A Day in the Life of my Rehab Director

So, it’s Friday again… this means that it’s time to learn about other disciplines! This week I was set up to follow my rehab director. My rehab director is Sara. She’s from Spokane and is so great! Any rehab director I have ever known is always SO busy keeping track, not only of their schedules, but everyone else’s too and has to know what’s going on with every patient being seen by her therapists. Sara is no exception. Sara is an occupational therapist that has been in charge of the rehab department for about a year I believe. She knows every resident in the building along with all those staying temporarily. She is in charge of doing wheelchair evaluations (which I was lucky enough to partake in with her one day… I’ll explain about these in a minute).

Sara starts her day each and every day with a series of meetings to make sure things are running smoothly. We started out in a meeting with all the other heads of the other departments- nursing, human resources, event director, maintenance, food services…. and all other departments that I can’t seem to think of right now. We talked about any new admits the building was getting, any discharges, events for the day and anything else that might pertain to anyone present at the meeting. Once that was over we had a healthcare meeting to discuss any pertinent healthcare concerns. For instance, I did an evaluation on a patient last week- maybe you remember me writing about it- the guy that fell and broke all three bones in his leg and was waiting for surgery. Well, he was supposed to have surgery on Tuesday and return to the nursing home for rehab. We found out at this meeting that he went to the hospital on Tuesday but they did not perform surgery. His white count was elevated and there were some other concerning lab results so he is staying in the hospital until all of these things are managed and under control so he can have surgery. His surgery is tentatively set for this up coming Tuesday. Keep your fingers crossed that he will be able to undergo surgery.

The next meeting we went to dealt with the financial side of therapy- which I have very little experience with so this was good. I’m going to try to explain this in a very superficial way with as few details as I can. So, basically, to be reimbursed for therapy from Medicare, you have to prove that the patient is receiving adequate therapy. There are different rehab levels that correspond to the total number of minutes of therapy received (between physical therapy, occupational therapy and speech therapy) each week. Higher levels will receive a larger reimbursement. These levels are called RUG levels. When a patient is first admitted and evaluated, we determine what RUG level they are going to be at and have to make sure they are receiving that exact number of minutes of therapy per week otherwise the facility will not be reimbursed. This can be complicated if a patient decides to refuse therapy one day for whatever reason (which happens quite a bit) because then these minutes that they refused need to be made up later on in the week or there will be no reimbursement. Now, patients CAN change RUG levels (move up or down) but this involves a lot of paperwork on the administration end (which is part of this meeting). If it’s medically necessary for a patient to be receiving more intensive therapy (because they are improving and getting ready to go home) then they are moved up a RUG level (which means longer treatment sessions) and the facility will be reimbursed a little bit more. That’s the down and dirty version of it. Of course, there are MANY more details that go into reimbursement (checkpoints, annuals…) but this was a great meeting for me to be part of because now I understand the importance of keeping track of minutes accurately and how many people beyond just the therapist, are involved in the care of patients in therapy.

Now back to these wheelchair evaluations. When a patient at the nursing home gets to the point where they would benefit from an electric wheelchair, an evaluation must be performed to determine their eligibility. Medicare does NOT want to pay for anything unnecessary so there are 9,468 loops to jump through before anything can be approved. So these evaluations ask MANY different questions about the patient’s current level of function and where there level of function is predicted to be in the near-ish future. Once the evaluations are performed and filled out, they are sent in for approval. Once the wheelchair is approved, the company that we contract with for our wheelchairs sends a representative over to measure the patient for the correct fit. Seat depth and height, arm rest height, back support, leg rests- these are all measurements taken. And you wouldn’t believe the options available for these chairs- each option needs to have necessity and approval which is why these evaluations are so important. You want elevating leg rests- prove why you need them. You want a reclining seat back- prove why you need it. Basically- prove everything you can! During the measuring appointment, the patient gets to pick out the color they want for their wheel chair- they have some cool colors to chose from (the patient I have been following with her wheelchair evaluation process picked the purple chair- it’s a brand new color option AND the first purple chair that will be in our building. I LOVE PURPLE!) So after the measurements are taken, the chair is ordered. It will be sent to the reps shop in a million-bazillion pieces. He’ll put it together and when it has been tested and is ready- he’ll deliver it to the patient who has been waiting for approximately two months from the evaluation to receive their chair. I’m so excited to see this purple chair delivered to this sweet woman living in the nursing home. I hope it gets delivered before my time here is done!




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