Long-term care and therapy: It's complicated

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Shelly Mesure, MS, OTR/L
Shelly Mesure, MS, OTR/L

There is an option in Facebook to mark your relationship status as, “It's complicated.” This is a great way to sum up everything, without getting too personal. Even though posting your relationship status on Facebook is personal. It's also great way to characterize long-term care therapy.

Recently, there was a $3.8 million settlement reached by the U.S. government and Life Care Services and CoreCare V LLP. The agreement was reached to “avoid the cost and uncertainty of protracted litigation,” according to a statement released by Life Care Services. The primary reason for the litigation was the federal government felt that the “therapy provider, RehabCare Group East, Inc., allegedly engaged in a variety of practices to maximize reimbursements, including putting patients into the highest level of therapy without evaluating their actual clinical needs.”

Before we go any further, let me emphasize: Nursing Homes MUST oversee their therapy providers.

I'd like to clarify my terminology: Skilled nursing facilities with “in-house” departments don't use an outside therapy provider; whereas, SNFs with “contract providers” use rehab companies to operate, manage, and staff their rehab departments.

Therapy is a high maintenance department to manage, from patient scheduling, RUG monitoring, staffing and recruiting issues, and so on. It's an extremely important department to the financial health of any skilled nursing facility. Therefore, it's not uncommon for SNFs to want a contract service to manage this department.
Unfortunately, it also adds a layer of complication since there are now different policy and procedures, salary/benefits/HR issues, and so on. Many times, I've often heard the rehab staff referred to as the “step-child” department. However, it's important for rehab to have strong relationships with all departments.

Accountability seems to be the main theme in many of the lawsuits flying around. Is there any wrongdoing? Who is accountable? Who is to blame? And the accusations keep rolling in this direction. I truly believe that most rehab professionals and their companies try to provide the highest quality of care in an ethical manner. However, maybe we need to also do a better job with communication to express how we are achieving this outcome.

I feel that the department head meetings, Medicare meetings, and QA/QI meetings could be the perfect opportunity to provide better communication. For example, during your Medicare meeting, does rehab inform the team of the current RUG level of each patient? And if so, is it discussed by the interdisciplinary team to demonstrate input from nursing, social services and the MDS coordinators?

I think department head meetings are a great opportunity to express the findings of any screens or referrals that were recommended by the other departments. For example, housekeeping referred “Ms. Toni” due to gait instability while demonstrating poor safety awareness while ambulating around their bedroom. Rehab completes the screen and decides to either evaluate Ms. Toni or make some small recommendation for nursing to follow-up.

Does the housekeeping staff also get notified of these results? The department head meeting could be a great way to communicate this information.

With better communication and documented policies to indicate this process, it will lead to proof of accountability, and we all live happily ever after.

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.

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Rehab Realities is written by Renee Kinder, MS, CCC-SLP, RAC-CT.  She currently serves as Director of Clinical Education for Encore Rehabilitation and acts as editor of Perspectives on Gerontology, a publication of the American Speech Language Hearing Association.

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