Physical Therapy- help me to understand

Specialties Geriatric

Published

Hi. I am one year into my first nursing job in LTC. Can anyone tell me HOW the world of Physical Therapy works in LTC. Keeping in mind I didn't major in Medicare and the World of Reimbursement/Insurance......is there a monetary reason why my facility would "seemingly" (to me) push Physical Therapy on many patients, although they are, say 90 years old and just plain tired (and many ready for Hospice) If you could help me to understand...your comments and insights are appreciated.

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They really don't push therapy, in fact they have to jump through all kinds of hurdles to be able to provide therapy- physician certifications, evaluations, more certifications, budget constraints, insurance permission, more budget constraints and recommendation from the I.D.T., and more paperwork that you might think. Aside from that any patient at any age (and even if they are bedbound) can benefit from therapy- the longer a patient is immobile, the more they decline in function. The more they decline in function, the more they decline overall. Then they end up back in the hospital, which causes further complications and more problems, and more expen$e. And in general, Medicare doesn't pay for custodial care- patients admitted to SNFs are sent there so they can hopefully improve phsyically, and return to their prior level of functioning, and leave. And yes- even hospice patients can receive therapy, if only to help relieve pain, help them to be able to eat without choking, etc. Think about it this quirky way: Most nursing home patients (Medicare) aren't there for 'nursing care', they are there for... therapy?

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Specializes in Acute Care, Rehab, Palliative.

Keeping people moving will increase their quality of lfe, decrease their pain, decrease the incidence of skin breakdown and reduce general health decline. Being old doesn't mean they don't need physio to keep them moving.it also would be a benefit monetarily because active people stay healthier longer. helping people to maintain what little mobilty/ROm/independence they have left is always a plus.

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I am asking because one of the families who is always there to watch as physical therapy is there for their very elderly mother asked me the other day, "All "they" they do is walk her. Your aides walk her to the restroom. Why can't the aides walk her in the hall? Seems like a waste of money." And, yes, I am a nurse and understand the physio. I was asking as monetary issues. Thanks for your thoughts>

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Specializes in NICU.
"All "they" they do is walk her. Your aides walk her to the restroom. Why can't the aides walk her in the hall? Seems like a waste of money."

PT is highly trained on body mechanics and is not just "walking" the resident. They are observing their gait and helping them walk properly so as not to put too much stress on their body. CNAs are not qualified to help them improve their mobility. The same analogy is if you went to the gym to lift weights, do you want someone off the street to help you or an Exercise Physiologist or BS in Fitness Training?

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If therapy is walking that elderly patient, there is a probably a skilled need for her to be in the SNF, paid for by Medicare or other insurance. Otherwise the patient would not be there. Part of the therapy plan is for nursing or restorative to compliment therapy- nursing is there 24/7, and therapy is not. It wouldn't make sense for a patient to receive therapy a few units a few days a week, and then be left sitting in a chair the rest of the time. If nursing is walking the patient in the room, it would be because therapy has instructed the nursing staff to do so, and how. But there's much more to therapy than you might realize- if you talk to a therapist, or watch a therapy session, or read therapy evaluations and plans of care, to include their goals (which are quite specific), you might realize it's more complex than just 'walking' a patient. And rest assured that your facility would probably love to not have the major expense of paying for therapy, at all- but then the place would be empty of patients. Every minute of therapy has to be justified, based on a skilled need.

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Specializes in Acute Care, Rehab, Palliative.
I am asking because one of the families who is always there to watch as physical therapy is there for their very elderly mother asked me the other day, "All "they" they do is walk her. Your aides walk her to the restroom. Why can't the aides walk her in the hall? Seems like a waste of money." And, yes, I am a nurse and understand the physio. I was asking as monetary issues. Thanks for your thoughts>

If you understand the role PT plays then why are you mentioning the fact that they are 90 years old? What does age have to do with it?

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If therapy wasn't proven to be effective, Medicare wouldn't pay for it. And even though therapy costs SNFs a lot of their revenue, a day in a SNF is a fraction of the cost of a day in the hospital. And the cost of even a few months in a SNF is paltry compared to the total cost of a hip fracture. That said- it can be argued that the older a patient is, and the more at risk for fractures and oher problems, that more therapy would be even more cost effective for older and older patients.

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Specializes in Acute Care, Rehab, Palliative.

Plus physiotherapists can teach a person safe methods of mobilizing/transferring and provide important feedback regarding any safety issues or concerns. They can assess a person's mobility and notify staff of nay decline in ability.

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Naaw..this is the kind of stuff referring to ...I cut and pasted this ...." The documents also reveal stories of patients, like a "92 year old...dying of metastatic cancer...Two days before [his] death, he was spitting out blood. Therapists, however, still recorded 48 minutes of physical therapy, 47 minutes of Occupational therapy, and 30 minutes of speech therapy that very day."

"At another facility, the entire rehab staff signed a letter to their boss. It reads in part, "we have been encouraged to maximize reimbursement even when clinically inappropriate."

So, back to original post, they would benefit from billing and doing, because they have "in house therapy?" Don't get snooty Silver...I am asking about the monetary benefits. So, the only way LTC benefits is actually if they used fraud????? Thanks!

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Sam J..that is the kind of info I was looking for..:yes:

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Kudos to those therapists for attempting to make that unfortunate patient's last days more bearable.

In 30 years I have yet to encounter a single unethical therapist, of any mode. And I suspect I'll never live long enough to hear a patient's family proclaim that their loved one's receiving therapy is a 'waste of money'. I also suspect you have a bone to pick with a therapist that may have called you on the carpet for your nursing ability, your poor and ignorant attitude, or some other concern.

Your accusations are offensive, and even fantastical.

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