Frequently I have noted patients being admitted to the SNF with orders for a mechanically altered diet and thickened liquids as well as orders for free water. The Frazier Free Water Protocol developed at the Frazier Rehab Institute allows people with dysphagia access to water with minimal incidence of aspiration pneumonia, as water is tolerated by the lungs and is quickly absorbed into the bloodstream. The incidence and prevalence of dehydration is significant among the long term geriatric population. Allowing free water may facilitate the reduction of dehydration. The Frazier Water Protocol is fairly simple. Free water is permitted before and between meals. Free water is not permitted with meals or other oral intake. Medications are not to be taken with water, as pills may be washed into the lungs. Implementing a good oral hygiene care program is crucial in dysphagia management because patients who have dental disease and exhibit poor oral care are more likely to develop aspiration pneumonia, regardless of whether they are dependent on others. Likewise utilizing the Frazier Free Water Protocol, requires good oral care. This means brushing all areas of the mouth including tongue, palate, cheeks and sulci.
The Centers for Medicare and Medicaid Services, (CMS) as well as The American Health Care Association, (AHCA) introduced an initiative in early 2012 to improve the quality of care by decreasing the use of antipsychotics in SNFs. Their goal was to decrease the use of antipsychotics by 15% by December 2012.
Ever feel like your treatment sessions are stuck in a rut? Sometimes we find a technique that we love and is appropriate for a wide variety of patients and then we use that intervention until we are blue in the face. So when it’s time for something new we often have to search outside our departments. Continuing education is the best choice, and a requirement for board certification, but how much to we really utilize it? As therapists, are we only doing the minimal amount required, or are we taking advantage of all opportunities to better our practice? How does cost factor in? Do departments provide a stipend for continuing education or is it an out-of-pocket expense? Does the location of your facility play a role; i.e. are you able to find seminars in your area that are applicable to the skilled nursing setting?
In the long term care setting, therapy departments are required to balance both Medicare Part A and Medicare Part B patients. Though it may seem like you should just treat all the patients whenever they need it (and in theory you probably should), staffing patterns don’t always allow that to happen. As the Part A caseload increases, the ability to treat the Part B folks diminishes. Unfortunately, we therapists are always good at increasing the Part B caseload when the Part A is slow.
As soon as a patient walks through the door he is clamoring to be discharged back home. It’s not because he dislikes the facility or the staff; but when given the choice, who wouldn’t prefer to be in their own home? When a patient is cognitively intact and appears "good enough" to go home, it can be difficult to rationalize a longer period of on site therapy services.
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:
- 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.
Its that time of year again, the holidays! The time when all of the staff want off to spend with their families and departments need extra staff to make up for the employee days off as well as the federal ones. Of course, this shouldn’t cause any real stress because everyone has an ample per diem pool that is always eager to help out, right? (Sarcasm)
