Failure to Provide Ongoing PT for Resident with New Prosthetics
Penalty
Summary
A deficiency occurred when the facility failed to provide ongoing physical therapy (PT) interventions for a resident with bilateral leg amputations and new prosthetic legs, despite documented improvement and continued need for therapy. The resident, who had a history of Type 1 diabetes mellitus and both right above-knee and left below-knee amputations, was initially referred to PT for assessment and training in sit-to-stand transfers and ambulation with new prosthetics. The PT evaluation and subsequent treatment notes showed the resident required varying levels of assistance for transfers and ambulation, but demonstrated progress over six PT sessions, improving from maximal to moderate assistance for both sit-to-stand transfers and walking in parallel bars. Despite this progress, PT services were discontinued after only six sessions, with the discharge summary citing a decision made in accordance with the physician or case manager, and referencing the resident's health insurance coverage as a limiting factor. The discharge summary recommended that the Restorative Nursing Aide (RNA) continue sit-to-stand training, but did not include further gait training or ambulation, which the resident had not yet mastered. Interviews with the resident, therapy staff, and the interim director of rehabilitation confirmed that the resident was motivated to walk, had requested more therapy, and that the therapy team believed the resident could have benefited from additional PT to reach a higher level of function. However, there was no documentation that the therapy department discussed the resident's progress or the possibility of extending therapy services with the physician prior to discharge. Observations of RNA sessions showed that the resident was able to perform sit-to-stand transfers with minimal assistance and was eager to progress to walking, but the RNA sessions were limited in scope and duration. The facility's policies required that therapy services be provided to restore residents to their highest level of function, but the lack of communication with the physician and failure to advocate for continued therapy services resulted in the resident being discharged from PT before achieving the goal of independent ambulation with prosthetics.