The PT said WHAT????

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Specializes in LTC.

I had a resident admitted to the hospital for pneumonia and a UTI. She is recovering from a stroke about 6 weeks ago and making great progress with HH PT. Her family called me yesterday and said the head PT at the hospital said that they are not going to give her anymore PT and that she is no longer appropriate for ALF. WHAT???? First of all, she is no worse than when she left us and is probably in a better state now that she has gotten treatment for the pneumonia and UTI. Second, can a PT make that kind of judgement call? I make the dedcisions at our facility as to who is appropriate and who is not. Not a PT that knows nothing about what we require. THe family is very upset and so am I. SHe is A&O, can propell herself in a w/c, uses contact guard for transfers, and is a min assist. Trust me, we have residents in far worse conditions that live in ALF. What's worse is I can't get in touch with anyone at the hospital to talk about this. What do you guys think? Have you ever heard of a PT making a dispo decision?

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Specializes in ED, ICU, PSYCH, PP, CEN.

Yes, a PT can discharge a pt from PT, and they can make a recommendation that pt is no longer in living arrangements that are safe or suitable. It is very strange though that you can not contact the PT for further explanation.

Did you call the hospitals PT department and ask to speak to the PT?

In every scenario I have worked in the PT would take the call and discuss this with you.

Sounds like pt is doing well if they are min assist, can manage their wheelchair and are alert and oriented. Perhaps in this economy the pt is too healthy to qualify for the PT. But that doesn't explain the ALF thing.

I do not believe the PT can keep the pt from returning to ALF. That is something that the ALF facility, pt and family and pt doctor would have to decide. In this instance the PT only gets to make a recommendation, not a ruling.

Perhaps the pt can restart HH PT when they come back. I worked in PT as a LPTA for 5 years so I know a little about this.

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perhaps the PT has a vision similar to mine of what clientele an ALF serves.....and this patient certainly doesnt fit....

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Specializes in acute care and geriatric.

There must be a way for the family to appeal- they should approach the SW of the hospital. If you are willing to take her back and can prove that you can take care of her- I am sure the PT will change her mind. But it is the family and the pt herself who has to push this.

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

the PT's at our hospital evaluate and decide who is approriate for STR or not

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

Wonder what the RUG rate is for the patient if they go to LTC/Skilled vs. the rate for the ALF PT? Does the patient have to go to that physical therapy department? Is there another PT who can evaluate for another opinion?

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Specializes in Gerontology, Med surg, Home Health.

The PT can only state an opinion. Unless he/she is employed by the ALF, he/she has no standing in whether or not the patient is readmitted to an ALF. I would hazzard a guess that the PT hasn't a clue on the kinds of services available in an ALF. I had an EMT come into my building (a SNF) one day and was surprised that we did IV's! Not everyone knows what we can and can't do at our facilities and it is up to US to decide whether or not we can safely care for a particular resident.

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Specializes in Ortho, Case Management, blabla.

I work on an ortho floor and work very closely with PT every day. Yes, they can make this call and believe it or not that's part of their job. However, what they say is a recommendation and your best bet is to have the family get in touch with the discharge planner and physician to discuss this patient's options. You may make the decisions about who is appropriate and who is not at your facility but that doesn't mean that the people at the hospital are going to feel the same way that you do. Also if it is a medicare patient then the PT's recommendation could make the whole situation very sticky. Perhaps the patient is ready to graduate to actually going home or something?

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The "problem" here is that nationally, assisted living facilities are in no way uniform as to admission criteria, the types and intensities of assistance available, staffing levels and mix, and physical plants (one self-contained building or several, one level or several floors etc.)

Physical therapy and occupational therapy recommendations can be invaluable to both the patient/family and the residential facility, but they lose a lot of their strength if they fail to consider the available resources on an individualized rather than generic basis.

In this area, most ALFs require residents to perform activities of daily living with set up, with the exception of some assistance with bathing, or perhaps some very minimal assistance with dressing. They are mobile and transfer independently although perhaps with devices. The resident might have some degree of cognitive impairment which makes management of their numerous medications or meal preparation potentially unsafe. Or perhaps they are at a point where they just need some general monitoring. My point is, these folks need very little hands-on type care/assistance and the facilities are stafffed and equipped accordingly. A person who required even min assist with most of their ADLs would not do well here.

It seems that the OP's facility routinely provides more assistance than I described and can hopefully demonstrate that they have the staff and equipment to do so safely and effectively. Why not invite the therapists and case managers out for a tour and a nice meal to show what you can offer? Or at the least deliver some marketing materials which give some specifics regarding your resources? Not only could you preclude a recurrance of the present misunderstanding, you may very well see some additional referrals. Just a thought.

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Specializes in LTC.

I went out and assessed this lady yesterday. She was weak, but who wouldn't be if you were confined to a bed for 6 days. They aren't even letting her get up! I asked for a gait belt to transfer her to a chair and they said they didn't have one. Can you believe that?! UGH! She transfered well. I talked to the RN and she said that they are recommending a stay in a subacute for 2-3 weeks so that she can get more rest. That doesn't make any sense. It's not as if we are going to have her up doing jumping jacks or something. I talked to our PT and he said that he can work with her as much or as little as needed. I advised the family that they have 2 options. 1. They can send her to subacute for a little while and then bring her back. 2. They can bring her back to us and get a companion to assist her until she gets her strength back and have her continue with her PT with us. The lady DESPERATELY wants to be with her husband and not be spearated from him.

THe PT overstepped and misspoke in this situation. She can make a recommendation, but not issue an edict. She scared this family into thinking that their mother was never going to improve and would have to live out her days away from her husband in a SNF.

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If it's anything like the place I work now or just about every single place I've ever worked, I bet it has a lot to do with $$$$. I've discharged people home that I thought (but what do I know) had no business going home, but then of course, someone mentioned that their insurance ran out and they can't afford to private pay..

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Specializes in LTC.

The PT did mention her Medicare days were running out....so that means she isn't going to progress??? SInce when is there a correlation between Medicare and ability to improve? The whole system frustrates me!!!!

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