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.
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.
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)
Working in the Long Term Care industry means that we are often face-to-face with end of life care. Patients we have just met as well as patients we have known and loved for years are put on Hospice every day. Sometimes these patients are on Hospice for quite some time, with ups and downs along the way. Frequently, when a patient is on Hospice, therapy is hands-off, but is that really the best course of action? What role could therapy play for patients on Hospice to ensure we are providing the best end of life care possible?
Treating patient’s with dementia is a difficult reality in the Skilled Nursing setting. Some therapists are experts and embrace the challenge, while other shy away from the difficulties that will come.
Every good treatment starts with the evaluation process. A thorough evaluation is key, but the documentation is cumbersome and time consuming. Frequently, therapists give away services to the Part B population of the skilled nursing facility simply because they feel the services are too insignificant to warrant the laborious task of documenting what we do.
This treatment technique for working with patients with recall and memory problems was developed by Megan Malone, M.A. CCC SLP and Dr. Cameron Camp, Ph.D. at Myers Research Institute Beachwood, OH www.myersresearch.org. This memory intervention provides an opportunity to practice recall of pieces of information while progressively increasingly the interval of time. As the interval of time increases the information then becomes part of procedural memory. The technique taps into the patient’s ability to read; use of declarative memory as well as procedural memory. I have found use of this technique particularly helpful for the patient to recall hip precautions, remember room numbers, remember use of adaptive devices, as well as safety precautions.
When a facility receives notice from an intermediary that they would like to review a record, HHI recommends the facility takes a team approach to pulling that record together. When only one member of the team takes on that responsibility, then the record may not be complete. Has your facility received Additional Development Requests, and if so, what role did therapy play in the process?