INTERVENTIONS TO REDUCE CLAIMS INTENSITY

1. INTERVENTIONS TO REDUCE CLAIMS INTENSITY Session 18: February 27, 2006 Session Producer: Stephen LaPierre Senior Vice President Penn Treaty Network America

2. PANEL • Sharon Kurfuerst, OTR/L • Dawn Clayton Bieber, OTR/L

3. In the next hour we will . . . • Review the trigger language for the ADL • Benefit trigger [ NTQ policies] • Take a peek at ADL plans of care • Components • Effective functional assessments • Examine interventions to independence • Show & Tell • Q & A

4. LTCI Triggers • Medical Necessity • Cognitive Impairment • Activities of Daily Living [ADL]

5. Activities of Daily Living Ambulation /Transfer Toileting Eating Bathing Dressing

6. ADL Defined Bathing: The ability to wash yourself in a tub or shower, or to give yourself a sponge bath, without the assistance of another person.

7. ADL Defined Dressing: The ability to dress without the physical assistance of another person.

8. ADL Defined Ambulation/Transferring: The ability to move from place to place, including getting in and out of bed or a chair, without the physical assistance from another person.

9. ADL Defined Eating: The ability to get nourishment into your body by any means once it has been prepared and made available to you, without physical assistance from another person.

10. ADL Defined Toileting: The ability to get on and off the toilet and to maintain a reasonable level of personal hygiene.

11. ADL Plan of Care: The Theory Early intervention means A greater opportunity to ensure the most effective treatment at best pricing is delivered to the client resulting in A shorter duration/least costly claim [Client gets better-quicker-cheaper]

12. ADL Plan of Care • Need to consider: • Services provided • Who’s providing • Are deficiencies being addressed • Expected duration of services • Prognosis for independence • Maximizing opportunities for reaching the highest level of independence

13. ADL Plan of Care • Starts with an effective assessment • RN or OTR • Effective assessment includes • Interview of past performance • Review of medical history • Observation and evaluation of current performance and the skills that may impact this performance including: • Range of Motion • Balance • Coordination • Strength • Cognitive abilities • Pain • Activity Tolerance • Results in a client centered approach with collaboration to determine goals and treatment interventions

14. Next step Identify opportunities to restore or improve independence Don’t just document deficiency and not comment on possible interventions

15. Unique Contribution of Occupational Therapy • Brings holistic training and well-rounded approach to care • Facilitates client engagement in occupation to achieve goals • Provides activity analysis and adaptation to maximize success • Encourages health promotion • Supports lifestyle re-design

16. Unique Contribution of Occupational Therapy Activity analysis and adaptation to maximize patient success • Breaks an activity down into component parts • Chooses and modifies activities to provide the appropriate level of challenge • Develops activity plans that promote wellness and minimize excess disability

17. Unique Contribution of Occupational Therapy Lifestyle Re-design • Examines client’s routines, habits, roles • Incorporates activities into a client’s overall life plan that meets their occupational needs and desires given current abilities • Analyzes and adapts behavioral and environmental factors to promote health and functional performance • Prepares client for independent living – explores access to community resources, adaptive equipment, etc.

18. Unique Contribution of Occupational Therapy Encourages Health Promotion • Helps client engage in and access activities that are supportive of well being and health • Focuses on specific behaviors and activities that support healthy living • Uses education as a vehicle to promote continued health and wellness

19. Interventions to Independence:Why bother? • Eliminate Dependency / Eliminate Trigger • Win / Win • If Unable to Eliminate Trigger: • Reduce dependency resulting in . . . • Reduced intensity of services resulting in… • Reduced Cost 

20. Interventions to Independence • Health and Well Being • Exercise • Education • Lifestyle re-design/activity adaptation • Adapted Technique • Restore function • Compensate for lost function • Modify environment • Adaptive equipment • Identify most appropriate equipment • Teach and train in use of equipment

21. Interventions to Independence • Exercise • Education • Energy Conservation/Work Simplification • Adapted Techniques • Environmental Modification

22. Adaptive EquipmentShow & Tell

23. Bathing • Tub safety rail • Tub transfer bench & shower hose • Long handle sponge • Dressing stick • Hand Held Shower Hose • Grab bars

24. Bathing • Bathtub Safety Rail

25. Bathing • Tub transfer bench • Shower hose

26. Bathing • Long handle sponge • Dressing stick

27. Dressing • Velcro on shirts or pants behind buttons and on shoes • Elastic Shoe Laces • Button hook / Zipper pull • Reacher • Sock aide • Dressing Stick • Long shoe horn

28. Ambulation/Transferring/Mobility • Walkers • Canes • Transfer Board • Transfer Pole/ Transfer Disc • Trapeze • Bed hoist • Bed Bar/Rail

29. Ambulation/Transferring/Mobility • Walker

30. Ambulation/Transferring/Mobility • Canes

31. Ambulation/Transferring/Mobility • Mobile Transfer Pole

32. Ambulation/Transferring/Mobility • Trapeze Bed Hoist

33. Eating • Large handled utensils • Adjustable angle utensils • Weighted utensils • Plate guard • Scoop bowl

34. Toileting • Safety frame & Raised Seat • Bedside Commode • Toileting paper aide [demo] • Hygiene Mirror

35. Toileting • Raised Seat & Safety Frame

36. Toileting • Toilet Paper Tongs

37. Toileting • Hygiene Mirror

38. Questions????