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Residential Aged Care Services Allied Health Services

Reason for Referral

September 2017

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Table of Contents

Introduction .................................................................................................................. 3

Dietetics ....................................................................................................................... 4

Occupational Therapy ................................................................................................. 5

Prosthetics and Orthotics............................................................................................. 6

Physiotherapy .............................................................................................................. 7

Podiatry ....................................................................................................................... 8

Speech Pathology ....................................................................................................... 9

Social Work ............................................................................................................... 10

Appendices ................................................................................................................ 11

MR09 1.4 – Allied Health Residential Aged Care Services (RACS) Referral Form ... 11

MR09 1.3 – Residential Care Central Intake Initial Needs Identification Form .......... 12

MR09 1.5 – Directorate of Allied Health External Services – Individual Service

(Assessment) ............................................................................................................. 13

MR09 1.51 – Directorate of Allied Health External Services – Individual Service

Agreement (Implementation) ..................................................................................... 14

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Introduction

Residents require a ‘reason for referral’ to be placed on the waiting list for an Allied Health Services assessment. ‘New resident’ alone is not accepted as a reason for assessment. It is not recommended to refer a resident at the end-stage of palliative care. All referrals for Allied Health Services are made on Allied Health Residential Aged Care Services (AH RACS) referral MR form (Appendix 1). These are processed through Allied Health Residential Aged Care Services Central Intake (AH RACS CI) on fax: 5320 3800. AH RACS CI form (Appendix 2) is to be only used by Allied Health Central Intake Staff and not completed by referrer. Please advise AH RACS CI if referred resident is transferred or deceased.

RISK A: IMMINENT RISK Patient at imminent risk of serious adverse event (includes imminent admission as inpatient or risk of delaying imminent discharge) and intervention likely to change that risk. If we don’t do it now they will be in hospital unnecessarily and/or suffer horribly B: SIGNIFICANT RISK Patient at significant risk of serious adverse event (includes imminent admission as inpatient or risk of delaying imminent discharge) an intervention likely to change that risk. If we don’t do it quickly there will be significant consequences POTENTIAL TO BENEFIT C: TIMELY Rx CRITICAL Effectiveness of intervention is time critical for optimal outcome; a significant delay in providing a service will exacerbate the situation/result in significant deterioration or result in an ineffective intervention. If we’re going to help, we need to start soon Reason for Referral Evidence base indicates that timely intervention is far more effective Client significantly restricted in usual activities and timely intervention likely to improve situation D: STABLE + BENEFIT Patient likely to benefit from intervention, but not time critical, as the situation is relatively stable. Can survive for now but we can help AND at least one of the following: Problem of less than three months duration Moderate impact on usual activities Complex care needs requiring a team approach E: BENEFIT UNSURE Patient unlikely to benefit from intervention. Don’t think we can help at this time/with this situation

BHS Psychiatric Services and Non BHS Residential Facility Referrals Please refer to Appendices 3 and 4 regarding the appropriate forms to be used.

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Dietetics INTRODUCTION The list below is to be used in conjunction with the Residential Services Nutrition (Standard 2.10) Clinical Practice Guideline. Priority A: Imminent Risk Enteral nutrition - new or poor tolerance Complex dietary requirements (acute/medical), including conditions such as Coeliac

Disease, Food Allergy, Food Intolerance, MAOI diet, Vegan (due to risk of nutritional deficiencies)

Priority B: Significant Risk Severe Loss of Weight (>5% loss of body weight over one month or >10% loss of body

weight over six months) or Loss of Weight where body weight decreases to less than 40kg

Severe Loss of Appetite/reduced oral intake (prolonged) Malnutrition (including MNA score < 17) Malnutrition affecting wound healing (pressure ulcers stage II-IV) Abdominal pain with eating, associated with gastrointestinal disorders such as

Pancreatitis and Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis) Ascites - severe Complex dietary requirements (social), eg. cultural food issues requiring dietetic

assistance with food provision/Catering Diarrhoea / Steatorrhoea / high faecal output Electrolyte imbalance (renal), requiring dietary modifications (not age-related) Priority C: Timely Review Critical Enteral nutrition - review due to weight gain Loss of Weight unplanned - other than severe (Refer to Nutrition CPG 2.10) for criteria when to refer to dietitian Poor chronic wound healing (pressure ulcers stage II-IV) Nutritional deficiency (eg. iron, zinc, vitamin C, vitamin D, vitamin B12, folate) Underweight/low BMI, where weight is stable Dysphagia/modified consistency diet requiring nutritional supplementation, may be

appropriate for residents receiving smooth puree or moist minced food, and/or thickened fluids

Blood glucose levels (BGLs) unstable (regular results <3mmol/l or > 15 mmol/l) or elevated HbA1c (>7%)

Diabetes - newly diagnosed (requiring education) Insulin commencement (requiring education) Priority D: Timely Review Beneficial Constipation (requiring Dietetic advice) Hyperlipidemia Please note: intervention is only suitable for residents under 65 years of age Obesity (BMI > 30) or weight gain Please note: active weight loss over 80 years of age is not recommended Priority E: Benefit Unsure None

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Occupational Therapy Priority A: Imminent Risk None Priority B: Significant Risk None Priority C: Timely Review Critical Staff advice required re: method of altering bathroom set-up in facility environment Risk of adverse event due to risk to self or others, residents/carers/visitors (wheelchair

use, transfers, equipment) Significant risk of development of, or deterioration of, pressure ulcers/wounds Staff and carer require OHS education in safe management of dependent patient in order

to continue care in facility Change in mobility aid to manual and/or motorised wheelchair with implications for safe

maneuvering and use inside and outside facility Priority D: Timely Review Beneficial Change in ability to safely perform transfers, eg. need for a chair platform Change in resident’s size, pathology that leads to potential issues related to seating

positioning, posture, seating, pressure care Change in ability to perform self care tasks, eg. request for equipment prescription Change in ability to manage own meals, eg. adapted cutlery and crockery Difficulty with positioning, function and hygiene, eg. palm protector for hand contractures Home Assessment to enable discharge/home leave Priority E: Benefit Unsure Evidence-base indicates that the intervention will not work for this client Intervention unlikely to work because client unable or unwilling to participate effectively Previous intervention for the same problem with no significant benefit.

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Prosthetics and Orthotics Priority A: Imminent Risk None Priority B: Significant Risk None Priority C: Timely Review Critical Prosthetics Patient unable to don/doff prosthesis - not coping with prosthesis Oedematous residual limb preventing use of prosthesis Pressure areas on residual limb causing pain and/or discomfort Prosthesis in a dysfunctional state of repair Orthotics Facilitate ambulation for: neuromuscular dysfunction, contractures, pressure areas and

foot ulcers. Limitation of motion for: joint instability, fracture management, neuromuscular dysfunction

and contractures Orthosis Review/Replacement: Unable to don/doff orthosis Orthosis in a dysfunctional state of repair Oedematous limb preventing use of orthosis Pressure areas causing pain and/or discomfort Priority D: Timely Review Beneficial Prosthetics Patient and carer unable to don/doff prosthesis - not coping with prosthesis Orthotics Facilitate ambulation for leg length discrepancies Limitation of motion for: joint instability, skeletal or soft tissue pain, neuromuscular

dysfunction Oedema control: Pressure garments (Class 2 and above) Orthosis Review/Replacement: Change of prescription required Current orthosis user - not coping with orthosis Priority E: Benefit Unsure Evidence-base indicates that the intervention will not work for this client Intervention unlikely to work because client unable or unwilling to participate effectively Previous intervention for same problem with no significant benefit.

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Physiotherapy Priority A: Imminent Risk None Priority B: Significant Risk Respiratory Dysfunction: Acute Respiratory condition where patient exhibits two or more of the following;

o Acute CXR changes and/or added sounds on auscultation o Acutely productive of sputum/change in sputum production o Ineffective cough/requiring suction o Unable to mobilise (if normally ambulant) o Increase in WCC or temperature related to a chest infection o Decrease in SaO2 due to a respiratory condition and requiring O2 o Post-op for upper abdominal/chest surgery o Does not have a current NFR or not for active intervention order.

Priority C: Timely Review Critical A change in ability to safely/independently mobilize and/or increased number of falls or

increased risk of falls Recent deterioration in mobility and function causing increase in number of falls, or

significant increase in risk of falls Recent deterioration in medical status affecting mobility and function (eg. exacerbation of

progressive neurological conditions such as Parkinson’s disease) Recent change in weight-bearing status due to injury or illness (this may be specified by

medical personnel, eg. to be NWB 6/52) Prescription or modification of gait aid. Priority D: Timely Review Beneficial A change in strength, endurance and/or balance not impacting on safety Post joint immobilization where there is a marked loss of strength, movement and

function. (eg. after removal of plaster) Post discharge from acute/sub-acute hospital when treating physiotherapist has

recommended ongoing physiotherapy follow-up. Priority E: Benefit Unsure Prescription of exercise programs for non-functional upper limbs Prescription of exercise programs for fully dependent/bed bound patients Long-standing contractures (> 6/12) Chronic painful conditions not related to recent reduction in mobility/function (eg. arthritis,

osteoporosis, lower back pain) Mobility problems related to cognitive issues or reduced co-operation/motivation Deterioration in mobility related to acute medical problems such as UTI/pneumonia.

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Podiatry High ACFI Only Priority A: Imminent Risk Signs/symptoms of infection associated with foot ulceration and history of amputation Priority B: Significant Risk Acute Charcot Neuroarthropathy Signs / symptoms of infection with foot ulceration Cellulitis with portal of entry located on foot Pedal pressure area (Stage 1– 4) Extreme neglect of nails / skin causing skin integrity breach and infection Priority C: Timely Review Critical Deterioration of foot ulceration within previous 48 hours Second opinion ulceration management History of foot/leg ulcer (currently intact) at risk of recurrence due to medical status Chronic neuropathic foot Complex medical issues and associated feet pathology (eg. significant history of vascular

disease) Extreme neglect of nails / skin causing skin integrity breach Vascular assessment required prior to commencement of condition management (eg.

ulceration, lymphoedema) Priority D: Timely Review Beneficial Initial Residential Services Assessment and Care Plan Priority E: Benefit Unsure Foot pathology not affecting ability to perform ADLs Reduced ability to self-care, no underlying pathologies or medical conditions that place

the foot at risk of complication

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Speech Pathology Priority A: Imminent Risk Resident has had recent neurological event or deterioration in status which has resulted

in immediate risk of aspiration/choking. E.g. Coughing or choking with every mouthful of food/fluid and chest status is compromised.

Priority B: Significant Risk Resident has had recent decline in ability to swallow and manage food/fluid that is not

commensurate with expected neurological and/or cognitive decline and moderate risk of aspiration and/or choking is suspected. Resident has an agreed plan in place for active management of consequences related to choking and/or aspiration.

Priority C: Timely Review Critical Resident has had a recent change in swallowing status and has had evidence of loss of

weight and increased episodes of coughing with meals (strategies can be given, ie. Downgrade meals/fluids until assessment by Speech Pathologist).

Resident has had recent change in intelligibility/ability to communicate that is not related to cognitive impairment. It may be related to progressive neurological disorder and is affecting ability of staff/family to understand residents needs/requests.

Priority D: Timely Review Beneficial Resident is on modified diet and fluids and requests upgrade Family meeting needs to be organized to discuss future care needs in relation to

Dysphagia in QOL reasons (but not imminent need) Resident may benefit from assistance of new updated communication device. Priority E: Benefit Unsure Resident/family continually request inappropriate foods in spite of training. Education

already given by Speech Pathologist Long term communication issues Family requests another review.

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Social Work Priority A: Imminent Risk Elder Abuse apparent or suspected (financial, physical, sexual, psychological, neglect) Placement at risk. Priority B: Significant Risk Consultation around need for application to VCAT for Guardian / Administrator or review

of current appointment/s. Priority C: Timely Review Critical Family meetings to assist positive outcomes for resident Advocacy for resident Adjustment issues related to transition to RAC. Complex psychosocial issues impacting on resident. Priority D: Timely Review Beneficial Nil Priority E: Benefit Unsure Nil

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Appendices

MR09 1.4 – Allied Health Residential Aged Care Services (RACS) Referral Form (Epicor no. 706111)

To be used for ALL referrals

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MR09 1.3 – Residential Care Central Intake Initial Needs Identification Form (Epicor no. 702904)

Allied Health Central Intake Use Only

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MR09 1.5 – Directorate of Allied Health External Services – Individual Service (Assessment) (Epicor no. 711092)

Note: This form will be used for BHS Psychiatric Services except for Dietitian referrals. This form is also used by non BHS

residential facilities who do not have BHS contracted AH services.

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MR09 1.51 – Directorate of Allied Health External Services – Individual Service Agreement (Implementation) (Epicor no. 711093)

Note: This form will be used for BHS Psychiatric Services except for Dietitian referrals. This form is also used by non BHS

residential facilities who do not have BHS contracted AH services.

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