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Cognitive disability and reimbursement for rehabilitation and psychiatry.

Neither psychiatry nor rehabilitation has been able to develop acceptable criteria for diagnostic-related groups. The difficulty.in both instances may be related to an inability to clearly state intake criteria as well as the functional outcomes produced by different levels of care. The need for care is largely determined by the functional difficulties a person has in managing their own affairs. Competency to manage one’s own affairs is based on cognitive ability.1 The degree of cognitive difficulty in doing everyday activities as well as the person’s ability to learn to overcome these difficulties are important intake criteria. When further improvement in competency is not expected, discharge should occur. What is required is a measure that is sensitive to important changes in the person’s ability to do daily activities. Just as important, when residual cognitive disabilities exist, is a measure that predicts the social assistance required to protect the patient’s safety.