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Abstract
This study examined the effects of Medicare's Prospective Payment System (PPS) on occupational therapy practice in skilled nursing facilities (SNF). According to a billing audit, interviews with occupational therapists (OT), and a comparison with the Standards of Practice, PPS has changed the focus of intervention in several ways. The findings indicate less therapy time spent in activities of daily living (ADL) and a perception among therapists of an overall change in the quality of intervention-including barriers to the practitioner's ability to be client-centered. A comparison to the Standards of Practice suggests a discrepancy between American Occupational Therapy Association ideals and actual practice in some areas.
Additional information
Notes on contributors
Jennifer Kennedy
Jennifer R. Johnson was a graduate student in the School of Occupational Therapy, Texas Woman's University, Houston, TX at the time of this study. She is currently employed as an Occupational Therapist at Touro Infirmary in New Orleans, LA
Debra Stewart is Lecturer, School of Rehabilitation Science, McMaster University and staff therapist at Erinoak Centre, Missis-sauga, Ontario. She is currently completing a MSc (Design, Measurement and Evaluation) at McMaster University.
Ronald L. Mace (deceased, June 29, 1998) was also affiliated with The Center for Universal Design, School of Design, North Carolina University.
Lois Rosage and Geraldine Shaw are Occupational Therapist Consultants who provide evaluations for the housing programs at the Philadelphia Corporation for Aging.
Lois Rosage and Geraldine Shaw are Occupational Therapist Consultants who provide evaluations for the housing programs at the Philadelphia Corporation for Aging.
Debbie Rand is Occupational Therapist, Beit Rivka Geriatric Rehabilitation Hospital, Petach Tikva, Israel. She completed this study in partial fulfillment of the requirements for the Master of Science degree in Occupational Therapy, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem. Her mailing address is 50 Heh B'Eyar Street, Apartment 5, Rosh Ha'Ayin, Israel, 48056.
Maureen McKenna is a Licensed Physical Therapist and Licensed Marriage and Family Therapist in California. Her Current position is: Assistant Professor of Physical Therapy, Wheeling Jesuit University, 316 Washington Avenue, Wheeling, WV 26003.
Heather Lambert was funded in part by a Health Canada NHRDP Fellowship, a REPAR Fellowship, a doctoral bursary from the Fonds de la Recherche en Santé du Quebec, and a Canadian Occupational Therapy Foundation-Royal Canadian Legion Fellowship in Gerontology.
Trish Wielandt was supported by a University of Queensland Postgraduate Research Scholarship (UQPRS).
Dr. Leigh Tooth was supported by a NHMRC Fellowship (#997032) while some of this research was undertaken.
J. D. “Herb” Herbert is Occupational Therapist, Rocky Mountain Menders LLC, 363 Pioneer Road, Lyons, CO 80540. At the time of this study, he was a graduate student, Department of Occupational Therapy, Colorado State University, Fort Collins, CO.