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 - - PowerPoint PPT Presentation

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Dec 20, 2022 396 likes •552 views

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

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SLIDE 1

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

“A TOOLBOX WITH HINGES”

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SLIDE 2

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

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SLIDE 3

STONECREST CENTER

  • De mo g ra phic s
  • L
  • 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

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SLIDE 4

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
  • 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*

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SLIDE 5

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%
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SLIDE 6

“A TOOLBOX WITH HINGES”

Co o rdina tio n with Outpa tie nt T e a m BCBA Ca se Ma na g e me nt Mo de l Spe c ia liza tio n

  • f Clinic a l

Sta ff

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SLIDE 7

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
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SLIDE 8

CASE MANAGEMENT MODEL

  • Mo de l
  • MCR Audits/ Co rpo ra te I

nitia tive

  • Audit F
  • 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

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SLIDE 9

MCR AUDIT GUIDELINES

RE QUIRE D DOCUME NT AT ION C- 1

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

F

  • 2

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

C- 2

Admissio n Physic ia n Ce rtific a tio n c o mple te d, sig ne d, time d & da te d

ADMISSION ME DICAL NE CE SSIT Y C- 4

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 (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 :

C- 5

  • 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

  • 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

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

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SLIDE 10

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

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SLIDE 11

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
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SLIDE 12

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
  • 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

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SLIDE 13

KATIE’S STORY