OASIS Alert
TRANSFER v. DISCHARGE: DO YOU KNOW THE RULES OF THE GAME?
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It's easy to become confused in the "what if" world of OASIS assessments, and the issue of when to complete a transfer versus a discharge OASIS is no exception. The good news is that making this call really can be quite painless, if you remember a few simple rules, experts tell Eli. Here's a scenario home health agencies commonly encounter: A patient with diabetes has a mild stroke and goes into an inpatient rehab facility for a couple of weeks, but the agency expects her still to require home care afterward, offers consultant Terri Ayer with Ayer Associates in Annandale, VA. In this case, you'd complete a transfer of care OASIS because you expect the patient will return to home care, she instructs. In fact, whenever a patient goes to a skilled nursing facility, a rehab facility or a hospital, the agency should complete a transfer OASIS, continues Chapel Hill, NC-based consultant Judy Adams with Larson Allen Health Group. When completing the transfer OASIS, agencies should indicate whether the patient will be discharged with the transfer, Adams reminds providers. "If the HHA expects the patient to return to home health services, they should mark 'transfer, not discharged from the agency,'" she explains. "If they believe the patient will be permanently placed in another level of care and not return to home health, they should indicate 'transfer to an inpatient facility, patient discharged from agency.'" Agencies should complete a discharge OASIS when the patient is discharged to the community, which could include "another home health agency, a hospice program or because the patient meets one of the agency's criteria for discharge (i.e., goals are met)," Adams advises. You should never find yourself completing a transfer of care and a discharge OASIS assessment. Think of the beginning and end of an OASIS episode as though it were a light switch, Adams suggests. "The OASIS light is turned on, or the episode begins, with the SOC or ROC OASIS. The OASIS light is turned off, or the episode ends, with a transfer, discharge or death at home OASIS assessment. Just as you turn a light switch on or off by moving it one way, only one assessment is needed at the start and one at the end of an OASIS episode."
Adams offers the following answers to other common "what if" scenarios agencies encounter:
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