How many clinicians (physical, occupational, and speech therapy) can honestly say that they have achieved full independence with 100% of every patient they have ever worked with? Unfortunately, I definitely cannot make that claim myself. But is that always the intention anyway?
Too many times, healthcare professionals get on what I like to refer to as “auto-pilot mode.” While in auto-pilot, we end up with a narrow view of services, treatment approaches, goals and so on. So when I ask many therapists, “Why do we treat our patients?” the most common response is “to help them overcome their declines and function, and help them resume their prior level of function.” Or, in other words, “help them get all better again.”
While this is an extremely important aspect of our patient demographics, I’d like to remind everyone that it is only a portion of our patients, and not the entire scope of care.
In my opinion, we have at least five main reasons to follow when determining rehab potential:
1. Decline in Function – the most popular reason, and we hope to get our patients to return to the prior level of function
2. New Rehab Potential – a barrier to rehab may have resolved, such as pain, medical holds, weight-bearing status, etc.; which allows new rehab potential to be re-established
3. Improvement in Status – patients may have chronic functional deficits that begin to return. For example, a patient with late effects of a CVA may start to have muscle twitching and movement return to her affected side many months (if not a year or two) after the initial stroke. These patients would benefit from rehab to help them achieve their highest level of function with the new movements or function that has returned.
4. Quality of Life – the end-stages of a disease can be very difficult for any patient; however, we can provide our services to improve pain, seating and positioning, splinting and contracture management, and so on.
5. Prevention – “Prevent or slow further decline” is one of the key statements from the Jimmo lawsuit that was settled in 2013. Establishing customized restorative nursing programs is one example of how we can establish goals for safe and effective carryover of the RNP programs to prevent further declines of the patient’s functional status.
I’m sure I’m probably overlooking many more areas, but we should use these five as our guide to establish the minimum requirements for rehab potential.
Shelly Mesure (“measure”), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a veteran speaker and writer on therapy and reimbursement issues.