Many Registered ‘Treatment’ Nurses are now receiving specific training in carrying out complex pain management interventions, and can carry these out in accordance with prescribed directives; as per the ACFI User Guide either a registered nurse or an allied health professional may provide complex pain management and practice for a Directive-4a.

Physiotherapists specialise in the assessment and provision of modalities for the management of pain, stiffness, immobility, loss of function, etc. In order to ensure that these assessed needs are appropriately identified, many organisations are maintaining the assessment and prescription of directives as the role of the physiotherapist, and referring some of these interventions to the Treatment Nurses. The ACFI User Guide states that it is permissible for the service to be provided by a different health professional than the one who gave the directive, provided they are included in the list of health professionals who can undertake the service and are operating within their scope of practice.

Using this approach aged care facilities dramatically benefit, both clinically and financially, by having a combination of interventions in terms of complexity and/or frequency. This often involves a mix of Directive-3’s, Directive-4a’s, and Directive-4b’s. To achieve the 6-points from a Directive-4b, this must be performed by an Allied Health Professional. By utilizing a Treatment Nurse to complete the Directive-4a’s, then this potentially allows the Physiotherapist or Occupational Therapist to provide more Directive-4b’s, allowing sites to improve both from a financial and resident outcomes perspective.

Reference: ACFI User Guide
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-1007-userguide.htm

Prepared by: Michael Peachey
Presented by: Wellness & Lifestyles Australia

Do you find that the way some staff are documenting is affecting your funding, or that they’re not always performing the interventions required? Especially when it comes to understanding the business rules, we commonly hear that carers:

• Can’t find the time
• They’re doing it but not documenting the interventions, or
• They just aren’t doing it as they don’t feel confident in providing these interventions

By keeping track of our sites’ validation results, we’ve determined that many sites do not have a good understanding of the ACFI business rules. This is a big concern, especially when a downgrade of only one category can result in a loss of up to $13,000 per year!

That is why Wellness & Lifestyles have created the Aged Care Funding Instrument Overview, which helps to solve these issues and problems.

What this training can do for you?

• Get all levels of staff on board to help maximize ACFI funding
• Improve your staff’s understanding of documentation requirements to maintain funding at validation
• Ensure that your staff know how to correctly provide the interventions to improve compliance and clinical outcomes
• Gain a better understanding of the ACFI business rules – learn a proactive approach to maximize funding whilst minimizing documentation

Included in this training is…

• How funding is determined
• What are the ACFI Domains
• The ACFI Cognitive Skills & Behaviours Domain
• The ACFI Complex Health Care Domain
• Proactively using ACFI Business Rules

Who should use this training?

You and your staff should go through this training if you have residents at your facility that you think are not maximised, you’ve ever been downgraded in any domain, or you’re just concerned that you might not be getting the funding for services you’re already providing to your residents.

Some of the sites we’ve provided training to rarely were resubmitting residents because they just weren’t confident… even though they were actually requiring much higher care than they were getting funding for. Now nearly every resident is resubmitted in a timely manner. This lead to an increase in funding of huge proportions!

We’ve realized that not all staff at facilities need (or want) the same level of training regarding the ACFI and it’s components; the needs of care staff and clinical staff responsible for submitting the appraisals are quite different.

It’s important for all levels of staff to have an understanding of the basics and how to do the interventions too, because we’ve found that the RN’s and CN’s providing mentoring and guidance to the care staff helps with job satisfaction and compliance.

Read the rest of this entry »

Prepared by: Daniella Kittel

Explaining the knee arthroscopy procedure and providing all of the important details you need to know for a successful rehabilitation.

Do you want to prepare yourself physically and mentally for your knee arthroscopy? Do you find that you have questions about the procedure and rehabilitation?

Knee arthroscopies are a relatively non-invasive surgery and often do not require long hospitalization.

Having a guide on how you should be caring for your knee at home and when you should be introducing activities like driving will be useful for the safe recovery of your knee and your peace of mind.

By having an up to date and comprehensive understanding of knee arthroscopies, you will be able to achieve the best results from rehabilitation.

What this e-book can do for you!

• Give an understanding of the anatomy and biomechanics of the knee joint
• Provide an explanation on what knee arthroscopy surgery involves and give some common variations
• Have an all you need to know to rehabilitation

Included in this e-book is:

• Knee anatomy
• Knee arthroscopy – indications for surgery
• Knee arthroscopy – the procedures and variations
• Advice and information for after an arthroscopy
• Explanation of correct walking technique
• Rehabilitation exercises after surgery stages 1 and 2

Who should use this e-book?

Anyone who has a knee injury or degeneration and requires knee arthroscopy surgery would benefit from this e-book. By having a clear understanding of the anatomy of the knee, what the surgery involves and what to expect, you will to well prepared for your surgery. By having a rehabilitation program you will be able to ensure that your knee makes a quick and safe recovery.

We realise that by just reading this book you are not going to be proficient in all aspects of knee arthroscopy rehabilitation. Practical training by a specialist physiotherapist or occupational therapist is always recommended. Wellness & Lifestyles Australia can provide you with these therapists if needed. The book should only be used as a resource document following some interactive training. E-learning modules by W&L are also available.

To read the Knee Arthroscopy E-book, please log in below.

The human hip joint is both one of the most movable and most stable joints in the human body. Known as a ball and socket joint, it is made up of the rounded head of femur (ball) and the concave acetabulum (socket), which is encased by a strong joint capsule and surrounded by a number of muscles and ligaments which stabilise the joint and allow movement to occur. Some of the most important muscles acting upon the hip joint are the buttocks, which are responsible for moving the leg backwards, turning it outwards and lifting it to the side. In a healthy adult, these muscles are large and strong, and provide good support for the hip joint from the back and side, helping the joint capsule to stop the joint from dislocating.

However, with age, a number of changes may occur within the hip joint, including degeneration of the joint surfaces due to osteoarthritis or rheumatoid arthritis, thinning of the bone due to osteoporosis, death of bone in the femoral head due to poor circulation (avascular necrosis) or tumours developing within the joint. Falls often also affect the hip joint, as thinning bones make hip fractures more likely. To help correct these changes, and reduce the pain and disability associated with them, joint replacement surgery is a common option.

What happens during surgery?

The two main types of hip replacement surgery are a total hip replacement (arthroplasty), where both the head of femur and acetabulum are replaced, or a hemiarthroplasty, where only the half of the joint, usually the head of femur, is replaced. The procedure for both types of surgery is similar, with either a posterior or lateral approach being used. The posterior approach involves surgeons making an incision at the back of the hip joint, cutting through the gluteus maximus muscle, and dislocating the joint with the leg bent up, rotated inward and brought across the midline. The lateral approach, on the other hand, involves detaching the gluteus medius, gluteus minimus and vastus lateralis, which are more to the side of the hip, and dislocating the joint with the leg bent backwards, rotated outwards and brought across the midline.

Why is there a risk of dislocation, and how can it be avoided?

Both the posterior and lateral approaches involve removal of the joint capsule, and cause the buttock muscles to be weakened, which means that the support they are able to provide will not be as good as it was prior to surgery. Subsequently, there will be an increased risk of the joint dislocating until the tissues surrounding the joint heal and the muscles become stronger. To avoid dislocation, there are several simple movements that should be avoided in the first 6 weeks following surgery. These movements are: bending the hip to more than 90°, allowing the operated leg to cross the midline and rotating the hip inwards.
While simple, there are multiple situations in which activities will need to be modified to avoid these movements. To avoid bending the hip past 90°, those with hip replacements will not be to pick up objects off of the floor, reach their lower legs or sit on low beds and chairs. This means they may need to have pick-up sticks in place to be able to reach low-lying objects, have assistance with dressing and putting on shoes, and have toilet seat raisers, high chairs and adjustable beds in place at all times during the first 6 weeks post-surgery.

To stop the operated leg crossing the midline, habits such as crossing legs in sitting or resting in side lying will need to be avoided. Additionally, a pillow placed between the legs while in bed will assist in maintaining the correct position while sleeping. It will also often be easier to get out of bed on the non-operated side, and get into bed on the operated side, to prevent the leg from moving inwards. During these transfers, the operated leg should be kept straight out in front and in line with the trunk, with both legs moving at once both into and out of bed.

When rising from a sitting position, the operated should also be kept in front, with most of the weight being taken through the un-operated leg, and the arms being used to push upwards to achieve a standing position. When sitting down, the un-operated leg should once more be held out in front, and the arms used to gentle lower down into a sitting position.

As well as the previously mentioned precautions, avoiding twisting the operated leg when walking and turning is essential to stop hip rotation. This means taking small steps when going around corners or changing directions, and turning in the direction which is furthest from the operated leg (for example, turning clockwise if the left is the operated hip). A walking aid will also almost always be required during the first 6 weeks post-surgery, which usually be a frame and will be prescribed by a physiotherapist prior to discharge from hospital.

When walking, it is important for the walking aid to go first, followed by the bad leg, and then the good leg. Even steps should be encouraged, with the operated leg always facing forwards rather than turning in. To go up steps, this patter is altered slightly. When going up a step, the walking aid goes first, followed by the good leg, and then the bad leg. Going down a step, the walking aid once more goes first, then the order of the legs is reversed, with the bad leg going down after the walking aid, followed by the good leg.

For the non-weight bearing resident

While the majority of those undergoing hip replacement surgery will be able to place weight on their operated leg post-surgery, for those who are weak, frail or have experienced complications post-surgery, it may be necessary for additional equipment to be used during transfers. To avoid dislocation, the process for using a sling lifter with someone who has recently undergone a hip replacement is the same as for other individuals, with the addition of longer legs straps being used at all times to avoid bending the hip past 90°.

Further information on exercises to aid recovery, as well as necessarily levels of assistance and equipment to assist with care can be provided by Wellness and Lifestyle Physiotherapists and Occupational Therapists.

References:
•    White, M & Shiel, N 2009, A Patient Guide to Hip Replacement Surgery, Concord General Repatriation Hospital, Australia, viewed 09 June 2011 <http://www.sswahs.nsw.gov.au/concord/orthopaedics/pdf/Knee/THR%20Booklets%2009.pdf>
•    Griffith Rehabilitation Hospital n.d, Total Hip Replacement, Australia
•    Regional Health Sciences Centre 2005, Yours Total Hip Replacement, St Joseph’s Hospital, Canada, viewed 09 June 2011 <http://tbh.net/programs_&_services/surgical_services/hip_surgery/Your%20Total%20Hip%20Replacement.pdf>

Swallowing disorders (dysphagia) due to dementia, stroke, Parkinson’s and other neurological diseases affect 40 to 60% of nursing home residents. However, only 22% are referred to a speech pathologist for an evaluation. Licensed nurses who DO NOT refer residents to speech pathologists for evaluation, are placing residents at risk. Unrecognized and unmanaged dysphagia may lead to malnutrition, dehydration, aspiration pneumonia, and asphyxiation.

‘Malnutrition and dehydration are associated with infections (including urinary tract infections and pneumonia), pressure ulcers, anaemia, hypotension, confusion and impaired cognition, decreased wound healing, and hip fractures. Residents may become weak, fatigued, bedridden, apathetic, and depressed’¹.

“This is no way to live. I wish I were dead and buried.”
—‘A 76-year-old man who died weighing 31 Kg, 54 % less than his ideal weight of 68 kg’1.

According to the Elder Abuse Prevention Association, dehydration and malnutrition are signs of neglect, for which residential facilities are liable.

Research shows that a multidisciplinary approach may prevent or reverse malnutrition and dehydration. Speech pathologists promote nutrition, hydration, and pulmonary safety, by assessing appropriate diet and fluid consistencies.

Overheard in a facility’s nurses station last week:
Personal carer: ‘Mr. Smith is coughing a lot during meals’
Nurse: ‘I know. Let’s put him on a soft diet and thickened fluid’

Diet and fluid modifications that ARE NOT followed up by a speech pathology evaluation may place residents at risk of dehydration, malnutrition and aspiration. These are potentially fatal conditions, for which the residential facility is liable.

Evaluation by a Speech Pathologist should be conducted to ensure appropriate diet and fluids.

Here is why:

• Thickened fluids may exacerbate some symptoms of dysphagia, reducing safety when swallowing.
• Inappropriate diet consistencies may lead to aspiration and pneumonia.
• Inappropriate diet and fluid consistencies may reduce quality of life.
• Health care settings are obliged to ensure diets and fluids are provided to the correct consistency. Incorrect consistencies jeopardise pulmonary safety, nutrition and hydration, and may increase a facility’s liability.
• Thickened fluids are costly and have a high level of wastage.

DO YOU HAVE 10 RESIDENTS ON THICKENED FLUIDS?
This is costing you approximately $3000 annually! Did you know that RN/ENs overprescribe thickened fluids by 30%? Speech Pathology assessments reduce the number of residents on thickened fluids by 22%, eliminating unnecessary costs, saving $700 annually!

DID YOU KNOW:
Between 30% and 70% of thickened fluid is wasted, costing facilities up to $2100 annually for ten residents!

Research shows that speech pathology reviews facilitate appropriate diet and fluid consistencies, and may increase oral intake by 100%. This NOT ONLY promotes nutrition and hydration, but may reduce wastage and reduce liability.

Wellness and Lifestyles’ speech pathologists are specially trained in dysphagia management in aged care, and can help promote nutrition and hydration, cost reduction due to wastage, and reduce liability risks. For a speech pathology assessment, please call Wellness and Lifestyles on (08) 8331 3000. Our mobile Speech Pathologists will come to you within 24 hours.

Reference:
1. Burger, S., Kayser-Jones, J., & Bell, J. (2000). Malnutrition and dehydration in nursing homes: Key issues in prevention and treatment. National Citizens’ Coalition for Nursing Home Reform.

Prepared by: Michael Peachey
Presented by: Wellness & Lifestyles Australia

Do you find that the way some staff are documenting is affecting your funding, or that they’re not always performing the interventions required? Especially when it comes to understanding the business rules, we commonly hear that carers:

• Can’t find the time
• They’re doing it but not documenting the interventions, or
• They just aren’t doing it as they don’t feel confident in providing these interventions

By keeping track of our sites’ validation results, we’ve determined that many sites do not have a good understanding of the ACFI business rules. This is a big concern, especially when a downgrade of only one category can result in a loss of between $9000 to $13,000 per year!

That is why Wellness & Lifestyles have created the ACFI Activities of Daily Living, which helps to solve these issues and problems.

What this training can do for you?

• Get all levels of staff on board to help maximize ACFI funding
• Improve your staff’s understanding of documentation requirements to maintain funding at validation
• Ensure that your staff know how to correctly provide the interventions to improve compliance and clinical outcomes
• Gain a better understanding of the ACFI business rules – learn a proactive approach to maximize funding whilst minimizing documentation

Included in this training is…

• An overview of the ACFI
• The ACFI Activities of Daily Living Domain
• Documenting assessed needs
• Level of assistance – ACFI definitions
• Level of assistance – Definitions for Q1-Q4
• Recording continence

Who should use this training?

You should go through this training if you have clients at your facility that aren’t a Medium or High in Activities of Daily Living, you’ve ever been downgraded in Activities of Daily Living, or you’re just concerned that you might not be getting the funding for services you’re already providing to your clients.

Some of the sites we’ve provided training to have previously claimed poorly in Activities of Daily Living because they just weren’t confident… even though they were actually providing the services. Now nearly every resident is maximised. This often leads to an increase in funding.

We’ve realized that not all staff at facilities need (or want) the same level of training regarding the ACFI and it’s components; the needs of care staff and clinical staff responsible for submitting the appraisals are quite different.

This session is set-out in a progressive format, where ACFI Business Rules and strategies build upon previous information, and are left to the end. It’s important for all levels of staff to have an understanding of the basics and how to do the interventions too, because we’ve found that the RN’s and CN’s providing mentoring and guidance to the care staff helps with job satisfaction and compliance.

Read the rest of this entry »

Prepared by: Kirsty Masters
Presented by: Wellness & Lifestyles Australia

This training will help anyone who works in aged care facilities with residents to understand the importance of exercise to reduce the risk of developing serious complications

Do you find that your staff lack a basic understanding of exercise? Are residents left in their rooms due to poor understanding of the need to exercise?

Do you work in an aged care facility? Would you be interested in learning how to delay/prevent long term complications with residents through exercise? If you answered yes to any of these, then this e-learning module is for you!

Our highly experienced physiotherapists have developed an e-learning module with advice on why you should exercise, how much exercise, awareness of safety issues, barriers and strategies, exercise variety and practical programming ideas to design your own exercise programs.

What this training can do for you…

• Educate you on safe exercises and how it benefits residents
• Delay and/or prevent long term complications associated with non-exercise
• Provide you with practical ways to improve residents mobility

Included in this training is…

• Why exercise?
• How much exercise is recommended
• What type of exercise is best
• Basic exercises that can be done anywhere
• Risks of exercise
• Barriers to exercise
• General guidelines for existing injuries
• Aerobic and cardiovascular exercise
• Challenges

Who should use this training module…

You should use this training if you work in an aged care facility and are looking for ways to prevent long term complications of not exercising.

Clients who we have provided this module to have reported a better awareness of the problems associated with non-exercise. This has therefore enabled them to take action and start basic exercise programs with residents.

This education session does not cover all possible exercises for the elderly however it will provide a valuable core understanding for carers looking to provide a higher level of care.

It is set out in an easy to follow format which will benefit both clients and carers. It is important for people to understand and appreciate that exercise is vital to maintain quality of life.

Read the rest of this entry »

W&L continues its momentum to deliver the best in aged care therapy services and our commitment to quality does as well. And for that reason, the SAI Global audit documented that no systems needed immediate improvement and that W&L ‘passed with flying colours’.  As a result, our certification in the ISO 9001 program continues and we couldn’t be happier. The audit review highlighted our “comprehensive documentation systems” and noted evidence of our “continuing commitment to improvement in system changes and updates.” It also emphasised our investment into IT infrastructure as secure and specific to maintaining our ongoing growth and sustainability.

The level of depth undertaken by SAI Global showed that “W&L consider the Quality System an integral part of their overall business management.” It also noted that our “good team approach within the organisation” was “evidenced through the W&L Credo and W&L Family Core Values,” principals we hold to a high regard and standard. The audit also reported on opportunities for improvement and applauded W&L’s movement to a paperless system allowing us to “escalate the system documentation, audits and improvements” regarding all aspects of W&L.

W&L’s vision is to become the benchmark for aged care therapy services in Australia, supply ‘best in class’ services that surpass needs and to be recognised as the industry expert on the needs of the older population. With quality systems, documentation and processes this can be achieved. By performing at our best and ensuring our management systems are compliant, we continue to meet and understand the needs of the aged care industry.

For more information, visit the Wellness & Lifestyles website at www.wellnesslifestyles.com.au or call us on +61 8 8331 3000.