Ron: 
I work for a company that requires 90 percent productivity in a skilled 
nursing facility.  I had a hard time convincing myself that this was ethical 
or plausible.  I did work out a system where I could be 90 percent and 
knowing I was doing the best for the patients.  I spent my morning doing 
selfcare ADL's which was planned from the day before so nursing knew who and 
what part of morning ADL's I was going to do.  I usually spend 35-60 minutes 
with each patient (approx 4-5 patients).  I work in a situation where I can 
carry the progress notes with me on a clipboard so I was able to write the 
daily PN immediately following the morning tx.  The afternoon 4 hours I spent 
half of it doing group tx and the other half individual tx or evals.  During 
the afternoon I try to write the daily note with the patient and I always 
complete the evaluation 700 with the patient.  It is harder when the caseload 
is higher then 10.  In that case I rotate between group and individual tx and 
seem like I spend half the day running around like a chicken with my head 
cutoff!!!  However, on the days I do morning selfcare I usually spend more 
time education and instructing and get extra time( increasing productivity).  
Now, I do have to monitor minutes because the patient is only allowed 25% 
group tx a week under medicare A.  It all seems to work out and I feel more 
patients then not like working with other people with similar situations for 
motivation and socialization.    

Now on the other hand I work PRN at another SNF where I have to be 75 percent 
productivity.  I thought this would be less stressful then my fulltime job.  
However, the paper work is in the patient's hard chart and I spend so much 
time looking and getting the charts from other professionals I feel like I am 
just as busy even though my billable time is much less!  

Jennifer     

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