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Considering a nursing home after surgery

“Moreover, older adults who are hospitalized are 60 times more likely to develop a disability than those who are not. ”

This is HUGE!

We know some of the common statistics such as an adult over 80 years that falls and breaks a hip has a high likelihood of death within one year.

There is some research about reserve capacity and the body’s ability to withstand a major obstacle such as a fall or hospitalization. Reserve capacity is essentially the amount of ability that a person has that exceeds daily needs.

For instance, if you typically walk 2.5 mph, but have the ability to walk at 5 mph, the reserve capacity would be the difference between usual speed and RESERVE gait speed.

“… recovery of function during a SNF stay is inadequate under usual care”

I’ve worked in a SNF and will attest to this based on experience. I stuck out like a sore thumb during my time in the SNF.

I got many of my patients up and walking. I would stand next to the patient to motivate, encourage and correct any safety issues that I noted during a movement or exercise.

Many of my “peers” were sitting at computers about 20-30 feet away from patients barking out directions from across the gym. The atmosphere was more party like for the roles of professionals, in which many conversations revolves around personal lives of the therapists, instead of the patient.

“The 2017 Medicare payment advisory commission reported no change in functional outcomes as measured by a patient’s ability to perform bed mobility, transfers, and ambulation.”

This is crazy! A patient goes to a rehab unit in order to rehabilitate to a safer functional level. If there are no changes in outcomes…why bother!

I did some research on total knee replacements when creating the protocol for our outpatient facility and there was much research showing that patients that went home after surgery did better than those that went to a “SKILLED” nursing facility.

Again…why bother!

There may be some lower level patients that need the nursing care at a facility like this, but we really do need to do a better job of planning a patient’s discharge from the hospital.

“specifically in SNF’s, annual expenditures comprise 50% of the $60 billion US allotted to post acute care. The discrepancy between high levels of spending in SNF’s and sub optimal outcomes strongly suggest the need for innovative clinical research designed to advance models of care delivery and assert the value of SNF rehabilitation therapists”

☝️ 🤔🤑

Leaving this one to stand on its own.

“… hospital discharge patterns away from SNF towards less costly home health or outpatient services.”

This makes sense and we are seeing this happen for some orthopedic cases that would previously be sent to a SNF. It took incentivizing hospitals and physicians to get them to change the way they treat patients.

“Nursing home literature suggests patient motivation to participate in treatment, such as physical therapy is linearly correlated to patient perceptions of and satisfaction with support from peers, family, and staff.”

Wonder why some patients may not be motivated to work with staff?

Read this article.

Excerpts from:

Gustavson AM, Boxer RS, Nordon-Craft A et al. Advancing Innovation in Skilled Nursing Facilities through Academic Collaboration. PTJ-PAL. 2018;18(3): 5-16

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A Penny saved is a penny earned

We’ve all been there! That place in which we are sinking instead of swimming. You ain’t alone.

Hear my story below.

Check out my episode “A penny saved is a penny earned” from Movementthinker: a physio’s perspective on Anchor: https://anchor.fm/vincent-gutierrez/episodes/A-penny-saved-is-a-penny-earned-e298p5