This text based course is a transcript of the live webinar titled "Effective Treatment Strategies for Dementia Management", presented by Kathleen Weissberg, M.S., OTR/L.
>> Kathleen Weissberg: I want to welcome all of you to today's training where we are going to talk very specifically about treatment strategies for dementia management.
Introduction/Objectives
We have two objectives today. We are going to talk about a variety of different treatment options for clients in each of the stages of dementia and about documentation to reflect skilled care.
Dementia
Hopefully some of you were in on our initial session where we talked about evaluation of the person with dementia, and if you were, you remember that dementia is a progressive loss of cognitive skills. There are seven stages and you will sometimes see it categorized as one of the stages, or it can be categorized as early, middle, or late stage dementia.
Along with that we have an Advocacy Model of Care and this is really important as we start to look at treatment. The restoration level of that Advocacy Model is not something we are going to be doing with our persons with dementia. We are not going to be able to restore their cognition or function back to their prior level. Depending on what stage of the disease process, we might be able to give them compensatory strategies or a piece of adaptive equipment. We are going to be treating them at an adaptation level, setting up the environment or activity so the person will be successful. It is very important that we know the stage to guide our treatment options.
Documentation
As we talk about dementia, most likely our primary payer source is going to be Medicare. There are certain things that Medicare looks for in your documentation.
Prior level of function. This is one of the first steps in justifying our intervention as occupational therapists. Our prior level should focus on something related to functional performance of ADL or safety issues. We do not want to focus on a cognitive status, because again we are not going to be able to improve their cognition. For example, “They were able to sit up in their wheelchair for four hours, but now they have fallen twice in the last month.”
Reason for referral. The reason for referral needs to be very specific to OT and should state why this person requires your therapy intervention at this time. Inability to dress and bathe without assistance would be a reason for you to get involved.
Plan of care. Your treatment duration for your patient with dementia should be clinically appropriate to allow you to achieve your long-term goals, but keep in mind because of the disease process and that we are probably treating an adaptive level of care, our duration is probably not going to be that long. It is going to be a little bit shorter than your other typical plans of care. I bring that up, because I have done numerous audits in my lifetime, and I have seen plans of care where the therapist really thought they were going to help their client with dementia get better.
Medical necessity. We need to focus on what would happen if we did not treat. Why is OT necessary at this time? For example, without our intervention to evaluate their status and develop a functional maintenance program, the caregivers will be unable to cue the patient during their ADL. That is a medical necessity.
Skilled service. What are you doing that nursing, PT or speech cannot do. Are you focusing on a performance component of OT? For example, maybe we need to establish a cueing strategy based on the patient's level in order for them to complete their ADL.
Rationale or justification. Why do you think, as an OT, you can impact the patient's condition at this time, even if they have been a longtime resident of your facility? There was a court case late last year that is now coming into play where we are able to treat a patient for maintenance reasons or add an adaptive level of care, and are still going to get paid by Medicare for that. That is a nice change, particularly for the dementia population. I am not going to go over Figure 1, but these are some examples of what a rationale or summary statement would look like. I put summary statements for all three of the disciplines here so you can see how those might be laid out in your documentation.
