Case Study Nursing Home

At the end of my clinicals, there was a meeting about not over recommending a skilled nursing facility (SNF) for people who do not truly need a SNF according to the hospital. One of the criteria for not needing a SNF was if the person was functioning at the same baseline they were functioning at before surgery. This became a dilemma for one patient who had a total knee replacement because the patient could barely stand upright and walked with a severe genu valgum. According to the patient, she was not very mobile before surgery and her husband helped take care of her. However, the patient seemed motivated to improve her functional status and wanted to be able to walk normally again. My CI recommended home with home physical therapy (PT) for
My CI realized that this is a true statement and considered recommending a SNF, but she was functioning at her baseline, she was able to get out of bed and walk short distances, and she lived in Georgia making going home or to a SNF near her difficult. He then remembered that although a TKA does not qualify for acute rehab, rheumatoid arthritis does, which the patient also had. We talked to others involved in her case and they all thought it was a great idea and we managed to send her to a local acute rehab hospital to improve her functional mobility and quality of life. Therefore, we got over the ethical dilemma of doing what the hospital wants us to do and doing what was right for the patient by recommending acute rehab for the patient instead of a
The situation is about the physical therapist doing what is right for the patient. The patient needed extra rehab beyond acute care or home care and the PT had to do what was right for the patient. The cardinal realm of this situation is the organizational realm because the hospital is encouraging PTs to send patients home who are functioning at their baseline level even if their baseline level is not very functional to begin with. The meeting about when to recommend SNF upset many of the therapists because there are numerous patients who did not meet the criteria that the meeting laid out that could benefit from further rehab. Furthermore, this situation would not have existed if the department never had the SNF meeting and made my CI question if this patient should receive more intensive rehab. Therefore, the hospital recommendations are making PTs question their own judgement on who deserves to go to a SNF. Even though we managed to get around this situation, this does not resolve the issue of the guidelines still being in place and another patient not getting the care they need due to a PT questioning if they deserve it based on hospital