The Pulse

Patient Information: Male, Age 49

Diagnosis: Pneumonia / Neuropathy

History: This gentleman was found by EMS unable to get out of bed and covered in soiled bedding with insect infestation, and reported he hasn’t been out of bed for “quite some time.” He
was admitted to the hospital with pneumonia, then transferred to a skilled nursing facility
for rehabilitation services.

Range of motion (ROM) deficits may affect an individual’s ability to move, care for themselves, or perform typical daily activities including self-feeding, walking, and dressing. Decreased ROM is a common deficit addressed regularly by rehab professionals in all settings. Contractures arise from shortened muscle or other joint structure restrictions, leading to reduction in mobility and deformity with resultant reduced function.
• Prevalence of contractures in nursing homes is estimated at 55% with significant functional and medical consequences. (Offenbächer, 2014)
• Patients who are immobilized for a prolonged period are at risk of developing joint contractures, which often affect functional outcomes. (Born, 2017)

Patient Information: Male, Age 96

Diagnosis: Fall / Compression Fracture

History: This gentleman was referred to a skilled nursing facility following hospitalization due to a fall in his garage which resulted in a thoracic compression fracture of the spine. Prior to the fall, he lived at home and was independent with ambulation, driving and mowing his yard.

Patient Information: Female, Age 77

Diagnosis: Esophageal Cancer / Muscle Weakness

History: This woman was referred to a skilled nursing facility for rehabilitation services due to weakness and a decline in functional mobility after hospitalization due to esophageal cancer and feeding tube placement. Prior to her hospitalization she was living alone in a senior living apartment with an elevator and was independent for transfers and activities of daily living with her manual wheelchair due to prior bilateral below knee amputation.

The use of outcome measures has become the standard of care to objectively assess changes in function, quantify clinical observations, enhance interdisciplinary communication, and examine intervention effectiveness at the patient and practice levels. Inconsistent use of outcome measures remains an issue due to difficulty identifying the most suitable measures based on patient diagnosis, acuity of condition, or practice setting.

Patient Information: Female, Age 76

Diagnosis: Chronic Obstructive Pulmonary Disease (COPD) / Chronic Heart Failure (CHF) / Diabetic Neuropathy

History: This woman was referred to home health therapy services due to numerous falls, poor balance, and a decline in functional mobility. Over several months she became wheelchair-dependent in part due to fear of falling. Prior to this decline, she was independent with transfers and able to walk with a rolling walker to the dining room for meals in her assisted living facility.

Patient Information: Female, Age 70

Diagnosis: Left Femur Open Reduction Internal Fixation (ORIF) / Pain

History: This woman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a fall at home resulting in a left femur fracture requiring surgical repair. Prior to her fall, she lived in a 2-story home with her husband and was independent with walking and all activities of daily living.

What do you do in your free time? 
Having two young and energetic daughters doesn’t leave me with an abundance of free time, but my wife and I do love spending time with them and cheering them on in soccer, gymnastics, and school activities. I enjoy golf, hiking, spending time with family and friends, and travel. Over the winter, we traveled as a family to Thailand and we are looking forward to London and Romania this summer.

Per the American Physical Therapy Association’s (APTA) “Defensible Documentation Tips” resource¹, the top 10 payer complaints about documentation (reasons for denials) include: