15th Case of the Week Due 11/15/18, by 1pm EST

FIDA Emblem/HIP SNF, Review 10/5/18
CCR5. 86 yo female s/p fall d/t Syncope & collapse resulting in Fx Lt Proximal Humeral & Pelvic Ring. Target LOS 21 days provided to facility based on DRG number: NA. TGD: 10/2/2018. Expected DCP: Lives at home w/support from others. D/c date: 10/16/18. SW to contact family regarding DCP. Number of Skill Days used out of 100 days: 22 days as of 10/3/2018. PMH: HTN, HLD, Dementia, Anemia, Osteoporosis, Hx of falls. PLOF: Able to ambulate indoors w/cane, outdoors w/ a rollator walker for up to 1/2 block w/ SBA from HHA/family. DMEs: Grab bars, cane, rollator. HHA 6 hours/day, 7 days/week. Home Set Up: 3rd floor walkup apartment w/family.

*Skilled Medical Needs: Precautions: Fall risk, NWB on LUE with arm sling & WB as tolerated on LLE. Tylenol 650mg Q6H, Oxycodone HCL 5mg Q4H/PRN, Simvastatin 20mg QHS, Ferrex 150mg QD, Colace 100mg QHS, Meclizine 25mg Q8H, Miralax QHS, Senna 8.6mg QHS, Vitamin B-12 1000mcg QD, Lidoderm 5% patch QD for 12 hours.
*Current Mental Status: AAOx1
*Ambulation: Max A 20’ parallel bars (CCR4 Max A 15 feet).
*Bed mobility: Mod A (unchanged CCR4). Pain in LUE.
*Transfers: Mod A (unchanged CCR4). NWB LUE and WBAT on LLE. *Standing: Dynamic- Poor (+) (unchanged CCR4). Able to stand with support. WBAT on LLE with FWW and LUE support.
*Stairs: Total dependence (unchanged CCR4).
*Bathing: Max A (unchanged CCR4). Hygiene/Grooming: Mod A (unchanged CCR4).
*Dressing: UB: Min (improved CCR4), LB: Mod A (unchanged CCR4). *Toileting: Min A (CCR4- Max). *Toilet transfers: Min A (unchanged CCR4). *Speech Tx: Regular/Thin liquid. Self-feeding: Set-up.

Case Conference CCR4, MD discussed pt plateauing & needing LTC. Per PT/OT pt not making reasonable gains in major functions; SW discussing alternative DCP w/family for custodial care/LTC.


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