Page 51 - Ombudsman Participant Manual Optimized_Neat

The RNAC does not exist in personal care homes. PCH is required

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to o annual support plans for each resident and residents can be

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involved n that process. There is a physical assessment that

must be done but the rest of the process is rather informal

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compared o the process used in nursing homes.

Rehab manager / Rehab Director Licensed clinician who is the “lead” in the Rehab Department;

attends care plan meetings; coordinates the various modalities to

assist residents in achieving their highest possible level of

function. Nursing homes are required to help a person achieve –
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and maintain – their highest possible level of function. n order
to o that, they typically have a variety of therapists and therapy

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assistants who provide hands-on-therapy and rehab services to

the residents living at the facility. The Rehab Director is a

licensed therapist of some kind (physical, occupational, etc.) who

functions the department “head”. They supervise staff &

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services; focus on documentation and clinical assessments;

reimbursement; regulatory compliance, etc. They can provide

“hands-on” care, or they may be strictly administrative – it
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depends n the facility.

Most personal care homes do not have a rehab department.

They may offer rehab services through a sub-contractor or

outside provider. But rehab is not a PCH requirement.

Physical Therapists Licensed clinicians who focus on mobility and regaining function
and independence. Physical therapists and Physical Therapy

Assistants provide the ‘hands-on” therapy to residents on their

caseload. Residents may not need/receive treatment from all

modalities. Their therapy plan is driven by their assessment &

diagnoses and their discharge plan. Therapy staff are rarely

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involved n the admission process. They refer to the admission

paperwork when deciding the needs of the resident. TIP: A

“key” piece of information included in the admission paperwork

is the discharge goal. f someone other than the resident has

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completed the admission paperwork it is possible that the goal
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listed not the goal that the resident truly wishes. For example,

a concerned daughter may indicate that the resident is staying

“long-term” because it’s “what is best” even though the resident

may wish to return home. n this scenario, the therapy
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department would not be as “aggressive” in therapy since the

resident only needs to be able to function in the facility. The

resident becomes frustrated because they are not progressing

and not aware that the therapy department is under the

impression they are staying. Often a care plan meeting will not

occur until the last third or fourth week after admission, so the

issue isn’t identified until several weeks into the stay. Advocacy

tip: when you have a resident frustrated with therapy/lack of

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therapy always encourage the resident to speak with the Rehab

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Director o they can compare notes regarding goals and

discharge plans.
Office of the LTC Ombudsman
Office of the LTC Ombudsman
Version 1.0 September 2020
Version 1.0 September 2020
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