Reassessment and Showing Progress
Who may reassess, how often, and what a reassessment has to demonstrate — including when the numbers are not moving.
Who reassesses, and how often
The Conditions of Participation require that the qualified therapist — not the assistant — assesses the patient and the effectiveness of therapy on an ongoing basis, and that the plan of care is updated as the patient changes.
In practice:
- The evaluating therapist owns the plan, the goals, the progression, and the discharge decision
- A PTA or COTA may deliver the plan but may not evaluate, reassess, change the plan, or discharge
- The therapist must be involved often enough to know whether the plan still fits
- State practice acts set their own supervision and reassessment intervals, and they vary — know yours
See Supervising LPNs and Therapy Assistants.
What a reassessment has to show
Not that you saw the patient. That you assessed, judged, and decided.
- Objective measures repeated under comparable conditions — see Tests and Measures
- Comparison against the evaluation and the last reassessment
- Each goal addressed: met, partially met, or not met
- For anything not met, why, and what you are changing
- Whether the frequency still fits
- Whether the discharge criteria are closer
- Whether the patient still meets homebound criteria and still has a skilled need
Showing progress when the numbers move
Straightforward — say what changed and what it means functionally:
TUG 18.2 seconds with rolling walker, from 24.6 at evaluation. Gait speed 0.71 m/s, from 0.48. Patient now ambulating to the bathroom independently at night, which she was unable to do at SOC. Remains above the fall-risk threshold; continuing gait and balance training with the goal of independent access to the mailbox by 11/07.
Showing progress when they do not
This is where episodes get lost, and it is usually a documentation problem rather than a clinical one.
If a goal has not been met, say so and say what you are changing. A reviewer accepts slow progress with a reasoned plan. What they do not accept is four identical notes.
Sit-to-stand goal not met at reassessment — patient achieving 3 of 5 attempts with contact-guard assist, unchanged from three weeks ago. Reviewing the HEP log shows completion on 2 of 7 days; patient reports knee pain limits practice. Analgesia timing discussed with the patient and physician notified for review. Modifying the programme to a higher chair height to reduce demand, and adding seated strengthening to progress without loading the knee. Extending the goal target date to 11/21.
That paragraph shows why it did not work, what you did about it, and why more visits are justified.
If nothing you change moves it, the honest options are a maintenance plan or discharge. Both are legitimate; drifting is not. See Maintenance Therapy.
The question at every reassessment
Does this patient still need a therapist, or could what remains be carried out safely by the patient or a trained caregiver?
When the answer is the second, train them and discharge — see Discharge. Continuing past that point is not generosity; it is an uncovered episode and it occupies a visit someone else needs.