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    Speak Up on Requirements for Care of Patients With Dementia in Nursing and Rehab Centers

    The Joint Commission’s (TJC) proposed accreditation requirements on care for patients with dementia in skilled nursing and long-term rehabilitation facilities will impact physical therapists and physical therapist assistants who manage these patients. TJC wants your feedback on the requirements before they are made final.

    The deadline for input is September 3. To comment, visit The Joint Commission webpage, read the proposed requirements, and respond by online survey, an online form, or mail. Instructions for responding are on the webpage.

    TJC says the intent of the requirements is to address the prevalence of dementia without creating unintended consequences for those in the nursing home who do not have dementia. The requirements focus on activity programming, the physical environment, and alternatives to medication use for managing behaviors.

    If you have questions, contact Beth Ann Brehm, RN, LNHA, SPHR, MBA, MSN, TJC associate project director and specialist, at 630/792-5951 or bbrehm@jointcommission.org.


    Comments

    My mom has dementia, and is getting PT in a NH right now. She understands that she needs PT to go home. Patients who would regress if not given PT should be candidates for PT. Individuals who would not improve or regress should not be a candidate. In January 2014 Medicare will have to change their criteria for approving and denying skilled PT due to a class action suite brought against them. Medicare cannot deny a patient if they do not improve - it was ruled illegal. If a patient regresses if they are not given skilled PT, Medicare has to approve PT according to the settlement agreement on, 1/24/13. Pts with dementia have the same rights. Pam Chaney, PT
    Posted by Pam Chaney on 8/16/2013 5:31 PM
    Patients with Dementia at whichever stage benefit from skilled physical therapy. A patient may not have cognitive functional carryover, but could sustain motor carryover. also you could have a independent patient in NH that has dementia and when assessed is found to have subacromial impingement. Therapist could identify what that impingement is and treat it succeully through manual techniques and daily exercise routine where the patient would have succesful results
    Posted by Manuel Rodriguez -> @GS\=J on 8/17/2013 10:39 PM
    My mother in law has Alzheimer's and is in a skilled nursing facility. Over the past year I have seen her physically deteriorate without the benefit of PT. We are paying for a full time CNA to assist her with ADL's but her spine is collapsing with osteoporosis and muscle tone loss. I would think that biw PT would be extremely helpful to keep her indep. This month she is mostly chair bound and her condition is not terminal. She will cont to deteriorate w/o exercise. She fracture her hip a year ago but only received PT in the hospital for a few days.I have treated her once or twice when I visit from out of state. Manual therapy assists her in improved standing and walking. Ex and manual treatment would definitely improve her quality of life.
    Posted by Jill Thompson, PT on 8/18/2013 2:22 PM
    My Mom has dementia (is 84 years old)and PT has not made a long term difference in the past year. Prior to that she would participate in therapy with the PT/OT and family and made progress with limited visits. She could be taken care of at home. As she is losing touch with reality, she is refusing sessions, is combative, and has motor planning issues. She is not able to do more than stand for transfers. The level of cooperation and mental status appears to be a very big factor on regression/maintenance/progress vs a standard diagnosis.
    Posted by gwenn guthrie PT on 8/19/2013 5:07 PM
    Corrupt employers require PTs and OTs to exhaust Medicare benefits rapidly..even before and when patients cannot benefit to hit rug levels to maximize corp. profits in SNFs, to bill MCRE for time spent documenting,locating, and in meetings to produce max bills to MCRE. In memory care employer required 97% productivity (they call it 85%) even though much of day is spent in meetings, teaching free classes,documenting, calls, admin. Continuous threats from employers (increase billing or lose benefits, hours, jobs)create a hostile work environment. The system for working with pts with dementia relies upon honesty but employers require and reward overbilling Medicare and the patients do not know the difference...there is no accountability. Corrupt contract staffing companies need to be excluded from the system.
    Posted by Annapurna East on 8/22/2013 10:11 AM
    This is a very wide scope subject, however I would broched it by its most simple aspect, for examle,that every incoming resident of a nursing home, on a ,mandatory basis should undergo an initial screning of all rehabilitation disciplines and have stablished a profile of the functional status and areas that should be addresed in order to prevent deterioration, as well as stablishing preventive goals. As soon as residents are taken care an remedies have been stablished by Rehabilitation team,the homes most provide the carry over maintenance. This could only happens if there is the appropiate ratio between caregivers and residents. As well the resposability that all relatives should show in participating as much as possible/feasible in residents welfare. This level of accomplishmente should be minitored at least every 60,90 to 120 days fallow up reassessment.
    Posted by Francisco Herrero-Garcia on 9/5/2013 1:57 PM
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