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Concerned with well-being of ind, & advocacy for this well-being. Services must be fair, ethical, and unbiased with reasonable fees.
OT has cooking group where ind. has dietary restrictions based on religious beliefs. OT offers app. food choices during cooking group.
No harm is done to the person. Relationships with client & OT should be non-exploitative, objective, & professional at all times.
An OT should maintain professional boundaries with a client if transference & counter-transference is occurring between therapist & client.
Respect the right of the ind. or ind. designated representative to choose, self-direct, and refuse intervention. Full disclosure of potential outcomes & risks of interventions & obtainment of informed consent are required. All records are confidential. HIPPA
Autonomy & confidentiality
An OT must inform a pt. recovering from partial thickness burns that pain may be experienced during intervention & explain that tx is necessary to prevent edema, scarring, & contractures & promote fun. recovery.
Autonomy & confidentiality
Service provision is provided in a fair & equitable manner to all persons regardless of their economic status, age, ethnicity, race, disability, marital status, sexual orientation, gender, gender identity, religion, culture, political affiliation.
OTs must recognize societal inequities & advocate for just treatment for all
If a child is having diff. obtaining the resources needed for implementation of post-secondary transition plan, OT must advocate for the provision of these vital supports.
Abiding by local, state, federal laws, institutional policies, & code of ethics. OTs responsible for those they supervise to provide just services & admin. & employees understand code of ethics.
If an administrator asks an OTA to document that a resident needs OT in SNF even though they don't, the OTA should decline & the OT should inform the admin that this request is inappropriate
Honest, fair, complete, and accurate. OTs must always accurately represent their credentials, education, experience, competence, and qualifications. OTs must fully disclose any potential conflicts of interest that may arise
An OT who moonlights as A/E sales rep. is asked to conduct a workshop on actiivty adaptation & env. mods. to an arthritis group. The OT must disclose his sales position & identification of the potential conflict of interest.
Respectful, fair, discrete, and ethical. Accurate representation of colleagues contributions & qualifications & prevention, correction, exposure, and reporting of ethical breaches in conduct are required. Knowledge of steps to resolve ethical dilemmas & procedures & policies for handling ethical complaints is expected.
OT being asked to provide reference for ind. seeking OT position who failed NBCOT & had temp. license revoked would include therapist advising the person to cease misrepresenting himself as capable of fulfilling the position. If scenario included person accepting the job, the therapist should inform the stare regulatory board of the ind. misrepresentation.
Who can discipline an OT who has violated ethical principles to the point of malpractice and/or professional conduct
State regulatory Boards (SRBs)
- 1. Failure to do what another OT would do under similar circumstances
- 2. Doing what another OT would not do under similar circumstances
- 3. End result was harmful to client
- 4. OT, OTA responsible for thier own negligence
When can a malpractice suit be filed by ind. or caregiver?
If OT is viewed to be personally responsible for negligence or other acts that result in harm to client.
t/F OTAs can be activities coordinators at SNFs & supervise OT aides
Who can train OT aides to perform non-skilled tasks
OTAs or OTs
Non-skilled non-client tasks include __________ & _________________
- routine maintenance & clerical act.
- Preparing clinic area for interventions, organizing supplies, clerical act.
Non-skilled client tasks include _________ & can only be delegated to OT aide after conditions have been met
contact gaurding client during transfers
T/F: OTAs can supervise other OTAs administratively as long as service protocols & documentation are supervised by OT
T/F An OTA can be an administrator
- An OT with graduate degree or continuing ed. relevant to managing & expereince app. to size & department
Field work coordinator
OT or OTA with 3 yrs practice exp.
- OTA at intermediate or advanced level
- OTA with advanced professional degree & intermediate to advanced skills in teaching
OT & OTA meeting state regulatory requirements & need SPV from OT
Person who specializes in physical med. & rehab, leads rehab team
Primary liasison between pt. & doctor, often serves as primary case manager
advanced nurse who can serve as primary care providers, prescribe meds, & complete referrals
nurse practitioner (NP)
evaluated prevocational skills, interests, and counseling. Refers ind. to app. vocational program, liasion between state ed. & vocational departments for persons with disabilities for needed services
Vocational rehab counselor
Services must be ________ & _________ and OT must result in _________, ________ improvement in a person's level of fun. over a reasonable time.
- reasonable, necessary
- significant, practical
Medicare & maintenance in SNF
What will it cover & what it wont cover
- 1) OT can be reimbursed for dev. of the maintenance program
- 2) training of caregivers to implement the plan
- 3) and periodic reevaluation
- Won't cover implementation of maintenance program
T/F Medicare will reimburse DME if it is considered useful to a person who does not have an illness or disability.
T/F Medicare will reimburse for 3:1
T: not considered useful to person without disability
T/F Medicare will reimburse for raised toilet seat and/or grab bars
F: useful to those without disability & not medically necessary.
T/F Private payment is often primary source of income for OTs working in wellness & prevention programs
Payment system where the provider is paid prospectively (monthly basis) a set frr for each member of population (health plan members) regardless if no health care is covered pr extensive care is delivered.
- Payment is determined in terms of "per member per month" PMPM, healthier enrollees, few services & provider retains more PMPM
A standardized recommended intervention protocol for a specific diagnosis
Descriptive categories established by CMS that determine the level of payment as a per case rate
Diagnostic related group (DRGs)
Nationwide payment schedule that determines the Medicare payment for each inpatient stay of the Medicare beneficiary based on DRGs
Prospective Payment System (PPS)
Eligibility for Medicare (3)
- 1. 65 or over
- 2. Ind. all ages with perm. kidney failure
- 3. Ind. with long term disability who have received government-funded disability bevefits for 24m may be eligible
Part A of Medicare pays for (5)
inpatient hospital, SNF, home health, rehab, & hospice
T/F Part A Medicare have specific time limits & require deductibles and co-insurance payments by benificiary
Medicare Acute Hospital
What is included
- 1) PPS based on DRG regardless of LOS & number of services provided
- 2) TX supplies including A/E are included
- 3) Ind. hospitals determine the combo of services one receives.
Part B of Medicare pays for:
Outpatient physician & other professional services including OT provided by independent practitioners.
T/F Part B is considered Supplemental Medical Insurance Program and therefore must be purchased, usually monthly premium
T/F Part B services have a specific time & requires 20% copayment
F-no specific time
Primary difference between Part A and B Medicare
Inpatient part A requires services for a minimum of ____ days per week and part B typically covers ______ days per week outpatient.
SNF & Medicare
OT is covered if person requires skilled nursing or skilled rehab (PT, OT, SLP) on a daily basis (5X/wk)
OT in home care is covered if the person is __________ & needed intermittent skilled nursing care, PT, or ST ________ OT began.
- OT can continue after PT or ST has ended.
Home bound criteria (4)
- 1. Confined to home
- - need for the aid of ambulatory, assistance of others, or special transportation.
- -considers medical, physical, cognitive & psychiatric conditions
- 2. If leaves home it requires taxing & considerable effort
- 3. Can leave for med. appts. & non-med shoort-term & infrequent appt. (hairdresser or church)
- 4. Need for adult day care doesnt preclude person from receiving HHS.
- Reimbursed under PPS
- DME excluded from HHA PPS
- HHA PPS uses a classification system called Home Health Resources Group (HHRG) to determine episode payment rate.
An _______ is defined as a 60 day period beginning the first billable visit & ending 60 days after the start.
OASIS-Outcome and Assessment Information Set
- OT can complete initial OASIS
- Must be completed within 48 hours of referral or person's return home
- OT can conduct follow-up, transfer, & discharge evaluations.
T/F OT is hospice care is provided to terminally ill pt. to enable pt. to maintain fun. skills, ADL perf., & control systems
T/F Rental and purchase of DME is covered if used in pt. home & if necessary & reasonable to treat illness or injury or to improve function.
T/F A Dr. prescription is not needed & must include diagnosis, prognosis, & reason for DME
F- Need prescription
3 criteria for DME
- 1. Repeated use can be withstood
- 2. Medical purpose (W/C or walker)
- 3. Not useful to person in absence of illness/injury
Ind. below an established threshold or who have disability
Mandated Medicaid services
- inpatient & hospital services
- outpatient & physician services (lab work, SN)
- home health (level & amount vary)
- Early periodic screening diagnosis (EPSD) and tx services for those 21 and younger
- Services needed to tx condition during EPSD including OT
- SNF receiving medicaid including OT
Intervention Plan documentation (2)
- 1) Prioritized problem list
- 2) Goals related to problem list & indicating potential for fun. & improvement.
Structure of Goal statement
- 1. Client "Client will"
- 2. Desired functional behavior/occupaiton
- 3. Underlying factors that need to be re-mediated
- 4. Circumstances under which the behavior must be preformed/conditions (ind. with cueing)
- 5. degree in which the behavior is exhibited (3/4 times, min. number of reps)
Goals written in SMART format
- 1. Specific (not increase self-care, but develop ability to button shirt with non-dominant hand)
- 2. Measurable (number of time or percent)
- 3. Attainable (100% return is unlikely)
- 4. Relevant to roles & environment)
- 5. Time-limited (anticipated time to achieve goals
1) Established Medicare & SSI
2) SSI enables ind. with disabilities to receive monthly income to live in community.
Medicare Title 18-PL 89-87
1) Prohibits discrimination on basis of disability in any program that receives federal assistance
2) All fed. agencies to develop action plans to hire, place, advance ind. with disabilities
3) Contractors who take federal contracts to take affirmitive action & employ ind. with disabilities
Rehabilitation Act 1973
1) Prohibits discrimination on bases of disability, religion, sex, color, race, etc.
2) Owners of housing to make reasonable exceptions to their standard tenant policies to allow ind. with disabilities to equal housing opp. (allows seeing eye dog in apt.)
3) allow residents to make reasonable modifications to common areas & private living space
4) newly constructed multifamily residences build to meet accessibility standards.
Fair Housing Act
1) Affirmed application of 504 of rehab act which prohibits discrimination in federally funded programs to a diversity of services (head-start, block grant program)
2) Medicaid funding to community-based services when services are demonstrated to be less than institutional care.
Omnibus Budget Reconciliation Act (1981)
1) Prohibits discrimination against qualified persons with disabilities in emplyment, transportation, accomodations, relecommunications, public services
2) Criteria for classifying ind. with disability
Americans with Disability Act (ADA)
ADA title I-Employment
- Prohibits discrimination
- Allows questions about one's ability to perform a job but prohibits questions whether one has disability
- qualified ind. with disability is one who can perform essential functions with or without reasonable accommodations
- US gov., Indian Tribes, religious groups, & private tax-exempt membership clubs are exempt from ADA employer guidelines
- 1. 15 + employees
- 2. acquisition or mod. to equipment/devices
- 3. Mod. adjustments to examinations, training materials, publications
- 4. acillary aids or services
- 5. modified or part time work schedules, job reconstructing, or reassignment to vacant position
- 6. improvement of existing facilitiies
Types of auxiliary aids & services
- 1. tapes texts, qualified readers, or other visually delivered materials accessible to ind. with visual imp.
- 2. interpreters or other methods that can effectively make orally delivered materials accessible to those with hearing impairments
- 3. mod or acquisition of devices/equipment
- 4. similar actions that increase accessibility
ADA- Title II Public Services
1. Cant deny in participation of services, programs, public entities (transportation, ed., employment, recreation, health care, courts, town meetings, voting)
ADA Title III-Public Accommodations & Services operated by Public Entities
- 1. public accommodations (hospitals, health care provider offices, schools, daycare) can't discriminate & respect participation and ability to benefit
- 2. all new construction of public accomodations must be accessible
- 3. public transportaton accessible
- 4. physical barriers removed
- 5. private services that serve public (stores, resturaunts) cant discriminate
ADA title IV-Telecommunications
- 1. All tvs must have closed cap.
- 2. phone cpompaines must provide telecommunicaiton relay services (TRS) for those with hearing/speech imp. 24hr.7 days
1. Strives for realistic easier for person with disability to work
2. Maintain medicare/Medicaid for 54m. after starting work
3. eliminates limits on medicaid buy in options
4. enables consumer to have choice in service provider beyond public assistance programs
5. community based & vocational planning & assistance programs
6. increase employment support services
7. all states design own program
Ticket to Work & Work Incentives Improvement Act
1. Fed. sponsored national employment & vocational training system
2. "ONE-STOP" delivery system seeking employment & training. Unemployment & vocab. training now in one place.
Work Investment Act (WIA)
T/F Ticket to work and Work incentives improvement act emphasizes self-determined work plans & community-based vocational services.
T/F Work investment Act (WIA) provides services for youth, 14-21 with disabilities to aid in their transition from school to work; making the WIA a valuable resource for schools with limited resources
T/F Questions about one's disability are allowed during job interview
F-only questions related to the essential job functions
T/F Federal employees have mandated ADA reasonable accomodations
F-US Gov., indian tribes, tax-exempt member ship clubs, & churches are exempt
T/F Child must be invited to transition plan meetings & transition begins at 14.
T/F IDEA does not appreciate self-advocacy & self-determination
T/F Student who is suspended for assulting peer must still receive home services.
T/F Ind. 65+ receiving SSI can work without any effect on their SSI benefits & their are no income restrictions.
Omnibus Budget Reconciliation Act (OBRA) 1990
- 1. Applied to all nursing home that receive fed. funds for medicare/medicaid pt.
- 2. residents rights, autonomy, self-determination
- 3. quality of care, enhancing QOL in nursing homes
- 4. Mandated comprehensive resident assessment system, Minimum Data Set (admin upon admission & annual basis unless sign. changes)
- 5. Psychosocial well-being & activity pursuit
- Restraint reduction
T/F Although self-determination & well-being are priorities in a SNF, maintenance for health, safety, & well-being will be priority.
T-SNF resident with dementia & diabetes continues to eat sugury candy & cookies, the SNF staff can justifiably restrict the person's diet due to health dangers presented by this habit.
1) Model that views ind. with disability as one who has incurred physiological insult that has resulted in reduced fun. capacity
2) focus on identifying the disease & treating the dysfunction using biomechanical or neurodevelpmental FOR.
1. Views ind. with disability as lacking knowledge or skills
2. Focused placed on learning or making behavioral changes needed to interact in env. successfully
3. FOR include role aquisition & cognitive rehab.
1. Views ind. lacking skills, resources, supports, for community participation.
2. Focus placed on identifying & dev. skills needed for one's expected env. or resources/supports needed to fun. in the env.
3. FOR include life-style perf. & occupation adaptation
- 1. Requires intervention to develop skills to work
- 2. D/C is usually to vocational program
- 3. D/c to work can occur if sign. abilities are developed
- 1. development of specific vocational skills
- 2. person has prerequs to work (good tasks skills and habits) but requires training for specific job and/or ongoing structure, support, spv to maintain employment
- 3. has to dev, skills to level for comp. employment
1. D/C not always goal
2. Maintenance of person in these structures env. can be desired objective or some ind. can D/C to other programs or work.
Rehabilitation workshops formally called sheltered workshops
1. Time limited (3-6 months)
2. D/C to competitive employment, supportive employment, or rehab workshops
Transitional Employment (TEP)
1. ongoing support, intervention & referrals as needed to a company's employees to maintain this employment
Employee Assistance Program (EAP)
4 basis steps to program development
- 1. Needs assessment
- 2. Program planning
- 3. Program implementation
- 4. Program Evaluaiton
Capital Expense Budget
- 1. perm or long-term purchases
- -ADL kitchen
- 2. Typically item above a fixed amount
- 3. Usually Expensive ($500=)
- 4. Seperated from other expenses due to depreciation of value & possible tax credits for purchases & investments.
Operating Expense Budgets
- 1. Daily financial activity
- 2. Direct expenses, indirect expenses, Fixed expenses, Variable expenses
Cost related to OT service provision such as salaries & benefits, office supplies, & tx equipment
costs shared by the setting; utlities, housekeeping, marketing
Expenses remain the same even when there are changes in amount of services provided; rent
change in direct proportion to the amount of services provided; splinting materials
Budget formula used to determine the number of personnel providing direct care
2 practitioners who do admin half the day & direct care half the day would equal
1 FTE (full time equivalent)
What is also called cost-volume-profit anylisis
What does it determine?
- Break even analysis
- the volume of services needed to be provided for revenues to equal cost and profits=to 0.
Debts within a budget
Indicates payments that are due for purchases or services rendered (equipment supplier or landlord)
The assets within the budget
indicates payments that are owed to the program, setting, institution (fees for services)
system-oriented approach that views limitations and problems proactively as opp. increase quality
prevention is emphasized
blame isnt attributed to persons, problems are related to organizational imporvement needs
Quality Improvement (QI)
creation of an organizational culture that enables all employees to contribute to an env. of continuous improvement to meet or exceed expectations
Total quality management (TQM)
systematic method to evaluate the appropriateness & quality of services
utilization of interdisciplinary systems focus
client-centered approach which focuses on rights, assessment, care & ed. of the person
Organizational ethics, improved organizational perf., leadership, management are emphasized
performance assessment and improvement (PAI)
plan to review resources within a facility
determination of medical necessity & cost efficiency
often component of QI & PAI
assess care to ensure app. services are appropriate & not overutilized or underutilized
groups of peers who evaluate the appropriateness of services & quality of care under reimbursement and/or state licensure requirements
professional review organization (PRO)
Evaluation of proposed intervention plan that specifies how and why care will be provided
used by 3rd party payers to apprve proposed OT intervention programs
eval of ongoing intervention program during hospitlization, outpatient, or home care
ensures app. care is being delivered
often component of QI & PAI
What type of approach should be used for a team that is experiencing conflicts among it's members
Team building approach with open communication
OT is asked to provide input on the dev. of capital budget for a new school. What items might be involved?
Any item $500-1000, computers, workstations
What expenses are considered when their are direct changes in the number of students serviced by OT staff
Variable expenses (positioning devices)
What expenses reflect those such as salaries/fixed costs
2 group design that includes random selection & assignment into exp. group that receives tx pr a control group that receives no tx. All other exp. are kept similar.
The two levels of TX (some and none) together constitute the __________ ___________ being manipulated.
- independent variable
- TENS on pain
What is the independent and dependent variable
The effectiveness of tens on pain
An independent variable is manipulated to determine its effect on a dependent variable but there is a lesser degree of research control and/or no randomization
What is often used in health care research when it's unethical to control or without hold treatment
Used to study intact groups created by events or natural processes
No manipulation of independent variable; randomization & researcher control are not possible
Used to study the potential relationships between 2 or more existing variables (attendance at day program and social interaction skills)
describes relationships, predicts relationships among variables without active manipulation of the variables
- P factor .05 is considered statistically significant closer to 0, the better
- 0.1 statistically significant
- 0.6-not good
T/F Qualitative research studies people, ind. or collectively, in their natural social & cultural context
study of 1 or more ind. & how they make sense of their exp.
Min. interpretations by examiner
Meanings can only be ascribed by participants
complete involvement of the researcher in the exp. of the subjects to understand and interpret phenomenon
aim to understand human exp. & its meaning
meanings can only be understood if personally exp.
Patterns & characteristics of a cultural group, including values, roles, beliefs, and normative practices
single subject or group of subjects is investigated in an in-depth manner
purpose can be description, interpretation, or eval
easy to use in most practice settings
What are the 3 measures of central tendancy (average or typical scores) and define
- Mean: average of all scores
- Median: midpoint, 50% above & 50% below
- Mode: most frequently occurring score
Measures of variability: a determination of the spread of a group of scores
what are the 4 types & define
- 1. range
- 2. standard deviation
- 3. normal distribution
- 4. percentiles & quartiles
the difference between the highest score & lowest
determination of the variable of scores (difference) from the mean
Most frequently used measure of variability
symmetrical bell-shaped curve indicating the distribution of scores; the mean, median, & mode are similar.
-half the scores are above the mean & half are below
-most scores are near the mean, approximately 68% of scores fall within +1 or -1 SD of the mean
-frequency of scores decrease further from the mean
-distribution may be skewed (not symmetrical) rather than normal; scores are extreme clustered at one end or the other; the mean, median, & mode are different
Percentiles & quartiles: describe a scores position within the distribution, relative to all other scores
Define each one
1. Data is divided in 100 equal parts; position of score is determined
2. data is divided into 4 equal parts & position os score is placed accordingly.
- 1. Percentile
- 2. Quartiles
Determines how likely the results of study of a sample can be generalized to whole population
An estimate of expected errors in an ind. scores; measure of response stability & reliability.
standard error of measurement
an estimation of true difference, not due to chance, a rejection of null hypothesis
Alpha level: pre-selected level of statistical significance
.05 or .01 indicates that expected diff. is due to chance, true diff. on measured dep. variable
Test of significance
- Standard error: expected chance variation among the means, result of sampling error
- Type 1 error: null hypothesis is rejected
- Type 2 error: null hypothesis is not rejected
Steps to take to explore the efficacy of a specific tx
- 1. complete comprehensive & systemic lit. review
- 2. critique of published research
- 3. Formulate research question
- 4. finalization of project design
T/F If using a standardized measure, if the mean, median & mode are different, the results are skewed & reliability of the data collection should be questioned.
T/F Using standardized measure, if reported scores are 1/2 below the mean and 1/2 above the mean, the distribution is NOT normal & these results don't provide meaningful & useful data.
F-the distribution is normal & it provides meaningful & useful data.
Respondents indicate their level of agreement according to a scale
Respondents place a number along side a list of items, indicating their level of importance
point scale with opposing adjectives at 2 extremes, measuring affective meaning.
T/F It is not app. for peer to document results from an eval she did not attend; however, a supervisor can provide documentation based on staff's input.
Plan to review the use of resources within a facility to determine medical necessity & cost efficiency.
T/F Potential fraud is a serious situation & must be brought to supervisors attention
T- this could be the case of another OT billing for full day of services when she was at a concert and you saw her.
To determine cost effectiveness you would complete a
Determine how well programs goals have been acheived
evaluate effectiveness of intervention
T/F The following are required in job description
2. employer expectations
3. expected productivity
4. how employee's perf. is measured
What is a censure
- Formal public disapproval of an OTs conduct
- Serious & public
formal written expression of a disapproval against OT conduct & is retained in NBCOTs files
perm. loss of NBCOT certification
OT given period of time to retain counseling or educaiton
Commission on Accrediatation of Rehab facilities
regulatory agency for the provision of rehab services
Joint Commission on Accreditation of Hospital Organizations
reviews medical care in hospital orgs.
Which info would be completed in a utilization review?
A. Therapeutic use of ADL apartment
B. splinting & A?E prescribed to clients prior to D/C
C. use of personal care attendants
D. craft & art materials
- A. Utilization review analyzes the use of resources within the facility. It examines the medical necessity & cost efficiency of the resources.
- ADL apartment is considered a facility resource
- Splints, A/E crafts, materials are not facility resources
- PCA is a personal resource, not facility.
T/F When doing human subject research, one must first obtain institutional review board approval (IRB) prior to consent from subjects