“A TOOLBOX WITH HINGES” S H A R I A L D E R P A U L A N D E R S O N A N D R E W R H O D E S J A R E D O L A F S S O N
OBJECTIVES • I ntro duc tio n o f Ca se Ma na g e me nt Mo de l • Building re la tio nships with a ppro pria te re so urc e s b y Clinic ia ns fo r se c ure disc ha rg e pla nning • BCBA c o nsults a nd pa ssing pla ns fo rwa rd to c a re g ive rs a nd suppo rt syste ms to c ha ng e the ho me e nviro nme nt
STONECREST CENTER • De mo g ra phic s • L o c a tio n • Spe c ia lize d Units • ADC (120.2 o ve r the la st ye a r) • Admissio ns Pro c e ss- DON & CNO a ssist sc re e ning fo r me dic a l issue s
MEDICAL CRITERIA AT STONECREST CENTER We will not take the following: AAA (Ab do mina l Ao rtic Ane urism) • Any Po rts - ve no us • Anyo ne unde rg o ing c urre nt Che mo the ra py o r with ra dia tio n impla nt • Ca the te rs-no F o le y/ indwe lling o r stra ig ht c a the te rs • De c ub s o r a ny o pe n wo unds-a llo wa b le e xc e ptio ns, 1 de c ub if skin is g ra nula te d; simple suture s • fro m c utting se lf Dia lysis • DNR • IV’ s o r c e ntra l line s; no PICC( pe riphe ra l Inse rte d Ce ntra l Ca the te r) line s • NG (Na so g a stric ) tub e s o r PE G (Pe rc uta ne o us E ndo sc o pic Ga stro sto my) tub e s • Pa tie nts a b o ve 500 lb s. due to we ig ht c a pa c ity o n unit b e ds • Pa tie nts c urre ntly o n o r re c e ntly re mo ve d (la st 30 da ys) fro m ho spic e a nd pa tie nts who a re DNR • (Do No t Re susc ita te ) Pa tie nts in ne e d o f E CT ( E le c tro c o nvulsive T he ra py) • Pre g na nc y • T ra c hs • T ra nspla nt pa tie nts • *68 intake s o n ave rag e o ve r this ye ar we re de nie d b ase d o n this c rite ria*
POPULATION SERVED • 25% MCR a nd 15% MHL / Ma na g e d MCR • MI He a lth L ink – Dua l MCR/ MCD pilo t pro g ra m, inpa tie nt b e ne fits c o o rdina te d thro ug h PI HP • 50% MCD a nd 15% Co mme rc ia l I nsura nc e • Avg L OS o f MCR – 14.8 days • ADC fo r MCR- ~30 pa tie nts o r 25%
“A TOOLBOX WITH HINGES” Co o rdina tio n with Ca se Outpa tie nt Ma na g e me nt T e a m Mo de l Spe c ia liza tio n o f Clinic a l Sta ff BCBA
OUR TEAM • Me dic a l Dire c to r a nd the I nte rnist • Ge ria tric Psyc hia trist • Die ta ry c o nsults • Psyc ho lo g ic a l te sting • Nursing • Ac tivity T he ra py • Music T he ra py • Re c re a tio n T he ra py • So c ia l se rvic e s • Co unse ling • Bo a rd Ce rtifie d Be ha vio r Ana lyst
CASE MANAGEMENT MODEL • Mo de l • MCR Audits/ Co rpo ra te I nitia tive • Audit F o rm a tta c he d • Mo nito ring / Pla n o f Co rre c tio n fo r de fic its unde r 90% • E xpe rtise a nd ma ste ry o f po pula tio n • T ra ining s • I n-se rvic e s
MCR AUDIT GUIDELINES RE QUIRE D DOCUME NT AT ION Admissio n Physic ia n Orde r spe c ific a lly sta te s “Admit to I npa tie nt”, sig ne d, time d & da te d C- 1 Admissio n I mpo rta nt Me ssa g e fro m Me dic a re sig ne d/ da te d a t a dmissio n b y pa tie nt/ g ua rdia n F - 2 Admissio n Physic ia n Ce rtific a tio n c o mple te d, sig ne d, time d & da te d C- 2 ADMISSION ME DICAL NE CE SSIT Y I nitia l psyc hia tric e va lua tio n c o mple te d (sig ne d, da te d & time d) within re q uire d time fra me pe r spe c ific sta te re g ula tio ns C- 4 (g e ne ra lly 24 ho urs), b ut no mo re tha n 48 ho urs fo llo wing a dmissio n inc luding : -Circ umsta nc e s re sulting in a dmissio n (sig ns a nd sympto ms) -Pa tie nt’ s sta te d c hie f c o mpla int in pa tie nt’ s o wn wo rds -Me nta l sta tus e xa mina tio n, inc luding g e ne ra l a ppe a ra nc e a nd b e ha vio r, o rie nta tio n, a ffe c t, mo to r a c tivity, tho ug ht c o nte nt, lo ng a nd sho rt te rm me mo ry a nd me tho d use d, e stima te o f inte llig e nc e a nd me tho d use d, c a pa c ity fo r se lf-ha rm a nd ha rm to o the rs, insig ht, judg me nt, c a pa c ity fo r a c tivitie s o r da ily living (ADL 's) -Curre nt dia g no sis/ c o nc e rns a nd tre a tme nt, inc luding me dic a tio ns a nd e vide nc e o f fa ilure a t o r ina b ility to b e ne fit fro m a le ss C- 5 inte nsive c a re . I f UT I , pne umo nia , re c e nt he a d tx, se rio us me dic a l issue , de mo nstra tio n tha t tre a tme nt is ne e de d re g a rdle ss o f this, a nd tha t BH issue s is distinc t a nd se pa ra te . -Me dic a l histo ry -Psyc hia tric sympto m a nd tre a tme nt histo ry -Sub sta nc e use histo ry -F a mily, vo c a tio na l a nd so c ia l histo ry -Stre ng ths a nd o ppo rtunitie s C- 6 Psyc ho so c ia l a sse ssme nt inc lude s pre limina ry disc ha rg e pla n RE QUIRE D DOCUME NT AT ION C- 3 Physic ia n Re c e rtific a tio n o n o r b y da y 12 DOCUME NT AT ION OF CONT INUE D ST AY ME DICAL NE CE SSIT Y IN NOT E S OF AT T E NDING C- 7 Ac tive tre a tme nt, a tte nding g ro ups, c o o pe ra tio n with the ra py a nd me dic a tio n a djustme nts a nd c o o pe ra ting with me dic a tio n C- 8 Be ne fitting fro m tre a tme nt/ re duc tio n o f ta rg e te d sympto ms tha t le d to a dmissio n C- 9 Co o rdina tio n with prima ry suppo rt syste m C- 9 Co o rdina tio n with c o mmunity pro vide rs C- 10 Disc ha rg e pla nning : Pla c e me nt, a fte rc a re se rvic e s, a ntic ipa te d d/ c da te
DISCHARGE PLANNING • Clinic ia ns b uilding re la tio nships with re so urc e s fo r se c ure disc ha rg e pla nning • A Pla c e fo r Mo m • Me dilo dg e • Sa va • Ho me He a lth Ca re Ag e nc ie s • I n-ho me Psyc hia tric Nursing • Othe r nursing ho me pro vide r ne two rks • Gro up Ho me Pro vide r Ne two rk L ia iso n • Ne ig hb o rho o d Se rvic e s Org a niza tio n- OBRA Sc re e ning • Re spite Ca re • T ra nspo rta tio n • Co o rdina ting with c a re g ive rs a nd suppo rt syste ms to a djust the ho me e nviro nme nt
TREATMENT • Bo a rd Ce rtifie d Be ha vio r Ana lyst c o nsults • F unc tio na l Be ha vio ra l Asse ssme nts • Be ha vio r Pla ns • Re minisc e nc e the ra py
POPULATION ISSUES • Me nta l he a lth • Grie f a nd lo ss • So c ia l suppo rts • Ab a ndo nme nt • L o ss o f a g e nc y • De me ntia / Alzhe ime r’ s • Co g nitive de fic its • E a rly Disa b ility
KATIE’S STORY
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