Rehab

Don't be tripped up by fall assessments

Rehab Regs, July 17, 2005

Therapists in skilled nursing facilities may be able to conduct fall assessments in their sleep, but providers across all rehab settings should know how to thoroughly assess a patient--especially if they treat Medicare beneficiaries.

Prime candidates for fall assessments include patients who have recently suffered a stroke, those with dementia and Alzheimer's, and patients who have had prior falls, says Janie Krechting, assistant professor in the department of behavioral sciences, Aging Services and Administration program at the College of Mount St. Joseph in Cincinnati.

"Seventy-five percent of people who fall will fall again," says Krechting, who also cites patients with vision and hearing problems as potential fall victims. Other potential fall triggers can include Parkinson's disease, neuropathies, high or low blood pressure, vertigo, or osteoporosis.

Various evaluations are available for therapists to use during their assessments. Called "objective mobility tests," they allow therapists to score patients' ability in activities such as walking, reaching, and balance.

"[These tests] are a predictor of how safe a patient will be in the community," say Kate Brewer, PT, MBA, GCS, director of clinical services and program development for Greenfield (WI) Rehabilitation Agency. "Functional ability and balance ability tests are very important if there are any walking impairments."

At Beaumont Health Center in Royal Oak, MI, patients can participate in Balance for Life, a personalized fall prevention program. Designed to decrease an individual's risk of falling and maximize safety and independence, the program uses OT, PT, vision and aquatic therapy, vestibular rehab, day rehab, speech-language pathology, and nurse case coordination.

"Patients are identified by their doctor, and then we try to figure out why they are falling," says Kelly Keim-Johnson, CBIS, neuro supervisor at Beaumont. "The PT or OT will then determine whether we need to go into the home."

For outpatients, a home visit can occur at any time during treatment.

The best way to observe patients' fall potential is to shadow them while they perform typical daily tasks, says Brewer. "Watch them go through their typical day navigating through their home and use your skills as a therapist to assess them," says Brewer. "For example, does their telephone cord stretch across the floor?"

If possible, also have any of the patient's family members or other caregivers attend home or therapy visits. "Make sure there is a lot of education for the family," says Keim-Johnson. "We encourage the families to come and talk about risks that might be in the home and explain the [patient's] home exercise program."

There is no specific Medicare form to fill out for a home visit and no specific codes to use for reimbursement purposes. Document your assessment in the patient's medical record and consider using the following codes for reimbursement, says Brewer:

97535 --activities of daily living retraining

97116 --gait training

97530 --therapeutic activities

97537 --community/home integration (if the patient is active in his or her community and does frequent car transfers)

"As part of a thorough plan of care, your goal is to return [patients] to their prior level of function and to make sure the gains they've made in therapy can carry over into their home life," says Brewer.

Remember that you can't bill for the time you spend traveling to and from the patient's home. Brewer estimates that the average home visit, excluding travel time, takes 45 minutes.

Because there is no standard Medicare form to use, customize any fall assessment checklists to the needs of your individual facility. Brewer says paying attention to the following basic elements factors will ensure that you complete an accurate assessment:

Car transfers

Entering the home (e.g., steps, locking and unlocking the door, mailbox accessibility)

Living room mobility (e.g., on carpeting, on throw rugs, etc., sofa transfer, recliner transfer, accessible television, and telephone)

Kitchen mobility (e.g., sitting and standing from kitchen chairs, using the sink, dishwasher, stove, and getting items from the refrigerator to the counter, microwave, etc.)

Bathroom mobility (e.g., accessible with assistive device, in and out of shower or tub)

Bedroom mobility (e.g., getting in and out of bed, retrieving clothing safely)

Brewer also suggests looking for throw rugs or cords that could be tripping hazards; reducing clutter; and ensuring that there is adequate lighting for bathroom use at night, laundry and a cordless phone are accessible, and that the patient is able to prepare light meals.

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