Note: this is designed to be a comment to a specific article that I recently read online at http://fairfaxcity.patch.com/articles/fairfax-nursing-home-pays-700k-settlement-for-unnecessary-treatments
I spent over 2 hours in the wee hours of the night working on a response to an article with several false claims. Then when I went to submit the comment, it told me I had way too many words. Every point listed in what I wrote is here for a reason. As I desire to keep what I wrote intact, as opposed to making multiple entries on the newspaper website, I decided to create this blog for the sole purpose of sharing the following. OK, I read with amazement the allegations in this article, starting with the misleading headline that proclaimed, "Lawsuit: Fairfax Nursing Home Forced Elderly to Undergo Useless Treatments". As an occupational therapist in FNC's therapy department from spring 2001- March 2012, I find issue with several of the statements in this article and so will share my perspective on them. In March 2012, as alluded to in a previous comment, a contract rehab began managing the rehab department. To be abolutely clear, the concerns address the period up to March 2012.
The headline itself is false as no one was forced to undergo treatments and treatments weren't useless. In this type of setting, the elderly individuals are often enduring one of the most difficult times of their life, for instance due to illness or injury. There are patients who are eager to participate in therapy. There are others who might require a little dash of kind, caring, loving, gentle encouragement to get out of bed or perhaps to try to stand. Fear might limit the person. There are a myriad of reasons that an older person might decline to do what a trained therapist feels is a beneficial therapeutic task for that individual. A person's family member can encourge them. And as therapists, we do our best to gently and kindly encourage that individual to do their best.
Some other concerns with this article:
#1 The article cites the three former employees stating, "They noticed other employees claim skilled therapy time for watching patients dress themselves".
Perhaps in including that statment, it would have been helpful to your readers for the author to educate your readers by including a brief description of the scope of practice of the respective rehab disciplines of physical, occupational and speech therapy. For instance, training in activities of daily living (ADLs) is quite often an essential component of the necessary occupational therapy services provided in a skilled nursing facility to a typical patient undergoing skilled rehabilitation. If a patient is admitted to a nursing home for short term rehabilitation, there are certain key abilities that a person ideally needs to be able to perform as safely and as independently as possible, this includes self dressing.The role of an occupational therapist includes assessing the patients ability and safety in performance of dressing so that any necessary training can be provided for the patient's loved ones or other caregivers, as needed. For example, a patient with a hip replacement that is unable to bend to perform lower body dressing would be taught how to use long handled equipment and a patient who had survived a stroke might be taught how to put a shirt on using a special technique. To illustrate the importance of proper training in dressing, if the patient with the hip replacement does not abide by certain precautions when dressing, then that patient could risk damaging the surgical site and causing dislocation of the hip. A patient with balance challenges might be assessed for safety in performing dressing tasks as well. The purpose is to support the patient by helping to ensure a safe discharge, so that the person as well as their loved ones will feel safe, comfortable and confident in performing that and other tasks of daily living. But therapists do not sit and "watch", rather as the therapy is active intervention, as necessary cueing, sequencing will be provided. Perhaps balance support will be provided. Perhaps training is given in how to incorporate dressing while using a mobilty device such as a walker for the first time. In general, the goal is to assist when needed while and assisting as needed while maximizing the patient's ability to do as much as possible independently. When necessary, assistance and training is provided to other staff and family. For a patient who will be living with someone else (ie a spouse or adult child), this information is essential to help make safe discharge decisions and arrangements. For example, a patient with Parkinson's disease might not be safe to be home alone due to congitive reasons or due to balance challenges, the therapists help assess the situation, precisely what the patient can do, so that the best safe discharge can be planned and recommendations made for amount of care hours. For patients going to an assisted living facility, information is provided if needed to assisted living facilities in helping determine the level of care a patient will need in that setting.
The following link provides a quick overview of a plethora of other daily living activities that might be of interest to those who have read this article, for it lists basic as well as more advanced "instrumental" activities of daily living that an individual needs to perform. http://www.payingforseniorcare.com/longtermcare/activities-of-daily-living.htmlOnce a patient has been evaluated and trained and approaches their maximum level of functionning, then the therapy services cease as the person is ready to be in the next environment in the continuum of care. The variety of patients includes those who will remain in long term care to those who return to their homes independently.
It is interesting to note that two of the therapists (Kelly and Beauregard) would be deemed believable as the first was a speech therapist who never observed an occupational therapy session and Beauregard was only employeed there for a short time.
#2 "Former FNC therapists Christine Ribik, Nadine Kelly and Stephanie Beauregard filed the suit filed under the False Claims Act after allegedly witnessing the nursing center threaten to fire its employees if they discussed discharge options with patients". This is another alarming statement from the article that contains not an iota of truth. Not once during my time as an employee in the FNC rehab department did I ever hear such a threat made to me or to another therapist and such threats were never mentionned in any meetings. Rather, as any therapist learns in therapy school, proper discharge planning commences on the date of admission. This was most definitely implemented in FNC. For example, upon initial therapy evaluation, a therapist would meet the patient and learn his/her story while assessing the current functional status of the patient. The therapist would discover what the person's prior level of functionning was so that they could make appropriate rehab goals based on their current status and rehab potential. As therapists we would ask the patient his/her therapy goals. And then we would strive in sessions to do our best to help the patient achieve those goals. This practice continued throughout duration of stay in treatment sessions as well as during formal planning in individualized patient care plans and weekly rehab department rounds. Likewise the therapists treating a particular patient would often share relevant information about a particicular patient and his/her discharge plan with each other.
Again, never once was a person theratened to be fired if discharge options were discussed. On the contrary, such dialogue with the patient and his/her family members was continually encouraged. Social services and case management services were also highly involved valuable resources in ensuring good discharge planning and were valuable resources for the patient and his/her family.
Patients would often say they want to go home and we would encourage this. In my time at FNC, I can only recall a couple times when a family member requested that the discharge NOT be discussed with the patient. For instance, if the patient's family was considering having their loved one to transition to moving to an assisted living facility or staying in a long term care setting, on extremely rare occasions, the family member did not yet want that conversation to occur with their loved one, as they wanted to have a little more time to prepare their loved one for sharing that decision. Likewise at one point, people were reminded in a professional manner to use cautious words in discussing discharge. Essentially the point of this was to gently remind staff that this planning for a discharge is a collaborative effort, a team environment so prior to giving a specific discharge date, we need to make sure there aren't nursing needs or speech therapy needs,etc. The point of this caution was to ensure the patient and his/her family wouldn't be frustrated if the stay needs to be a bit longer for medical or other reasons. Considerations in discharge planning include detailed collaboration among all involved parties. The patient's desires are essential, the family/support system of the patient are essential as well. It is important to know how much help the patient will need upon discharge, ie 24 hour help or help for several hours a day. Does the person require 2 helpers or 1 helper? Time is needed to order necessary medical equipment as well as to get other things in place such as home health services if needed and to ensure that nursing orders prescriptions
To retiterate, no one was ever threatened for discussing discharge plans. Good discharge planning was welcomed and appreciated.
#3 "They also accused Fairfax Nursing Center of claiming reimbursement when no skilled therapy services were provided. They noticed other employees claim skilled therapy time for watching patients dress themselves, or dragging patients who were completely debilitated and "close to death" around the facility.
As I've already addressed the first portion of this statement, I will speak to the last portion of that statement, ",dragging patients who were completely debilitated and "close to death" around the facility" Once again, these are completely ludicrous and absolutely untrue claims. As long as hope for improvement of one's quality of life, therapy sessions could occur. When a patient was declining and hospice services began, then yes, therapy stopped. Many times my coworkers and I were sad to see the sudden decline of a patient who just days before had been doing well and participating well and progressing towards therapy goals. At times patients might be seen to maximize potential prior to hospice commencing, in order to maximize functional potential and quality of life. For instance a patient who had an underlying eventually terminal conditon but had sustained a fracture might receive therapy to heal from that injury, then resume hospice once healed from the injury.
#4 Another false claim: "The complaint said FNC would allegedly threaten its therapists to find a way to continue providing services even after a patient refused treatment and wouldn't benefit from it. One such patient allegedly had terminal cancer and couldn't benefit from therapy services yet continued to receive them, despite the patient's complaints, until the patient died.
"No knowledge of the details on that specific situation. But therapists were not threatened in the manner described in that quote. At times a therapist might be encouraged or asked if everything possible had been done to assist a patient prior to discharge of services. If a patient was refusing particpation on a regular basis (ie this sometimes occurs with patients with certain types of dementia), we might be asked if we had invited a patient's family member to attend and support their loved ones to encourage participation. For patients with certain conditions, sometimes we might be asked if there were positioning or splinting needs for the patient. The supervisor who asked these questions had many years of experience and asked relevant questions worthy of the consideration of the therapists. Essentially this supervisor was ensuring the staff had dotted every i and crossed every t, in order to ensure the treating therapists had done the best possible service for the patient.Any therapist who has ever worked in a snf probaly has had days where a patient refuses particpation. Depending on the patient, one might reapproach the patient later and/or provide gentle encouragement to the patient. But again, if unsuccessful in encouraging the patient to participate, no therapist forced participation.
#5 "FNC management dictates in advance the treatment each patient will receive" without considering the patient's need or lack thereof, the complaint reads. Another untrue statement. Medicare guidelines that perhaps should have been included in the article dicate that patients be assessed for an estimated reimbursement category and this is done in advance of the treating period. So yes it is true that a new patient is evaluated and placed in a category of reimbursement that it is anticipated the patient will be able to tolerate. If needed, based on the patient's ability to tolerate therapy, the category would be adjusted. The supervisors were always willing to reconsider/assesss the intitial "best guess" of what their needs are and welcomed and appreciated those therapists that provided this information of anticipated patient tolerance. Therapists were asked many times to notify the supervisor (who scheduled the therapists and estimated treating times) to provide an estimated tolerance. Sometimes the patient's therapy time might increase. Other times, if a patient was unable to tolerate a certain time, their sessions would be decreased to a lower level and treatment would be compassionately stopped when necessary.But this is not something "dictated" by management, rather it is part of the responsibility of a supervisor.
As for the actual "treatment" the patient receives, Medicare requires an individualized treatment plan be established when the evaluation is completed. Therapists go to school to learn how to make and establish treatment goals with the patient. The therapy sessions are designed to work towards meeting those goals and adjusting treatments when needed.To reiterate, in my time as an employee of FNC, I was never once threatened or made to prolong treatments or extend treatment beyond a reasonable time.
I was honored to say I worked in that nursing home and with the colleagues I had, many of whom worked from their hearts to serve the patients. Many of the therapists, administrative and nursing staff strived to serve the patients the way that they would want their own loved ones to be treated. I know the supervisors I had as well as the administration and owners cared deeply for the well-being of the patients in their charge. During the time, many patients who had left and had another condition months or even years later who required a rehab stay would return to our facility for their rehab needs. We had others who would say they came to us based on a recommendation of a friend who had been at our facility.I hope future such articles will be better researched.
Thank you for reading.Posted