Posted Friday, November 14, 2008 by
Employee Relations
Many of you Physical Therapist, Occupational Therapist and Speech Language Pathologist travelers often feel that you would much rather work in any setting other than Skilled Nursing. But one key to being a successful traveler and working in the city of your choice is to compromise and be open to different settings. This blog is basically to explain and compare different settings versus Skilled Nursing. Take some time to read this and really think about the differences. You may discover that what you thought was a setting you really did not want to do, is something that you just might want to try.
1.) Acute care/hospital setting
These therapists are used to a single discipline approach. The therapist evaluates the patient, usually bedside, and then makes recommendations to follow up with their care. Average length of stay in an acute care setting is about five days at best. Therefore, the therapist becomes a great evaluator and “recommender,” but never really gets to see the patient progress as they are discharged to another setting, home health, OP, SNF, to continue their therapy. However, acute care does usually give a pretty flexible schedule in terms of hours/days due to the “captive” audience.
SELLING POINT: Therapists, by nature, want to see a person progress and improve. In the SNF environment, most therapists will get to see that happen. They will get to treat patients on a daily basis (or whatever is needed) to return that patient to their highest level of function. Under Medicare part A (PPS) they are given up to 100 days for therapy. Also, SNF is multi-disciplinary approach which is definitely more fun as it is a “team” environment and creates an overall aspect of treating the entire person rather than just a specific injury/illness.
2.) Outpatient setting
Outpatient is a demanding schedule that usually involves treating numerous patients at the same time. Normally patients are scheduled to overlap so that while one might be “icing an injury,” another is doing exercises under minimal supervision, while another patient is getting some “hands-on” treatment. The schedule is definitely for the newer (younger) therapists, as it is hard to keep the intensity for years. Most therapists that are still in an out-patient setting numerous years into their career are in the management aspect of the operation. Patients are set up on appointments and since a lot of those patients are of working age, the therapist's schedule must accommodate early morning and later evening appointments. These therapists will have a tough time grasping the PPS reimbursement model if they have been in OP for years. Also, this is another single discipline approach. A lot of the time it may just be a PT clinic with no OT or SLP even offered.
SELLING POINT: Schedule!!! The flexibility of a SNF schedule far surpasses any schedule an OP clinic can offer. If the therapist wants a varied schedule, that’s usually something that my RM’s are agreeable to. Once again, the multi-disciplinary team is a big selling point here as well. Also, in my experience, therapists see the same diagnosis over and over (back, neck) which allows the therapist to become quite bored, quite quickly. Most of our facilities offer a varied caseload of orthopedic and neurological injuries.
3.) Home Health
Most of the time therapists don’t want to leave HH due to the flexibility that it, supposedly, offers. Most therapists do get to schedule their patients when they want during the week, but an appointment still has to be kept. Also, there is considerable driving involved…a lot of companies have not increased their mileage reimbursement to keep up with the cost of gas/IRS standards, thereby having the therapist just write it off on taxes rather than getting it reimbursed. Once again, this is a single disciplinary approach and you are truly alone. Therapists might drive into unsafe areas and unsafe homes to treat patients. The paperwork in HH is significant as well…since sometimes it is just you and the patient. Documentation is key because if something happens with that patient, it is your word vs. theirs. Therefore, therapists spend an incredible amount of energy on HH documentation…I think the evaluation ( under OASIS) prints out to over 50 pages. These therapists are usually highly compensated (around here $75/visit) however, that doesn’t break directly into an hourly rate. I have had therapists give me the amount on their W-2 so that we can convert it to an hourly basis so that we are talking “apples to apples.”
SELLING POINT: Documentation…SNF requires an evaluation with a weekly note. That’s it! That’s huge to these therapists. Also, the flexibility is still there without all the driving into sometimes scary places. Interacting with other therapists is important to some as well. When it’s just you as the primary therapist with no other interaction, the therapist is only as good as their knowledge allows. In the SNF environment, there are usually other therapists of the same discipline or the ARD, RM to “bounce” ideas off of if you have questions.
4.) In-patient Rehabilitation setting
This setting is probably most closely associated with a SNF setting. These therapists get to see patients improve but usual lengths of stay are only about 30 days. They also utilize a multi-disciplinary approach as does SNF. A lot of patients that end up at SNF for rehab might be those that couldn’t withstand the intense schedule of an inpatient rehab program. Patients have to be able to tolerate at least three hours of therapy a day to qualify, therefore it isn’t for everyone. This setting, though, usually has the most structured schedule. Most patients are set up from about 9-3:00 each day with therapists starting at 8:00 and finishing at 4:00-4:30 after the last patient. They see, usually, the same patient for one hour/twice a day.
It’s a great schedule if you like 8-4:30 but there’s little flexibility. Usually in this setting there is daily documentation as well.
SELLING POINT: Schedule. Most inpatient rehab units don’t hire part-time therapists and most work a set schedule which is the same every day. There’s very little room for variation. Documentation…once again, SNF requires an evaluation followed by a weekly note. These therapists are usually the easiest to make the switch to SNF as the model of inpatient rehab most closely mimics SNF.
So ATTENTION all PT, OT and SLP travelers, the next time a recruiter from MDI Medical calls you to let you know that the only facility available in your city of choice is a SNF, make sure you tell them, "SIGN ME UP!"
Scott Ferguson
Super Recruiter
