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Cognitively Impaired Patients Require Comprehensive Assessment and Specifically Tailored Rehabilitation Programs

Often times, what begins as an estimated two week visit to a Skilled Nursing Facility for rehabilitative services after a serious injury or surgery turns into an extended stay. Post-injury patients with cognitive disabilities face the greatest risk for lengthy stays at nursing homes. According to a recent study, specifically tailored rehabilitation programs play a crucial role in the post injury recovery of such patients.

According to an article published in the July 2011 edition of the Journal of the American Medical Directors Association efforts towards research in rehabilitating cognitively impaired elders are minimal, despite the rise in the elderly popultion.

The report investigates the differences in functional recovery for cognitively impaired patients and cognitively unimpaired patients. The article, entitled “Postacute Rehabilitation in Cognitively Impaired Patients: Comprehensive Assessment and Tailored Interventions,” is available for purchase online. The authors, Francesco Landi MD, PhD, Rosa Liperoti MD, MPH and Roberto Barnabei MD, highlight the crucial role that tailored rehabilitation programs play in aiding those with cognitive disabilities as they recover from acute injuries.

Because cognitive disabilities restrict a patient’s capacity to adequately follow the steps of a rehabilitation program, programs must be modified according to each patient’s specific profile. In fact, the section of the Code of Federal Regulations governing the provision of specialized rehabilitative services (Title 42 of the Code of Federal Regulations, Subpart B, section 483.45) , specifically mandates:

(a) Provision of services. If specialized rehabilitative services such as but not limited to physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness and mental retardation, are required in the resident’s comprehensive plan of care, the facility must–
(1) Provide the required services; or
(2) Obtain the required services from an outside resource (in accordance with §483.75(h) of this part) from a provider of specialized rehabilitative services.

(b) Qualifications. Specialized rehabilitative services must be provided under the written order of a physician by qualified personnel.

The focus of this study was on the significance of the comprehensive plan of care, which specifically tailors rehabilitative services to the individualized needs of each patient, instead of a one-size fits all approach. Local California nursing homes, particularly nursing homes in the Orange County and San Bernardino County areas, can gain significant insight from this study, which would go a long way towards improving the quality of life of their residents and respecting Patients’ Rights.

The authors conclude that with varied approaches, including tailored tone of voice, nonverbal expressions, and environmental adaptations, these programs can become more effective toward aiding those who struggle cognitively in the rehabilitation process. In terms of the ideal location to implement such a program, the findings were inconclusive, but three settings, including post-acute hospitals, home care programs, and skilled nursing facilities, are proven venues for rehabilitation programs, so long as a comprehensive and specifically tailored care plan is methodically prepared and implemented. What the research does conclude is that such facilities must be family-oriented.

At the end of the day, cognitively impaired patients with hip fractures are certainly able to recover lost functions by means of rehabilitation programs specific to their needs. This is not possible, however, without sufficient care, if the program is terminated prematurely, and without continual family and social support.

If you are faced with the decision to place a friend or loved one in a nursing home, and your loved one requires rehabilitative services, follow up with the nursing staff to ensure that a specifically tailored care plan is not only designed, but also implemented.