It’s that time of year where we start to think of what we can do differently to make ourselves better people, so why not apply that same principle to your Medicare Team? What does your team need to work on this year to be more effective providers of good clinical care? Consider the following commonly identified areas:
Working with patients with dementia who are experiencing difficulty chewing and swallowing can be challenging. Patients with dementia may not only exhibit the typical chewing and swallowing symptoms that are often seen with patients with dysphagia. Because of the many changes in cognition, sensation and perception, other areas of difficulty that will impact safe and efficient oral intake might include:
- Being unaware of food when it arrives.
- Failing to do anything with food in the mouth, just holding it.
- Spitting food out.
- Eating very fast or putting too much into the mouth.
- Eating insufficient amounts or refusing food and/or drink.
- Talking with food or drink in the mouth.
- Not opening mouth to accept food/liquids.
- Reduced taste.
- Confused food location on plate.
- Impulsivity in intake.
- Confusion and/ or distraction.
As much as we would love for all of our patients to get better and go home, we know the reality is that some of them will have to stay long term. It’s ideal for therapy to train the nursing staff to ensure a good carry over from the skills they learn in therapy to the skills they need to maintain in the facility. Unfortunately, there can be struggles in this transition.
Speech Therapists and Occupational Therapists get ready for a new way to do cognitive rehab – with apps! The July 2012 edition of Advance for Speech Language Pathologists and Audiologists reported on a new app called Make Change. It offers a realistic way to practice counting money for people of all ages. According to the article, you can select the difficulty, ranging from "up to 10 cents" to "up to 5 dollars" with five steps in between. The most helpful setting is the tally: toggle on to show how much money has been counted as you go for teaching, toggle off for testing (Hello measurable goals!). You can even select the background color or graphic, making the screen as distraction-free as needed – a plus for those with visual attention or perceptual problems.
As a result of current federal constraints to Rehabilitation treatment paradigms and reimbursement, an area worth exploring which is currently allowed under CMS FY 2012 regulations is co-treatment. Under the new rules, multi disciplinary treatment sessions are reimbursable by both disciplines for the total amount of treatment minutes; i.e. ST and OT treat a patient simultaneously during a 60 minute meal, each clinician is able to bill the total amount of treatment time. This mode of service delivery has physical, psychological, and holistic advantages, and should be considered as a viable alternative to individual treatment sessions for all clinically appropriate candidates.
