Intermediate Care Facilities, Long Term Care

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Intermediate Care Facilities,Long Term Care
Rehabilitation Records

• HIM 2000

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Intermediate care facilities

• Mentally retarded
• Developmentally disabled individuals
• ICF/MR funded by Title XIX (Medicaid) and must
  meet the standards in the Conditions of
  Participation for ICFs/MR.

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ICF/MR

• Surveys performed by the states department of
  health.
• Coding ICD-9-CM and some DSM-IV coding for
  psychology/psychiatry services

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Long Term Care Settings

• Freestanding Nursing Facility
• Nursing home
• Long-term care facility
• Skilled nursing facility
• Acute care hospital, skilled nursing unit

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Types of Surveys

• State licensing agency
• Annual licensure renewal (unannounced)
• Complaint investigation
• CMS
• Annual certification for participation
• JCAHO
• -Optional survey for LTC

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Documentation

• Vital in evaluation of how a facility impacts its
  residents quality of care and life
• Impacts facility reimbursement by Medicare
• Vital to the defense of litigation involving
  negligence for poor care outcomes
• Care plans must be individualized to the resents
  care needs, strengths and individual preferences.

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Comprehensive Resident Assessment

• Primary vehicle for evaluating care outcomes
• Resident assessment instrument (RAI)3 components
• -Minimum Data Set (MDS)
• -Resident Assessment Protocols(RAPs)
• -Utilization guideline (specified in State
  Operations Manual)

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Minimum Data Set

• MDS data are utilized to classify patients into
  resource utilization groups (RUGs), which are the
  basis of payment under the skilled nursing
  facility (SNF) prospective payment system (PPS).
• MDS data used to track specific care and quality
  outcomes

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Quality Indicators

• SNF monitor some of the following quality
  indicators
• Pressure ulcer care
• Incontinence care
• Nutrition
• Prevalence of dehydration
• Incidence of contractures
• Psychotropic drug use

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Time requirements

• Within 14 days of admission or after any
  significant change in condition and on an annual
  basis
• Between comprehensive assessments, staff must
  complete a quarterly review of physical, mental,
  and psychological information.

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Basic Reimbursement categories and pay sources

• Medicaid
• Medicare Part A
• Medicare Part B
• Managed Care
• Commercial Insurance
• Private Pay

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Case study

• You are the consultant for the long-term-care
  facility that has recently undergone a survey in
  which the facility received several deficiencies
  for noncompliance with federal requirements. The
  most significant deficiency involved a noted
  pattern (7 out o10 examples) in which
  comprehensive assessments (MDS) were not
  completed within the required time frame (within
  14 days of admission). In addition, suveyors
  identified that there was no documentation to
  support that the triggered RAPs were being used
  in the assessment and care planning process. It
  was also noted that the nursing staff stated they
  did not understand what the resident assessment
  protocols were and they were unaware of the
  federal criteria for determining when a
  significant change had occurred. The
  administrator of this facility has called you to
  help develop a plan to correct these deficiencies.

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Case Study questions?

1. What would be your recommendations for overall
   system evaluation and revision?
2. What would be your recommendations for staff
   education?
3. How could the facility medical records specialist
   be utilized to prevent similar problems from
   occurring in the future?

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Rehabilitation

• Rehabilitation is the development of a person to
  the fullest physical, psychological, social,
  vocational, and educational potential consistent
  with his or her physiological anatomic impairment
  and environmental limitations.

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Rehab levels

• Acute rehabilitation- rehabiliative care provided
  for two to ten weeks until the patient is
  medicallly stable and has reached his or her
  maximum short-term improvement
• Postacute rehab- a setting providing long-term
  therapy to maximize functional status for
  patients who have successfully completed acute
  rehab, or have passed all acute medical problems,
  or are medically stable and ready for postacute
  rehab.
• Subacute rehab- rehabilitative care of lesser
  intensity provided to patients who have a
  discharge goal to return home or to a less
  restrictive environment, but are unable to
  participate or benefit from a higher level of
  rehabilitative care.

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Rehabilitation Services

• 2 voluntary accrediting agencies for rehab
  facilities
• Joint Commission on Accreditation of Healthcare
  Organizations (JCAHO) and the Commission for
  Accreditation of Rehabilitation Facilities (CARF)

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CMS criteria for inpatient rehabilitation

• 75 or more of the population must be treated for
  specific rehabilitation conditions with the
  remaining 25 or less being either rehab
  diagnoses or of a deconditioned nature that has
  the potential to be discharged to an independent
  living situation

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Documentation in Rehab

• CARF guidelines in patients medical records.
• The assessment of the patient
• Determination, modification, and implementation
  of the individual (discharge plans)
• Active participation in conferences
• Provision of direct services consistent with the
  needs of the patient
• Promotion of interdisciplinary functions and
  mutual support among all team members
• Promotion of the programs evaluation and
  treatment philosophy

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Functional Independent measure (FIM)

• FIM scores are an reliable and valid instrument
  in documenting the severity of disabilities as
  well as outcomes in rehabilitation. FIM scores
  are issued in thirteen motor and five cognitive
  areas. Each area receives a score ranging from
  one to seven.

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Changes in Rehab

• Due to rising hospital costs and shorter
  inpatient stays, there is an increased need for
  more sub-acute and outpatient rehabilitation
  facilities. Outpatient and freestanding
  rehabilitation clinics will also increase.