Although the concept of group
therapy is not new to long-term care, the implementation of the Patient Driven
Payment Model (PDPM) has ignited renewed interest in its utilization during a
skilled stay. From the resource availability to expand restorative nursing
programs that allow up to four skilled residents in a group, to the revised
group definition under Section O of the RAI manual, it is highly likely the
clinician, staff, and patient interaction throughout a stay will reflect an
exciting environment of peer motivation and social engagement.
Prior to PDPM, if a therapy
clinician executed a group with skilled residents participating, the group had
to be planned for no more nor less than four individuals. Now, when a skilled
resident is included in a group, the clinician has the autonomy to mold the
size of the group to include anywhere from two to six participants, as
appropriate. The psycho-social benefits and opportunity to apply functional
carryover techniques within a quality, patient-centered group have not changed.
As noted by CMS and in multiple
research studies, the psycho-social benefits of group are varied and include enhanced
learning, increased sense of support, decreased depression, and improved
motivation. Consider the story of a skilled patient who planned to return home
alone. Prior to the event that led to the skilled stay, she participated in
social outings once a week and depended heavily on loved ones to drop by for
social interaction. Her family and friends encouraged her to “get out more”,
but due to a self-perceived burden and a touch of embarrassment over her
functional changes, she frequently declined the invitations. Eventually, this
unintentional social isolation led to depression, sadness, and declining functional
health. In her weakened functional state, she fell and although no fractures or
breaks resulted, she did admit to the hospital due to altered mental status,
dehydration, and mild malnutrition. Once stabilized, she admitted to a skilled
nursing facility with the hope her weakened state could be reasonably reversed
for a safe return home. During her stay, she participated in a physical therapy
group once a week in addition to her daily individual therapy. Knowing her
history, the clinician formulated a peer group identifying patients with similar
goals targeting gait and balance, with the knowledge that this patient needed
the peer motivation and example for attaining and maintaining her functional
gains once she discharged home. During those sessions, the patient was
encouraged by the evidence that her story was not unique and allowed her to
self-identify the functional and emotional effects of isolation all while
achieving her physical therapy goals.
Group therapy presents the
unique opportunity for the therapy practitioner or restorative nursing staff to
engage the patient during their care journey in novel ways. As a result,
success is often amplified due to the underlying qualities inherent within
group formats that simply cannot be mirrored in individual treatment
sessions. Whether delivered by
restorative aides as part of a nursing program or by therapy clinicians as part
of a rehabilitation stay, there is magic in the makeup of a group that is
created with patient-centered intention and guided by staff who recognize the
benefits of community and teamwork.
