The ASHA Leader - February 2015 - (Page 52)

holding on...And letting go The gift my father gave me was the opportunity to push and pull each other as we together addressed the paradox of a good life while dying. And to face the fears we all face when it comes to death, terminal illness and grief. he sat down with a groan, his face registering the struggle. I offered that everything could be done bedside from now on, and he seemed surprised. "Really?" he asked. As I assured him it could, a look of relief crossed his face. His nurse was right. I knew now was the time to spend 24/7 with Zeke. During the first week Zeke was bedbound, he allowed me and other family members to care for him. The complementary therapists provided comfort measures such as massage and lymphedema management. As his need for pain medication increased, he slept more. His appetite declined to pleasure feeds only, and he began to cough while drinking thin liquids. But when I mixed thickener into his juice, he screwed up his face and grimly asked, "What's that?" In another "rehabilitation in reverse" moment, I put away the thickener. During his second week in bed, he slipped into a coma. Then several days later, on Feb. 12 at 6:10 p.m., I witnessed Zeke quietly take his final breath, as if satisfied with the good fight. It had been a little over a year since he first signed onto hospice care. It's now been seven years since my father passed away. Another story Even after reading this story about Zeke and me, you may be thinking, what do physical therapy models of palliative care have to do with me, as an SLP? My answer is: everything. Many of us do not recognize the value we bring to the interdisciplinary team treating patients who are at end-of-life-or even if we do, we may not market our services accordingly. What would SLP intervention, using models of palliative care, look like with a patient with advanced illness? Let me quickly tell you another story. Recently I had a patient, "Rosemary," with dementia. She returned home from being hospitalized for weight loss and dysphagia. During the hospitalization, her husband agreed to a percutaneous endoscopic gastrostomy tube placement. However, he told the home care nurse that he wanted to "see if we can get this feeding tube removed." I was consulted to assess her swallowing and nutritional status. Medicare Covers Skilled Rehab Services Regardless of Functional Improvement Speech-language pathologists and other rehabilitation professionals may bill Medicare for services that help patients maintain or prevent decline of function. The 2014 federal Jimmo v Sebellius settlement required Medicare to revise its policy manuals to reflect that reimbursement for therapy services will not be denied merely because the patient's function does not improve. Six manuals now state: "Coverage of skilled therapy does not turn on the presence or absence of a patient's potential for improvement from the nursing care, but rather on the patient's need for skilled care." This and other statements in the manuals place the responsibility of clear documentation of skilled services on the SLP. aSHa has developed documentation examples and guidance (on.asha.org/skilled-documentation). Federal officials who oversee the contractors primarily responsible for auditing medical records reviewed and accepted that guidance and distributed copies to those contractors. 52 February 2015 | THe aSHa Le aDer http://on.asha.org/skilled-documentation

The ASHA Leader - February 2015

Table of Contents for the Digital Edition of The ASHA Leader - February 2015