Total Joint PREP ClassKnee Replacement

T. Andrew Israel, MDT. Andrew Israel, MD

Luther Midelfort Orthopaedic & Sports Medicine Center

Goals for you and your family attending this class

Recognize knee replacement is a reliable operation to relieve pain and restore function.

Describe what to expect of the knee replacement procedure.

Discuss the risks of knee replacement surgery.

Goals of your knee replacement

Improve your quality of life Relieve your pain Restore function (knee movement,

alignment) Increase activity

Knee Arthritis

Loss of cartilage leads to narrowing of the joint space.

See the bone spur formation?

Knee Arthritis

As the cartilage wears, bone spurs develop which can cause stiffness

Surgical Technique

-Resurface the bony surfaces with metal and plastic

-Balance the ligaments

-Restore alignment and motion (straighten the leg)

Implant materials

Metal and plastic are used

The metal is usually a cobalt-chrome alloy.

The plastic is UHMWPE or “poly”.

Implants

--The end of the femur is capped with a metal component.

-The end of the tibia may have a metal plate or plastic.

-A plastic spacer goes between the metal cap and plate.

Implants

If the back of the kneecap is worn, it is resurfaced with a plastic button

Surgical TechniqueIncision

Made in front of the knee, usually from above the kneecap down to bump on shin bone

Length of the incision depends on the thickness of soft tissue

Surgeon will make the incision long enough to see the area around the knee

Surgical techniques continue to improve as technology advances

Surgeon will use techniques to spare muscle

Day of Surgery

Your surgeon will meet you in SurgiCenter to initial your knee and answer final questions.

Family can wait with you in the SurgiCenter. You will go to the Operating Room (OR) first,

then to Recovery (PACU). Surgery lasts 1-2 hours, recovery 1-2 hours.

Finally, you will go to the Med-Surg Unit 4500.

Post-opTherapy

Physical & Occupational Therapy is important for a good outcome.

Your participation will improve your result You may have a machine that bends the knee –

called a CPM. Therapy starts the day after surgery

Get you out of bed Bend the knee! Straighten the knee! Walk with a walker

Other Doctors Additional Doctors take care of non-

orthopedic issues (such as high blood pressure or diabetes).

If you have an Internal Medicine doctor here they will see you after surgery.

If your regular doctor does not see patients in the hospital, a Hospitalist will see you after surgery.

If you are not getting a medication you think you should, please ask.

Blood Clot Prevention

You are at risk of a blood clot after knee surgery.

You will receive medication (warfarin or aspirin) after surgery to prevent blood clots.

TED hose should be worn for 3 weeks after surgery, you may remove these at night.

SCD (calf squeezers) are used when you are in the hospital and should be worn whenever you are in bed.

Risks of SurgeryBlood Clots

High risk (>20%) if no treatment

Clots can go to the lungs and be fatal

Your risk is reduced to <1% if treated with medication, squeezers

Getting out of bed and walking helps to prevent blood clots

Risks of SurgeryInfection

You will get antibiotics at the time of surgery and for 24 hours after surgery.

Surgeons, assistants and scrub techs wear “spacesuits”.

Using all precautions, risk of infection is ~1%. Infection may occur months or years after

surgery. An infection may mean removal of your

implants.

Risks of SurgeryBlood loss

Tourniquets are used during surgery. There may be some bleeding into the knee

after surgery. Your surgeon may use a drain in the knee

and give you some blood back. Your blood count will be checked each

morning after surgery. If you have symptoms from a low blood count,

you may need a blood transfusion.

Risks of Surgery - Stiffness It is painful to move the knee after surgery

and some people get stiff. You need to work hard to prevent stiffness. Work on both getting the knee straight (0

degrees) and bending the knee (90 degrees.) Goal is more than 90 degrees flexion by the

first week If you have limited motion at 6 weeks, your

surgeon may need to perform treatment under anesthesia.

Risks of SurgeryNeed for Revision

We encourage patients to wait as long as possible before knee replacement.

Implants wear with time…

~90% of implants last 12 years Revision surgery may involve changing the

plastic or changing one or both metal parts. Revision surgery is more challenging with a

more difficult recovery.

Risks of SurgeryMedical Complications

Surgery is a stress to your body.

Heart and lung problems, stroke, stomach problems, constipation all may occur.

A physical with your regular doctor and an EKG are required before surgery.

Despite precautions, unforeseen medical complications may still occur.

Risks of SurgeryAnesthetic Complications

You will meet the Anesthesia providers the day of surgery.

They will discuss anesthetic options such as; general, spinal, epidural, nerve blocks.

Nausea and vomiting are common but more serious side effects or complications may occur.

Please tell the anesthesia provider of any past experience with anesthesia.

Summary

Knee replacement is a reliable operation to relieve pain and restore function.

As with any operation, there are associated risks.

All of the precautions we take are to minimize risk and provide for a “routine” operation.

The purpose of this talk is to provide you with information about knee replacement.

Questions or Concerns?Questions or Concerns?

Joint PREP Class

Patient Resource and Education Program

Goals for you and your family

Discuss steps to take to get ready for the surgical procedure.

Discuss what to expect of the surgical experience.

Identify what you need to do to achieve the best outcome.

Recognize why it is important for you to participate in your plan of care.

Plan Ahead

Finish any planned dental work at least 2 weeks before your surgery date.

Plan for your return home. Identify who will take care of you after surgery. Plan for about 2 weeks. Simplify meals. Plan for 2 weeks of easy or no preparation meals. Prepare your home now- take notes today and get started!

Plan Ahead

Appointments: Regular doctor for pre-surgery; Blood work, EKG, Physical exam, discuss medications. Surgeon for final discussion and update.

Stop smoking – talk to your regular doctor to get help.

Call your surgeon if you get a fever, cold, infection or rash before your surgery date.

What to bring to the hospital

Loose comfortable clothing Comfortable nonskid walking shoes Personal items Copy of your advanced directives Insurance cards Medication list, inhalers, C-PAP mask Any assistive devices you have Prepaid long distance calling card (optional) Your Total Joint Replacement information folder

What not to bring to the hospital

Valuables/Jewelry Credit cards, check book or large sums of

money Your medications (except inhalers)

The day before surgery

A SurgiCenter nurse will call you to: Review your medications Tell you what medications to take and not take the

day of surgery Update your health history and review allergies Review eating, drinking and smoking restrictions Give hygiene instructions Tell you what time to arrive at Luther Hospital

Day of surgery

Take medications at home as instructed. Check in at Luther Hospital Registration Desk.

Day of Surgery (continued)

You will be taken to the SurgiCenter You will be asked your name and date

of birth by everyone who has contact with you – this is done for your safety.

Family and Friends are welcome. Try to limit to 2 people on day of surgery.

SurgiCenter

Nursing admission in the SurgiCenter- We will ask you many questions and discuss your: Medical history Plan of care Rights and

Responsibilities Safety

Anesthesia visit

Surgeon visit

SurgiCenter (continued)

If ordered for your surgery: blood work, x-rays, clip hair at the surgery site.

Your personal items are stored and later taken to your hospital room.

Leg squeezers (SCDs Sequential Compression Devices) and TED hose are applied.

Leg Squeezers – SCDs

Going to the Operating Room

Operating Room (OR)

Monitors Antibiotics Anesthesia Surgical scrub Foley catheter Time in operating

room area OR Staff will

communicate to your family if the surgery is 2-3 hours

Recovery Room/Post Anesthesia Care Unit (PACU)

You will be in recovery for about 1 hour.

You will have Monitors and Oxygen on

Your nausea and pain are monitored and controlled

When you are ready, you will be transferred to a hospital room.

Arrival in your Hospital Room

You will have… Oxygen – to help breathing and healing A foley catheter – to measure urine output An IV – to give you fluids and medication Incentive spirometer – to encourage you to

take deep breaths to prevent congestion in your lungs.

A pulse oximeter – a device that fits on your finger to measure blood oxygen level

Pulse Oximeter

Arrival in your Hospital Room(continued) We will check on you,

take your vital signs Start your Nutrition Activity as you tolerate Work together with you

to keep you safe. Help you with control of

pain and nausea

Pain Management

It is vital for you to describe your pain and where it is located.

Rate your pain: The Pain Scale0—1—2—3—4—5—6—7—8—9—10NO MODERATE WORSTPAIN PAIN POSSIBLE PAIN

We must work together to treat your pain-what makes it better/worse?

Using medication, deep breathing-relaxation, distraction, position change are some ways to help manage pain and discomfort

After Knee Surgery

We will care for your skin and incision You may have a drain in your knee

incision area You may have a Cryo Cuff or ice pack

on your knee You will have a continuous passive

motion (CPM) machine

Continuous Passive Motion Machine (CPM)

Post operative day ONE

Blood work Medication

Pain control *Anticoagulation – Warfarin

Catheter and drain removed. Nutrition as you tolerate Activity-Physical Therapy and Occupational

Therapy Work together to keep you safe.

You are a Partner in your care!

Post operative day TWO plan

The person who will be taking care of you after you go home needs to come to the hospital to learn about:

Safety Incision care Activity – Physical and

Occupational Therapy Medication for pain control

and anticoagulation

Day THREE/Discharge day.

Prepare for discharge to home or transitional care unit.

The person who will be taking care of you after you go home needs to come to the hospital again to learn about and get discharge instructions for: Incision care TEDS and how to keep swelling down How to take pain medications correctly Anticoagulation – Warfarin and blood work Antibiotic coverage card When to contact your Surgeon

You are a Partner in your care!

Elevation of your leg

Elevate knee above hip

and toe above knee to decrease

swelling and pain

After Discharge

A person to care for you will need to be available 24 hours a day to: assist you at home the first two weeks drive you to appointments encourage you in your therapy and progress

Bathing

You may shower when your incision is dry (no drainage)

Place a new dressing on the incision after shower

Do not submerge the incision in a bathtub, pool, hot tub, etc, until the incision is completely healed

Driving

Talk with your surgeon about when you will be allowed to drive again.

You must be: off narcotic pain medicines to drive able to sit in car comfortably able to move foot from gas to brake pedal easily

You need a valid driver’s license! Practice in a safe area.

A Follow-Up Appointment with your surgeon will be made 10-14 days after surgery

At your appointment we will: Remove your staples Give you care instructions about your:

Incision Bathing TEDS Assistive devices Medications – warfarin and pain control Joint replacement - dental procedures and antibiotics

Questions or Concerns?

Start getting ready for surgery. Make your plans.

Watch the Total Joint Replacement Video at www.luthermidelfort.org

Click on Medical Services, then Orthopedics Center

Thank you!

Joint PREPJoint PREP

Physical TherapyPhysical Therapy

Total Knee ReplacementTotal Knee Replacement

Joint PREPJoint PREP

Physical TherapyPhysical Therapy

Total Knee ReplacementTotal Knee Replacement

Home PreparationHome PreparationHome PreparationHome Preparation

• Become familiar with Become familiar with exercise handoutexercise handout

• If you have a walker, If you have a walker, practice using it and make practice using it and make sure you can get through sure you can get through your house with it.your house with it.

• Become familiar with Become familiar with exercise handoutexercise handout

• If you have a walker, If you have a walker, practice using it and make practice using it and make sure you can get through sure you can get through your house with it.your house with it.

Physical TherapyPhysical TherapyPhysical TherapyPhysical Therapy

Your therapy will start the day after Your therapy will start the day after your surgeryyour surgery

Your therapy will start the day after Your therapy will start the day after your surgeryyour surgery

Activities include getting into a chair, walking and working on the exercises

Therapy will continue twice daily until goals are met or you are discharged from hospital

Therapy Goals

Includes in/out of bed, getting out of a chair,

walking and stairs 2. Independence with

an exercise program to continue at home

1. Independence with mobility

Therapy Goals Cont’dTherapy Goals Cont’dTherapy Goals Cont’dTherapy Goals Cont’d

3.3. Learn appropriate use of walking Learn appropriate use of walking devices such as walker/crutchesdevices such as walker/crutches

3.3. Learn appropriate use of walking Learn appropriate use of walking devices such as walker/crutchesdevices such as walker/crutches

Can bring your own to hospital to make sure it’s sized correctly and get familiar with it’s use

Goals ContinuedGoals ContinuedGoals ContinuedGoals Continued

4.4. Your family member or friend Your family member or friend should be available on the 2should be available on the 2ndnd or 3 or 3rdrd day after your surgery to become day after your surgery to become familiar with the exercises and any familiar with the exercises and any assistance that you will need at assistance that you will need at home.home.

4.4. Your family member or friend Your family member or friend should be available on the 2should be available on the 2ndnd or 3 or 3rdrd day after your surgery to become day after your surgery to become familiar with the exercises and any familiar with the exercises and any assistance that you will need at assistance that you will need at home.home.

Range of

Motion

Gaining full knee

extension(straightening)

Is

KEY!

Range of Motion cont’dRange of Motion cont’dRange of Motion cont’dRange of Motion cont’d

Goal is 90 degrees of flexion (bending)

by the end of the

hospital stay

Range of MotionRange of MotionRange of MotionRange of Motion

CPM (continuous passive

motion)

You will use this machine while in the hospital

Exercise after DischargeExercise after DischargeExercise after DischargeExercise after Discharge

• WALK!WALK!

• Continue with exercises from Continue with exercises from hospitalhospital

• Outpatient PT if ordered by your Outpatient PT if ordered by your surgeonsurgeon

• WALK!WALK!

• Continue with exercises from Continue with exercises from hospitalhospital

• Outpatient PT if ordered by your Outpatient PT if ordered by your surgeonsurgeon

Questions or Concerns?Questions or Concerns?Questions or Concerns?Questions or Concerns?

Rehabilitation Services

Joint PREP

Occupational Therapy

Rehabilitation Services

Joint PREP

Occupational Therapy

Why Occupational Therapy?Why Occupational Therapy?

• Your occupational therapist (OT) is trained in the field of rehabilitation and is concerned about your safety in performing activities of daily living

• Your occupational therapist (OT) is trained in the field of rehabilitation and is concerned about your safety in performing activities of daily living

Activities of Daily LivingActivities of Daily Living

• Your OT will show and teach you ways to safely do your daily tasks

-Dressing-Bathing-Toileting

• Your goals for OT include:-Increased Independence-Increased Strength-Increased Mobility

• Your OT will show and teach you ways to safely do your daily tasks

-Dressing-Bathing-Toileting

• Your goals for OT include:-Increased Independence-Increased Strength-Increased Mobility

Adaptive EquipmentAdaptive Equipment

• Your OT will help you order/purchase adaptive equipment if it is needed to assist you with dressing and bathing

-Reacher-Sock aid-Long-handled shoe horn-Dressing stick-Elastic shoelaces-Long-handled bath sponge-Tub/shower chair or transfer bench-Raised toilet seat

• Your OT will help you order/purchase adaptive equipment if it is needed to assist you with dressing and bathing

-Reacher-Sock aid-Long-handled shoe horn-Dressing stick-Elastic shoelaces-Long-handled bath sponge-Tub/shower chair or transfer bench-Raised toilet seat

Before surgery…Before surgery…

• Prepare your home with safety in mind

-Remove throw rugs and clutter from traffic paths-Rearrange your kitchen so you can

easily reach often-used items-Install grab bars in bathrooms

• Prepare your home with safety in mind

-Remove throw rugs and clutter from traffic paths-Rearrange your kitchen so you can

easily reach often-used items-Install grab bars in bathrooms

In the hospital…In the hospital…

• Occupational therapy will begin the day after your surgery

• You will be seen by your OT once a day

• Occupational therapy will begin the day after your surgery

• You will be seen by your OT once a day

Day OneDay One

• Your OT may…-Learn about your home set-up and

help available to you at home-Begin home safety instruction-Discuss home equipment needs-Instruct you in an upper body exercise program

• Your OT may…-Learn about your home set-up and

help available to you at home-Begin home safety instruction-Discuss home equipment needs-Instruct you in an upper body exercise program

Day TwoDay Two

• Your OT may…-Practice with adaptive dressing equipment-Order dressing/bathing equipment

as desired-Review upper body exercise program

• Your OT may…-Practice with adaptive dressing equipment-Order dressing/bathing equipment

as desired-Review upper body exercise program

Day ThreeDay Three

• Your OT may…-Work with you on safety with room

maneuvering-Help you practice getting in and

out of a tub with the use of a tub bench or chair-Encourage you to participate in a

bathing/dressing session to determine the level of

assistance you may need

• Your OT may…-Work with you on safety with room

maneuvering-Help you practice getting in and

out of a tub with the use of a tub bench or chair-Encourage you to participate in a

bathing/dressing session to determine the level of

assistance you may need

When you leave the hospital…When you leave the hospital…

• Keep SAFETY in mind!

• Stay ACTIVE and INDEPENDENT!

• Keep SAFETY in mind!

• Stay ACTIVE and INDEPENDENT!

Questions or Concerns?

Thank You!

Questions or Concerns?

Thank You!

Joint PREPJoint PREPJoint PREPJoint PREP

Social Services and Case Social Services and Case ManagementManagement

Social Services and Case Social Services and Case ManagementManagement

Department RoleDepartment RoleDepartment RoleDepartment Role

• Social Services and Case Management staff can assist with:

-Insurance concerns-Home Health Services-Skilled Nursing Care-Community Services and referrals-Power of Attorney for Health Care-Counseling and Advocacy

• Social Services and Case Management staff can assist with:

-Insurance concerns-Home Health Services-Skilled Nursing Care-Community Services and referrals-Power of Attorney for Health Care-Counseling and Advocacy

Insurance AssistanceInsurance AssistanceInsurance AssistanceInsurance Assistance

• Once you and your Doctor decide Once you and your Doctor decide you will proceed with surgery you you will proceed with surgery you should :should :

-Pre-register at the front counter-Pre-register at the front counter-Notify your insurance company-Notify your insurance company-Get your insurance company’s -Get your insurance company’s approval.approval.

• Once you and your Doctor decide Once you and your Doctor decide you will proceed with surgery you you will proceed with surgery you should :should :

-Pre-register at the front counter-Pre-register at the front counter-Notify your insurance company-Notify your insurance company-Get your insurance company’s -Get your insurance company’s approval.approval.

Insurance Verification continuedInsurance Verification continuedInsurance Verification continuedInsurance Verification continued

• Insurance plans vary in what is Insurance plans vary in what is required to authorize your surgery.required to authorize your surgery.

• Our insurance notification may not Our insurance notification may not be enough. Some plans require you be enough. Some plans require you to call too. to call too.

• Many Medicare Advantage plans Many Medicare Advantage plans require prior authorization.require prior authorization.

• Your insurance company may take Your insurance company may take 15-30 days to complete this process.15-30 days to complete this process.

• Insurance plans vary in what is Insurance plans vary in what is required to authorize your surgery.required to authorize your surgery.

• Our insurance notification may not Our insurance notification may not be enough. Some plans require you be enough. Some plans require you to call too. to call too.

• Many Medicare Advantage plans Many Medicare Advantage plans require prior authorization.require prior authorization.

• Your insurance company may take Your insurance company may take 15-30 days to complete this process.15-30 days to complete this process.

During your stayDuring your stayDuring your stayDuring your stay

• Doctor decides when you are ready Doctor decides when you are ready for discharge to the next level of for discharge to the next level of care.care.

• The next level of care might be:The next level of care might be:home with or without Home Carehome with or without Home Care־ Nursing home Nursing home־Rehabilitation HospitalRehabilitation Hospital־Transitional Care Unit/Swing BedsTransitional Care Unit/Swing Beds־

• Doctor decides when you are ready Doctor decides when you are ready for discharge to the next level of for discharge to the next level of care.care.

• The next level of care might be:The next level of care might be:home with or without Home Carehome with or without Home Care־ Nursing home Nursing home־Rehabilitation HospitalRehabilitation Hospital־Transitional Care Unit/Swing BedsTransitional Care Unit/Swing Beds־

During your stayDuring your stayDuring your stayDuring your stay

• The usual hospital stay is 3 nights The usual hospital stay is 3 nights and 4 days.and 4 days.

• Talk with your Case Manager about Talk with your Case Manager about services you want after discharge as services you want after discharge as soon as possible.soon as possible.

• Check your insurance to see if it Check your insurance to see if it limits who you can use.limits who you can use.

• The usual hospital stay is 3 nights The usual hospital stay is 3 nights and 4 days.and 4 days.

• Talk with your Case Manager about Talk with your Case Manager about services you want after discharge as services you want after discharge as soon as possible.soon as possible.

• Check your insurance to see if it Check your insurance to see if it limits who you can use.limits who you can use.

Options for continuing care once you Options for continuing care once you can leave the hospitalcan leave the hospital

Options for continuing care once you Options for continuing care once you can leave the hospitalcan leave the hospital

1.1. Transitional Care Units or Swing Transitional Care Units or Swing BedsBeds

2.2. Skilled Nursing FacilitiesSkilled Nursing Facilities

3.3. Home Care optionsHome Care options

4.4. Home with outpatient services.Home with outpatient services.

1.1. Transitional Care Units or Swing Transitional Care Units or Swing BedsBeds

2.2. Skilled Nursing FacilitiesSkilled Nursing Facilities

3.3. Home Care optionsHome Care options

4.4. Home with outpatient services.Home with outpatient services.

Transitional Care UnitsTransitional Care UnitsTransitional Care UnitsTransitional Care Units

• Bloomer, Barron and Osseo Bloomer, Barron and Osseo Transitional Care Units are owned by Transitional Care Units are owned by Luther Midelfort . Luther Midelfort .

• Other Transitional Care units include Other Transitional Care units include Durand, Stanley, Spooner, Hayward, Durand, Stanley, Spooner, Hayward, and Medford to name a few.and Medford to name a few.

• Medicare pays for your transitional Medicare pays for your transitional care stay like it would if you went to a care stay like it would if you went to a nursing home.nursing home.

• Bloomer, Barron and Osseo Bloomer, Barron and Osseo Transitional Care Units are owned by Transitional Care Units are owned by Luther Midelfort . Luther Midelfort .

• Other Transitional Care units include Other Transitional Care units include Durand, Stanley, Spooner, Hayward, Durand, Stanley, Spooner, Hayward, and Medford to name a few.and Medford to name a few.

• Medicare pays for your transitional Medicare pays for your transitional care stay like it would if you went to a care stay like it would if you went to a nursing home.nursing home.

Continuing Care Discharge OptionsContinuing Care Discharge OptionsContinuing Care Discharge OptionsContinuing Care Discharge Options

• Transitional Care Units (also referred Transitional Care Units (also referred to as Swing Beds) provide continued to as Swing Beds) provide continued skilled nursing and rehabilitation skilled nursing and rehabilitation care after your hospital stay. care after your hospital stay.

• Can provide closer medical Can provide closer medical monitoring and more intensive monitoring and more intensive rehabilitations therapies than regular rehabilitations therapies than regular nursing homes. nursing homes.

• Transitional Care Units (also referred Transitional Care Units (also referred to as Swing Beds) provide continued to as Swing Beds) provide continued skilled nursing and rehabilitation skilled nursing and rehabilitation care after your hospital stay. care after your hospital stay.

• Can provide closer medical Can provide closer medical monitoring and more intensive monitoring and more intensive rehabilitations therapies than regular rehabilitations therapies than regular nursing homes. nursing homes.

Nursing Homes (skilled nursing Nursing Homes (skilled nursing facilities) facilities)

Nursing Homes (skilled nursing Nursing Homes (skilled nursing facilities) facilities)

• Area nursing homes offer a range of Area nursing homes offer a range of services from short term rehabilitation services from short term rehabilitation stays to long term medical and residential stays to long term medical and residential care.care.

• Eau Claire area skilled nursing facilities Eau Claire area skilled nursing facilities include:include:

Clairemont Clairemont DoveDoveOakwood VillaOakwood VillaSyverson Syverson

• Area nursing homes offer a range of Area nursing homes offer a range of services from short term rehabilitation services from short term rehabilitation stays to long term medical and residential stays to long term medical and residential care.care.

• Eau Claire area skilled nursing facilities Eau Claire area skilled nursing facilities include:include:

Clairemont Clairemont DoveDoveOakwood VillaOakwood VillaSyverson Syverson

Other nursing homes include but not Other nursing homes include but not limited to:limited to:

Other nursing homes include but not Other nursing homes include but not limited to:limited to:

• Chippewa Manor-Chippewa FallsChippewa Manor-Chippewa Falls

• Wissota Health and Regional Vent Unit-Chippewa FallsWissota Health and Regional Vent Unit-Chippewa Falls

• Cornell Care Center- CornellCornell Care Center- Cornell

• American Lutheran Home-Mondovi/MenomonieAmerican Lutheran Home-Mondovi/Menomonie

• Hetzel Care Center-BloomerHetzel Care Center-Bloomer

• Dunn County Health Care CenterDunn County Health Care Center

• Colfax Area Nursing home-ColfaxColfax Area Nursing home-Colfax

• Dallas Health Care-DallasDallas Health Care-Dallas

• Pepin Manor-PepinPepin Manor-Pepin

• Spring Valley Nursing Home- Spring ValleySpring Valley Nursing Home- Spring Valley

• Chippewa Manor-Chippewa FallsChippewa Manor-Chippewa Falls

• Wissota Health and Regional Vent Unit-Chippewa FallsWissota Health and Regional Vent Unit-Chippewa Falls

• Cornell Care Center- CornellCornell Care Center- Cornell

• American Lutheran Home-Mondovi/MenomonieAmerican Lutheran Home-Mondovi/Menomonie

• Hetzel Care Center-BloomerHetzel Care Center-Bloomer

• Dunn County Health Care CenterDunn County Health Care Center

• Colfax Area Nursing home-ColfaxColfax Area Nursing home-Colfax

• Dallas Health Care-DallasDallas Health Care-Dallas

• Pepin Manor-PepinPepin Manor-Pepin

• Spring Valley Nursing Home- Spring ValleySpring Valley Nursing Home- Spring Valley

Medicare Skilled coverageMedicare Skilled coverageMedicare Skilled coverageMedicare Skilled coverage

• Medicare requires the following to Medicare requires the following to pay for your nursing home or pay for your nursing home or transitional care stay:transitional care stay:

1.1. You have a skilled nursing or You have a skilled nursing or rehab need (PT/OT)rehab need (PT/OT)2. You participate in therapies and 2. You participate in therapies and show progress.show progress.3. That you have a qualified 3 day 3. That you have a qualified 3 day stay at a hospital.stay at a hospital.

• Medicare requires the following to Medicare requires the following to pay for your nursing home or pay for your nursing home or transitional care stay:transitional care stay:

1.1. You have a skilled nursing or You have a skilled nursing or rehab need (PT/OT)rehab need (PT/OT)2. You participate in therapies and 2. You participate in therapies and show progress.show progress.3. That you have a qualified 3 day 3. That you have a qualified 3 day stay at a hospital.stay at a hospital.

Home Care optionsHome Care optionsHome Care optionsHome Care options

• Medicare will pay for home care services: Medicare will pay for home care services: -if you are homebound-if you are homebound-if you have skilled nursing needs.-if you have skilled nursing needs.-if you have skilled therapy needs.-if you have skilled therapy needs.

Medicare does not pay for:Medicare does not pay for:Help with meals, grocery shopping, etc.Help with meals, grocery shopping, etc.ShoppingShoppingPersonal Care (bathing, dressing, etc.)Personal Care (bathing, dressing, etc.)Housekeeping services Housekeeping services

• Medicare will pay for home care services: Medicare will pay for home care services: -if you are homebound-if you are homebound-if you have skilled nursing needs.-if you have skilled nursing needs.-if you have skilled therapy needs.-if you have skilled therapy needs.

Medicare does not pay for:Medicare does not pay for:Help with meals, grocery shopping, etc.Help with meals, grocery shopping, etc.ShoppingShoppingPersonal Care (bathing, dressing, etc.)Personal Care (bathing, dressing, etc.)Housekeeping services Housekeeping services

What are Advance Directives?What are Advance Directives?What are Advance Directives?What are Advance Directives?

• Written documents that tell your Doctor Written documents that tell your Doctor what you want for care when you are what you want for care when you are unable to speak for yourself.unable to speak for yourself.

• Allow you to describe the type of medical Allow you to describe the type of medical treatment you would like to receive or not treatment you would like to receive or not receive. receive.

• Allow you to identify the person you wish Allow you to identify the person you wish to be your decision maker if you are to be your decision maker if you are unable to make your own decisions.unable to make your own decisions.

• Written documents that tell your Doctor Written documents that tell your Doctor what you want for care when you are what you want for care when you are unable to speak for yourself.unable to speak for yourself.

• Allow you to describe the type of medical Allow you to describe the type of medical treatment you would like to receive or not treatment you would like to receive or not receive. receive.

• Allow you to identify the person you wish Allow you to identify the person you wish to be your decision maker if you are to be your decision maker if you are unable to make your own decisions.unable to make your own decisions.

How do you get an Advance Directive?How do you get an Advance Directive?How do you get an Advance Directive?How do you get an Advance Directive?

• Luther Hospital Social ServicesLuther Hospital Social Services

• Luther Hospital ChaplaincyLuther Hospital Chaplaincy

• Your personal attorneyYour personal attorney

• Luther Hospital Social ServicesLuther Hospital Social Services

• Luther Hospital ChaplaincyLuther Hospital Chaplaincy

• Your personal attorneyYour personal attorney

2 types of Advance Directives2 types of Advance Directives2 types of Advance Directives2 types of Advance Directives

• Declaration to Physicians or Living Declaration to Physicians or Living Will Will

• The Power of Attorney for Health The Power of Attorney for Health CareCare

• Declaration to Physicians or Living Declaration to Physicians or Living Will Will

• The Power of Attorney for Health The Power of Attorney for Health CareCare

Power of Attorney for HealthcarePower of Attorney for HealthcarePower of Attorney for HealthcarePower of Attorney for Healthcare

• With this document, you appoint a family member With this document, you appoint a family member or friend to follow you wishes and act as your or friend to follow you wishes and act as your health care agent.health care agent.

• Your Health Care agent will make decisions for Your Health Care agent will make decisions for you only when you are unable to make your own.you only when you are unable to make your own.

• This document is recommended because it is This document is recommended because it is much more flexible that the Living Will and gives much more flexible that the Living Will and gives health care providers a person to discuss your health care providers a person to discuss your wishes with.wishes with.

• This document also lists what you want in This document also lists what you want in different situations when you are unable to speak different situations when you are unable to speak for yourself.for yourself.

• With this document, you appoint a family member With this document, you appoint a family member or friend to follow you wishes and act as your or friend to follow you wishes and act as your health care agent.health care agent.

• Your Health Care agent will make decisions for Your Health Care agent will make decisions for you only when you are unable to make your own.you only when you are unable to make your own.

• This document is recommended because it is This document is recommended because it is much more flexible that the Living Will and gives much more flexible that the Living Will and gives health care providers a person to discuss your health care providers a person to discuss your wishes with.wishes with.

• This document also lists what you want in This document also lists what you want in different situations when you are unable to speak different situations when you are unable to speak for yourself.for yourself.

Safekeeping of Advance DirectivesSafekeeping of Advance DirectivesSafekeeping of Advance DirectivesSafekeeping of Advance Directives

• You should always keep the original document.You should always keep the original document.

• Copies can be given to family members.Copies can be given to family members.

• A copy can be brought to your doctor’s office or A copy can be brought to your doctor’s office or to the hospital to be kept in your medical record.to the hospital to be kept in your medical record.

• It is important that you discuss your wishes with It is important that you discuss your wishes with family and friends close to your.family and friends close to your.

• Decision making becomes easier when these Decision making becomes easier when these discussions have taken place and your wishes discussions have taken place and your wishes are clear.are clear.

• You should always keep the original document.You should always keep the original document.

• Copies can be given to family members.Copies can be given to family members.

• A copy can be brought to your doctor’s office or A copy can be brought to your doctor’s office or to the hospital to be kept in your medical record.to the hospital to be kept in your medical record.

• It is important that you discuss your wishes with It is important that you discuss your wishes with family and friends close to your.family and friends close to your.

• Decision making becomes easier when these Decision making becomes easier when these discussions have taken place and your wishes discussions have taken place and your wishes are clear.are clear.

Questions or Concerns?Questions or Concerns?Questions or Concerns?Questions or Concerns?