As the degree of frailty increases the potential for returning to baseline health status and completion of an intensive rehabilitation program decreases. This does not mean that the frail resident should not be placed in an active therapy program or that expectations at the outset will be for failure.
What does it mean and how can we plan for the best outcomes?
- Obtain as much information as possible before and immediately after admission to calculate a frailty risk score or to understand current function as much as possible.
- Communicate as a multi-disciplinary team to determine the most optimized approach to the the resident’s therapy program.
- Think outside the box: shorter periods of therapy over a longer length of stay or rehab goals based on function prior to hospitalizations (If Mom couldn’t climb stairs before she won’t climb them now – even with therapy!)
- Make sure everything is communicated with the family (and resident if able to participate): a. Frailty Risk Score – what does it mean in terms of all outcomes including rehab potential b: Your current functional assessment and what you know about their baseline function (look for agreement here) c: How you intend to modify your therapy program to accommodate their frailty status d: The realistic goals you have set (again look for agreement) e: When you will meet again to bring them up to date on the progress made and if there will be a Plan B if no progress is made
The goal is to bring the resident as close to baseline as possible and to avoid surprises for the family.