presented by Cindy Krafft & Diana 'Dee' Kornetti
What does the “typical” patient receiving therapy in the home setting look like? It seems the days of mostly orthopedic or post-CVA patients have passed, to be replaced by patients with much more complex medical conditions. Therapists need to be prepared to address the unique issues connected to specific patient populations, whose numbers are growing, that seek out home based options for care.
Cindy Krafft brings more than 20 years of home health expertise that ranges from direct patient care to operational and management issues. Years spent in the homes of patients confirmed that she was in the best setting to focus on functionality and the specific challenges faced by each patient. Cindy recognizes that providing care in the home environment is different from providing care in any other setting, which is evident in both her training and consultation activities. For the past 10 years, Cindy has been a nationally recognized educator in the areas of documentation, regulation, therapy utilization, and OASIS. She has served in several national projects and been an expert resource for OASIS updates. Her focus is on providing the knowledge and tools to operationalize external requirements while keeping the driver of care where it needs to be—the needs of each patient being cared for in the home setting. Cindy has been involved at the senior leadership level of the Home Health Section of the American Physical Therapy Association for more than 10 years and is the immediate past president of that organization. She has been working with APTA and CMS to clarify regulatory expectations and address proposed payment methodologies to ensure the long-term participation of therapy services in home health. She has written two books—The How-to Guide to Therapy Documentation and An Interdisciplinary Approach to Home Care—and co-authored her third, The Post-Acute Care Guide to Maintenance Therapy.
Diana 'Dee' Kornetti, a physical therapist for 30 years, is a past administrator and co-owner of a Medicare-certified home health agency. Dee now provides training and education to home health industry providers through a consulting business, Kornetti & Krafft Health Care Solutions. She serves as chief operations officer with her business partners Cindy Krafft and Sherry Teague. Dee is nationally recognized as a speaker in the areas of home care and standardized tests and measures in the fields of physical therapy, therapy training, and staff development in the home health arena. Dee is the immediate past editor of The Quarterly Report, a publication of the American Physical Therapy Association’s (APTA) Home Health Section, as well as a member of the Home Health Section’s Practice and Education committees. She currently serves as the president of the Home Health Section of the APTA and has been an active member in good standing since 1986. Dee also currently serves as the president of the Association of Homecare Coding and Compliance, and is a member of the Association of Home Care Coders Advisory Board and Panel of Experts. Dee is a published researcher on the Berg Balance Scale, and has co-authored APTA’s Home Health Section resources related to OASIS, goal writing, and defensible documentation for the practicing therapist. Dee has contributed chapter updates to the Handbook of Home Health Care Administration 6th edition, and co-authored a book, The Post-Acute Care Guide to Maintenance Therapy. Dee received her BS in Physical Therapy from Boston University’s Sargent College of Allied Health Professions, and her MA from Rider University in Lawrenceville, NJ. Her clinical focus has been in the area of gerontology and neurological disease rehabilitation.
Conditions such as heart failure are closely connected to issues with aerobic capacity, which necessitates a more detailed assessment than “endurance is poor." Therapists need to know which specific assessment and care planning practices will enhance their effectiveness with this specific patient population.
The impact of neuromuscular impairments, especially in late effect situations, is significant to both the assessment and care planning processes. Many times the questions are raised specific to what can be “improved” by therapy and when “stabilizing function” should be the focus.
At times, the home health patient presents with a multitude of medical, psychosocial and environmental issues and it can be difficult to prioritize functional limitations and determine the best course of care. The medically complex patient requires additional skills to manage and understand when, or if, improvement will happen or if maintenance therapy would be the most appropriate plan.