiasm to start fresh, create novel ideas and think outside of the box for methods of self-improvement in 2016. The same methodology can be true for facility administrators when looking at ways to improve the lives of the persons they serve while helping these individuals to attain and maintain the highest practicable levels of well-being.

Often time the rehab team plays in integral role in achieving this goal.

The following list should serve as a tool for collaborating with therapy professionals in order to determine facility and individual needs with potential benefits of skilled care for improving functional abilities and quality of life.

The key considerations for requesting a therapy screening to determine need for further evaluation are: Is there a new symptom or problem present? Has there been a recent change (decline or improvement) in function?

Take a stroll through your facility hallways, outdoor courtyards, activities areas and dining rooms. Visit with your residents in their rooms and during social activities. Speak with nursing teams.  Do you notice any of the following that could trigger the potential need for rehab?

Physical and Occupational Therapy

  • Bed Mobility

Have there been any changes in how individuals roll side to side bed; move from supine to sitting; move their legs from bed to floor/floor to bed; reposition selves in bed when uncomfortable; are able to access and utilize bed controls, call lights and bedside tables.

Have there been any falls out of bed and/or around the beds reported?

  • Positioning

Have there been any changes in how individuals achieve and maintain proper position in chairs/wheelchairs; reposition selves when uncomfortable regardless of surface; relieve pressure when upright and achieve ability to place both feet to touch the floor?

Do the patients slide out of the chairs or lean to one side; utilize restraints; have a kyphosis or other postural impairments?

Do the patients currently utilize positioning equipment? If so are they in place at the time the screen was administered?

  • Transfers

Are individuals able to move from sitting to standing; get out of bed and into wheelchairs; get onto commode/toilet; move from chair to shower chair or bench and transfer from wheelchairs to regular dining chairs?

Are any residents noted to “flop” or sit down to quickly when moving from one surface to another? Are individuals returning home able to complete a car transfer?

Physical Therapy

  • Ambulation

Are individuals able to ambulate with current assistive devices; able to ambulate functional distances; have there been any recent falls or losses of balance while ambulating?

Are any residents noted with increased episodes of furniture walking or attempts to hold on to surfaces to maintain balance?

Have individuals declined from walking ad lib or assistance to not walking at all?

For individuals returning to a home environment are they able to negotiate obstacles and walk safely over curbs, backwards (retro), to the side, on stairs and across uneven surfaces.

Occupational Therapy

  • Basic Activities of Daily Living

Do individuals demonstrate changes or needed increased caregiver assistance for completion of upper and lower body dressing, grooming or bathing?

  • Late Loss Activities of Daily Living

Are there any changes or needed increased caregiver assistance to complete bed mobility, transfers, eating or toileting?

Are there any significant changes in individuals upon review of MDS Section G: Functional Status?

Speech Language Pathology and Occupational Therapy

  • Instrumental Activities of Daily Living

Do individuals returning to prior living environment demonstrate functional skills for medication management, budgeting and ability to complete housework?

Are they able to complete functional sequencing, problem solving tasks, judgment and reasoning during familiar and new-situations?

Speech Language Pathology

  • Dysphagia/Difficulty Swallowing

During meal times do individuals present with oral holding or anterior loss of food or liquid; pocketing or stasis present in cavity after swallow; aversions with intake such as “spitting” during meals; or repetitive chewing at meals.

Are individuals noted with wet voice, throat clearing or coughing, watery eyes or runny nose at meals?

Are reduced 02 saturations present with intake?

Does review of MDS Section K or weights reveal a significant number of individuals who present with significant weight loss defined by 5% in 30 days or 10% in 180 days?

  • Language and Communication

During communication with residents are they able to name objects in environment, complete automatic tasks such as greetings, counting, naming days of weeks and months of the year and able to effectively communicate wants, needs and ideas?

Are individuals able to understand yes/no, multiple choice and open ended questions, discriminate  body parts, objects, and pictures and able to identify during ADL tasks and able to follow directions?

Are communication boards and augmentative communication devices effective in assisting with needs?

Does review of MDS Section B reveal changes in communication skills?

  • Cognition

Are residents able to attend to task during ADL routines? Are they noted to be easily distracted in environments with increased background noise? Do patients become agitated in specifics settings?

Are residents oriented to place, time, purpose and caregivers?

Have any residents been noted with reduced ability to formulate sentences with adequate semantic memory (i.e. word finding skills). Do patients “block” during interactions? Have complaints regarding “losing my words”.

Have any changes in function been noted for resident in Section C of the MDS?

Renee Kinder, M.S., CCC-SLP RAC-CT, is a clinical specialist at Evergreen Rehabilitation in Louisville, KY. She also serves as Editor for Perspectives on Gerontology a publication of the American Speech Language Hearing Association.