PASRR SUMMARY OF FINDINGS EXAMPLE
Youth with PASRR ID and RC conditions (“Tommy”)
Diagnostic Impressions Axis II Primary: Severe Intellectual Disability Axis II Secondary: Seizure Disorder, Cerebral Palsy Axis III: significant for aspiration pneumonia, hypoxia, history of hydrocephalus, tracheostomy placement likely secondary to chronic ventilator needs (trach was removed around toddler age), severe tracheomalacia, respiratory insufficiency, cerebral palsy, and a seizure disorder. His surgical history includes status post shunt and multiple revisions, EGD and biopsies, history of esophageal stricture status post dilation, and hip adductor release. He has a G-­‐tube and requires IPV for secretion management. He is currently prescribed Diazepam, Lasix, Zofran, phenobarbital, MiraLax, Zantac, and risperidone. Summary/History Tommy is currently hospitalized with respiratory insufficiency. He was born prematurely at 24 weeks and has cerebral palsy, an intellectual disability, and a seizure disorder. The Level II evaluator administered the standard WAIS on 2/22/2014 and found Tommy to be in the severe range of intellectual functioning with a Full Scale IQ of 40. Tommy is currently 19 years old. Before he was hospitalized, Tommy lived with his mother and his younger brother, Sam. Tommy attended XX Public Schools until the 8th grade. His mother withdrew Tommy from school because his medical problems had become too complex and had required numerous hospitalizations. When he lived at home, his mother was his primary caretaker. His mother reported that Tommy had not received waiver services, though she believed he was “on a waiting list for something”. Tommy’s mother says she very much wants for Tommy to return home, but would like to make sure that he is medically stable before he is transferred back to her home. His mother continues to be involved in his current and ongoing care planning. Tommy is congenial and very friendly. Though he uses a few words and sentences, he does use gestures to communicate his needs and wants. His mobility and fine motor skills are impacted to a great degree by the cerebral palsy. Familiar others understand his communications with far greater ease than persons new to Tommy. He requires physical assistance with activities of daily living and instrumental activities of daily living. He requires a G-­‐tube for nutrition. Tommy has no history of behavioral concerns. Unique Personal Characteristics, Skills, and Talents Tommy is congenial and cooperative with his medical caregivers as they check on him throughout the day. Tommy loves to interact with people, is quite responsive to others, and most especially loves to be sung to. He exhibits good frustration tolerance, even when his medical care was uncomfortable. He likes when caregivers chat with him, ask about his feelings, or engage with him in enjoyable tasks. He has a warm and supportive relationship with both his mother and brother. Specific Limitations and Needs Tommy does not usually verbalize his wants and needs. Caregivers must pay close attention to his behavior, gestures, and responses to situations to learn his needs and wants. He may not directly indicate pain or discomfort. Tommy has short attention span for structured or learning tasks. He requires significant supports to communicate, to manage his everyday needs, and to manage his medical needs. Tommy can get lonely, and misses his mother and brother. Tommy likes to “get up and get around” more than he is able to do on his own, because he can’t independently ambulate. PASRR Decision for Placement © 2014 ASCEND MANAGEMENT INNOVATIONS LLC. ALL RIGHTS RESERVED.
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PASRR SUMMARY OF FINDINGS EXAMPLE
Youth with PASRR ID and RC conditions (“Tommy”)
Tommy’s medical and functional needs make nursing facility placement medically necessary according to state criteria. Therefore, NF placement is approved. However, once his medical condition is stable, and supports can be arranged, Tommy is a good candidate to be served in the community with HCBS services and supports. Recommendations Both PASRR specialized and rehabilitative services of lesser intensity are recommended for Tommy while he resides within the nursing facility. Specialized services to be arranged by the state include (note each state determines which services are in the SS category and which are in the RS category. The categorization will vary state to state.) : • Communication skills: specifically, his interactions with NF staff may benefit from development of a communication aide, such as a rudimentary picture board • Education: Tommy qualifies for educational services until age 22, and may benefit from the socialization, interaction and the content of such • Feeding devices • Wheelchair seating/customization • Wheelchair seating/positioning • Mobility aids • Targeted case management and/or transition resource specialist: to assist Tommy and his mother to link with services and supports in the community sufficient to allow him to return to his mother’s home. Rehabilitative services to be arranged by the nursing facility include: • Non-­‐customized durable medical equipment: for ambulating • Occupational therapy • Physical therapy • Restorative nursing • Speech-­‐language pathology • Visual/hearing Physical and occupational therapy evaluations are needed in order to assess his current rehabilitative needs and help him achieve as much independence as possible, both with everyday ADL tasks, such as mobility and in using his hands and arms to communicate and interact with others. It is important that NF goals for Tommy aim for improvement in his functional abilities, as this will allow him more opportunity to engage with others in meaningful ways. For successful discharge to a community setting, he will require ongoing and significant assistance with activities of daily living, support to monitor and respond to his medical needs, oversight of medication administration, and full support for instrumental activities of daily living. Targeted case management is recommended to assist Tommy and his mother to actively explore available community placement options and resources for support and services that can help him return to his mother’s home. The nursing facility must ensure that a referral to [name of state and local ID services entities] is made, and specialized services are arranged for and delivered. The NF must collaborate with the targeted case manager to ensure Tommy and his mother are able to identify and explore waiver or local options for paid and/or unpaid A targeted resident review is recommended in 120 days in order to further assess his status, status of recommended specialized and rehabilitative services, and to assess for any additional needed specialized ID/DD © 2014 ASCEND MANAGEMENT INNOVATIONS LLC. ALL RIGHTS RESERVED.
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PASRR SUMMARY OF FINDINGS EXAMPLE
Youth with PASRR ID and RC conditions (“Tommy”)
services. Prior to the 120 day targeted resident review, the [local transition specialist entity] should review Tommy’s needs, service options, and to assist with community service planning. The goal is for discharge planning to begin upon admission to the nursing facility with the presumption that with sufficient individualized supports and services Tommy can live within an integrated community setting, with supports and involvement from his family and community providers. © 2014 ASCEND MANAGEMENT INNOVATIONS LLC. ALL RIGHTS RESERVED.
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