To the OTnow list,
Great discussion, the ability to practice occupation based treatment in
SNF is challenging. I agree with many of the contributors that there are many
limitations to ideal practice.....productivity demands....equipment/space/time
crunch....complex and copious documentation...inconsistent staffing...facility
census pressures to retain patients in building and on caseload. These have
been discussed before and remain barriers to quality OT (and -by the
way-decrease the quality of PT,SLP, and NSG/Case Management) interventions.
It takes a lot of energy and smarts/training and creativity and
flexibility to find a way to provide the most effective treatments to the most
needy patients.
Should we all just walk out of our jobs at SNFs? NO!By the way, I think
there are more OT and COTAs working in the SNF area than any other practice
area! Check the Stats with AOTA, geriatric rehab is a growting industry and we
better find a way to make it work for us, and be a relevant serivice, The
opportunities elsewhere in healthcare are fewer, and the need to service this
population is high. How do we change the system in real world terms? 1)
Stick to the goals and tx plan...I see a lot of treatments that are made up
just to pass time for a higher PPS category..Focsing on the plan can eliminate
the infamous "stupid card game" tasks frequently mentioned. 2) If you need to
pick a battle with admin. make it about your ability to show skilled treatment
in the documentation. This could lead to discharging the pt out of OT if needed
i.e. goals are met, or reducing the # minutes/RUG category/frequency of
treatment per week. 3) Know thy
patient... keep a consistent caseload and know their true interests and
goals, if they have no interests or goals, focus on basic functional
requirements for discharge and discharge setting, train caregivers, focus on
relevant interventions...home evals are good.
The problem in SNF is the reinbursment system which dictates that time in
therapy and time in building are equal to icreased $$. The so-called "bad OT
treatments" usually occur when a patient is being kept too long on caseload, or
for too long per session, or with too many other people at the same time. Or if
the patient has too inconsistent a team of therapists who don't work as a team
or know the patients because they are temps or PRN.
The patients in SNF need us to be professional, exercise good judgement,
planning and advocate for their best interests. We need to fight the wicked
pace of productivity standards and take time to use our training and design
meaningful/focused programs that achieve results. ..
I am now stepping of my soap box!
Keep up the fight
Brent C
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