And the best answer is…

by Bruce Chamberlain, MD and Julie Bruno, MSW, AAHPM Director of Education

You’ll recall the case of Mary Jane initially introduced in the May 26 AAHPM e-News.

Mary Jane was on service with the diagnosis of adult failure to thrive. She fell and was hospitalized with a fractured trochanter. Her pain was poorly controlled but she was scheduled to be discharged to home. Unfortunately, her family was unavailable to receive her till later in the week. You recommend…

1. Respite Care

2. GIP at a local skilled nursing facility

3. Provide continuous care

4. None-of-the-above: it’s the patient/family’s responsibility

The “correct” answer provided was respite, but, as noted by a number of you, there is an important factor that makes GIP a better answer: Pain was uncontrolled. Management of uncontrolled pain is a skilled need that would qualify the patient for GIP care. The duration of the GIP admission will be limited by how long it takes to manage the pain not the return of the family, so if, when the pain is managed, the family has not yet returned, then respite would be the best transition option. CMS has clarified that GIP should only be used based on the patient condition and should not be used due to caregiver “breakdown”. (CMS Quarterly Provider Update April 2007,

Continuous care could also be a reasonable choice, the requirement for skilled care is the same and it is a good option for a patient who really does not want to be in a facility. Documentation is more rigorous, reimbursement can be problematic and staffing can, at times be a challenge for some agencies, so most would elect to pursue the GIP option.

Key Points:

1. Respite is for the benefit of the family and is generally a planned event, it is also appropriate to use in cases of caregiver breakdown when there is not a skilled care need requirement for the patient.

2. GIP is to provide skilled care for the patient that cannot be provided in the home. Documentation for GIP based on pain must include:

  • Frequent evaluation
  • Frequent medication adjustment
  • Aggressive interventions to control the pain

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