Discuss appropriate referrals and consultations for the adult ✓ Solved

Discuss appropriate referrals and consultations for the adult-geriatric patient experiencing acute or chronic immobility. Differentiate the requirements for acute rehabilitation, skilled care (transitional care), long-term care, and hospice patients who are preparing for discharge from the acute care setting and may require bridge therapy to increase strength, balance, and conditioning prior to transitioning to a safe independent living environment. Discuss general admission criteria, including number of modalities of therapy, number of hours of therapy per day in which the patient must participate, and any restrictions such as renal dialysis. Identify at least one restorative level of care that an acute care adult-geriatric patient can be transferred to as a bridge to independent living and briefly describe the criteria for admission; e.g., number of hours of therapy and number of different modalities of therapy (speech, PT, OT, skilled nursing) within skilled or transitional care, home health, acute rehabilitation, long-term acute care, hospice, or other.

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In the context of adult-geriatric patients dealing with immobility, appropriate referrals and consultations are crucial in ensuring optimal recovery and quality of life. Immobility can be acute or chronic and often requires an interdisciplinary approach to address the diverse needs of patients. Understanding the various levels of care available is essential for providing effective treatment and rehabilitation.

Requirements for Different Levels of Care

Acute rehabilitation typically focuses on patients who require intensive therapy services following a significant medical event, such as a stroke, trauma, or surgery. For these patients, the requirements often include participation in at least two modalities of therapy, such as physical therapy (PT), occupational therapy (OT), or speech therapy, for a minimum of three hours per day (American Physical Therapy Association, 2020). This type of care is intended for patients who are medically stable but still require intense rehabilitative efforts.

Skilled care, or transitional care, serves those who need assistance but do not require the intensity of an acute rehab setting. Criteria for admission generally include the necessity of intermittent skilled nursing care, with access to therapy services as needed, typically less than an hour per day (Centers for Medicare & Medicaid Services, 2021). This care is particularly beneficial for patients transitioning home after surgery but requiring additional support to regain independence.

Long-term care often encompasses facilities that provide extended care for patients with chronic illnesses or disabilities, requiring ongoing assistance and monitoring. Admission criteria can vary widely, but generally, these patients might engage with rehabilitation services a few times per week, depending on their individual needs.

Hospice care, on the other hand, is aimed at providing comfort rather than curative treatment for those with terminal illnesses. The goal here is pain management and quality of life enhancements, with palliative therapy strategies being provided as per the patient's condition (National Hospice and Palliative Care Organization, 2020).

Restorative Level of Care

One effective restorative level of care available for acute care adult-geriatric patients is home health care. This service can be a crucial bridge to independent living as it provides both skilled nursing and rehabilitative services in the patient's home. Admission criteria generally involve a physician’s order, where patients typically receive therapy services for a few sessions each week, depending on their requirements and improvements observed (Home Health Care News, 2021). Patients must also demonstrate potential for improvement to qualify for home health services.

General Admission Criteria

When discussing general admission criteria for rehabilitation, it is important to highlight the number of therapy modalities involved and the intensity required. Most acute rehabilitation facilities require patients to engage in at least two different types of therapy. In transitional care settings, patients typically benefit from having at least one hour of skilled therapy intervention per day, which may include physical therapy and occupational therapy. Patients on specific treatments like renal dialysis must also be carefully evaluated to determine the appropriateness of therapeutic interventions during their stay (National Institute of Neurological Disorders and Stroke, 2020).

In summary, dealing with immobile adult-geriatric patients calls for a comprehensive understanding of their specific rehabilitation needs and an appropriate referral strategy to ensure they receive the optimal level of care. From acute rehabilitation to home health services, each transitional step holds significant value in the patient's journey back to independence.

References

• American Physical Therapy Association. (2020). Standards for Physical Therapy Practice.
• Centers for Medicare & Medicaid Services. (2021). Skilled Nursing Facility (SNF) Prospective Payment System (PPS) - Overview.
• Home Health Care News. (2021). 2021 Home Health Trends: Everything You Need to Know.
• National Hospice and Palliative Care Organization. (2020). NHPCO Facts and Figures: Hospice Care in America.
• National Institute of Neurological Disorders and Stroke. (2020). Rehabilitation in Stroke: A Guide for Patients.