Transcript OT and Family/Caregiver Education in the Skilled Nursing

OT and Family/Caregiver Education in
the Skilled Nursing Facility
Melanie M. Tidman DHSc, MA, OTR/L
Adjunct Professor
AT Still University: Doctorate in Health
Science Program
[email protected]
Course Objectives
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Name common diagnoses and reasons for
admission to a SNF
Understand the importance of FamilyCentered care in OT
Understand the steps involved in
development of a family education
curriculum at the SNF level
Understand the process of creating a Family
Support Group in the SNF
Identify attributes of the physical and social
environment that are likely to influence
patients in a SNF
Define general principles for training Families
of patients with Stroke or Dementia
Conduct a Home Safety Assessment Interview
with Families of patients prior to discharge
Common Admitting Dx’s
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Falls with fractures
Total joint replacements
Metabolic disorders (i.e. CHF, Sepsis, DMII)
Infections or Wounds (c-diff, MRSA, MSSA)
Drug Reactions (including drug errors or noncompliance)
Nutritional Deficiencies (FTT or malnutrition)
Electrolyte Imbalances (hypokalemia,
hyponatremia)
Depression or other Mental Health/Behavioral
Issues
Stroke, Hemorrhage, Brain Tumors
Cancers
The Family/Patient Intake
Interview
 Home
and family: PLA and PLOF
 Info about pt’s learning strengths or
deficits
 PMHX: comorbidities
 Hobbies and Interests: what motivates
them?
 Typical Daily Schedule at home
 Community Resources in PLA
 Discharge Plans
Goals of the Intake Interview:
 Identify
family dynamics/arrangements
 Identify PLOF skills and current deficits
 Identify Home set up and barriers
 Identify home equipment already in
place
 Identify home equipment needs
 Identify community resources in place
 Identify community resource needs after
discharge
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Intake Cont’d
 Make
a list of needed home equipment
and refer to facility Case Manager at
evaluation
 Identify Goals for patient while in Rehab
setting and include family in goal setting
 Provide family with community resource
list and equipment supply companies to
begin to search out equipment
Equipment Prescription
 Assessment
of physical needs in
ADLs
 Assessment of behavioral needs in
ADLs
 Assessment of caregivers
capacities
 Assessment of community
capacities
 Assessment of financial capacities
Caregiver Assessments
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Environmental Skill-Building Program (ESP) –
family caregivers
Montessori Approach to Care – formal
professionals
EASY Method – formal para-professional
caregivers
Tailored Activity Prescriptions (TAP) - family
caregivers
International Classification of Function (ICF)
The ICF for Caregivers
 Body
Functions and Capacities
 Body Structures and Physiological
capacities
 Activities and Participation Outside of
Caregiving
 Community Support Structures
 Environmental Factors in Caregiving
 Family Structures and Capacities
 Distance Caregiving
 Ethnic/Cultural Differences in Caregiving
Online Sites for Resources
City of Albuquerque:
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http://www.cabq.gov/seniors
State of New Mexico
 http://www.nmaging.state.nm.us/
Sun Van
http://www.cabq.gov/transit/paratransitservice
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Medical Equipment in
Albuquerque
HME Specialists
 http://www.hmespecialists.com/
A& R Medical Supply
 http://www.armedical.com/
Back in Use (free or low cost equipment)
 http://www.backinuse.com/
Identify Funding Issues
 Social
Security Disability (SSDI) is based
upon an individual’s work history. To
qualify it needs to be determined that the
patient may be unable to work up to 12
months or more post injury.
 Social Security Income supplement (SSI) a
federal program which is based upon
income and assets and patient’s inability
to work up to 12 months or more post
injury.
Funding Cont’d
 Institutional
Medicaid: a state program
which is for individuals who meet income
and residency qualifications and patients
needing an inpatient setting for 30 days or
more.
 D & E Waiver services: for disabled and
elderly including the COLTS waiver
Educate!
 The
Roles of the Rehab Personnel
 Definition of Physical Therapy
 Definition of Occupational Therapy
 Definition of Speech Therapy
 Definition of the role of the CNA, Med
Tech and RN
 Definition of the role of the Case
Manager
 Definition and role of the facility MD
Caregiver Training Concepts
Caregiver Information http://c-tips.com
A Caregiver Training program created by
Mary Cocoran, PhD, OTR/L, FAOTA
 Facilitating caregivers= focus on their
own emotional health
 Balancing caregivers=maintain a balance
between their needs and the care of the
recipient’s needs
 Advocating caregivers= mindful of the
care recipient’s well-being (mental,
emotional)
 Directing caregivers=focused on the
recipient’s physical health
Family Training for Dementia
Effective Strategies:
 Use words of encouragement and positive
statements
 Provide simple, one-step cues
 Avoid abstract, open-ended questions
 Redirect or distract person when agitated or
distressed.
 Modify the environment and make it safe
 Adequate lighting
 Sharp objects and hazardous materials out of
sight
 Avoid overstimulation and excess clutter
 Pathways and stairways clear
 Room temperature or odors that may see
unpleasant or distressing.
Family Education Concepts
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Simplify the task
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Allow extra time
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Establish a simple routine
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Set out and arrange needed items
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Break down the task into smaller parts
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Label drawers, containers, or cabinets
The Daily Treatment Schedule
Educate Families
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The daily routine for Rehab in the facility and
what to expect as far as schedules and time
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Weekend coverage for Rehab
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Anticipated timeline or duration of stay
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Their participation in treatment sessions:
scheduled times work best for families
Cont’d
 Incorporate
family and patient goals into
treatment
 Conduct family training during treatment
to ensure safe discharge. (You may write
a goal for this in your POC)
 Incorporate anticipated equipment into
your treatments and train families on this
as you go along (document this)
Family Centered!
 Provide
weekly updates on patient’s
achievement of goals with patient and
family members
 Revise goals with patients and families as
patients either progress or don’t progress
 Provide realistic goal attainment based
on patient progress and prepare families
for level of care needed post discharge
 Document all of the above!
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Support Group:
Family Education
on Stroke and/or
Dementia
BRAIN FUNCTION REVIEW
 Frontal
Lobe
 Temporal Lobe
 Brain Stem
 Cerebellum
 Occipital Lobe
 Parietal Lobe
Cognitive Interventions for
Family Members: Levels1-3
 Explain
to the individual what you are
about to do
For example, "I'm going to move your leg."
 Talk
in a normal tone of voice.
 Keep
comments and questions short and
simple. For example, instead of "Can you
turn your head to look at me “ direct
them to “Look at me”.
Family Interventions: Level IV
Tell the person who you are, where he is, why
he is there, and what day it is.
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Limit the number of visitors to 2-3 people at a
time.
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Keep the room calm and quiet.
Bring in favorite belongings and pictures of
family members and close friends.
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More Level IV
Allow the person extra time to respond, but
don't expect responses to be correct.
 Sometimes the person may not respond at all.
 Give him rest periods. He will tire easily.
 Engage him in familiar activities, such as
listening to his favorite music, talking about
the family and friends, reading out loud to
him, watching TV, combing his hair, putting
on lotion, etc.
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Level IV cont’d
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He may understand parts of what you
are saying. Therefore, be careful what
you say in front of the individual.
Talk to the patient and not about
him/her.
Limit extraneous conversations about
other things as he/she may think you
are talking about them.
Cognition Level V
 Avoid
playing into inappropriate
behaviors
 Use redirection and distraction
 Do not try to reason with the person
 Assume Short Term Memory deficits,
Use frequent repetition
 Keep comments short and simple
Cont’d
 Remind
person of the day, date,
name, location and reason they
are here
 Organize and simplify tasks
 Bring in family pictures and familiar
objects
 Give frequent rest breaks
Cog Level VI
 Person
is unaware of their deficits
 Don’t Argue with the person
 Encourage Rehabilitation program
participation
 Frequent Repetition of instructions is
needed
 Journal with the person on daily events
 Help to initiate activities through use of a
written or pictorial schedule
Cog Level VII
 Treat
person as their PLOF
 Try not to tease or use slang. Keep it
simple
 Reassure and discuss deficits
 Try to return to PLOF routines and
activities
 Discuss emotions and coping
strategies
 Seek outside support and
counseling
Symptoms and Behaviors:
What can families do?
This document defines each RLA level and
gives families strategies:
 https://www.jhsmh.org/LinkClick.aspx?fileti
cket=8hAd-OqTIQ0%3D&tabid=298
(note: these strategies also may work with
patients with dementia or other cognitive
symptoms)
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The Environmental Skill – Building
Program (ESP) for Family Caregivers
ESP is designed to provide family caregivers
with
 Education about the disease process and
the impact of environments on care
recipient behaviors
 Problem-solving techniques to identify
antecedents and consequences of
targeted problem behaviors, and
 Technical skills to modify the home.
 http://www.rosalynncarter.org/education
_support/
Tidman Home Safety
Assessment
 Date
of Home Assessment:
 Evaluator:
 Time:
 Patient:
 Present:
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Home/Neighborhood Setting:
Cont’d
 Kitchen:
 Bedroom:
 Bathroom:
 Transportation:
 Garden/Hobby
or Outdoor Areas:
Cont’d
 Summary
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of Barriers:
Equipment Needs and/or Resources:
Assessment Tools Needed
Take with you to the Assessment:
 Tape Measure
 Manual Wheelchair
 Front Wheeled Walker
 DME Catalog
 List of community resources (DME,
Transportation, Caregiver support)
Questions
and/or
Discussion?
References
AOTA CEU course: Neuro-Cognitive Disorders, AOTA
2014, revised.
 Gitlin, et al., (2005). Maintenance of effects of the
home environmental skill building program for family
caregivers and individuals with Alzheimer’s disease
and related disorders. Journal of Gerontology:
Medical Sciences, 60A(3), 368-374;
 Gitlin, et al., (2001). A randomized, controlled
randomized, controlled trial of a home
environmental intervention: Effect on efficacy and
upset in caregivers and on daily function of persons
with dementia. The Gerontologist, 41, 4-14.
Retrieved from:
http://www.rosalynncarter.org/UserFiles/File/gitlin.pdf
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Rancho Los Amigos Recovery Scale Retrieved from:
https://www.jhsmh.org/LinkClick.aspx?fileticket=8hAd
-OqTIQ0%3D&tabid=298