Guest Blog: "Mystery Patients"
This is a guest blog by Kaylee Altomari, OTR:
I am wondering if I am the only OT to have difficulty with the stress of working in nursing homes and the demands of rehab companies. I have been an OT for about 9 years working in various nursing homes for different companies. I have recently noticed the difference between working for a contracted therapy company versus an in-house company.
In my work, I have experienced contract companies try to use aides as therapists, minutes RUGged inappropriately, and therapy based on insurances rather than the needs of the patients. I have even witnessed aides changing assistive devices for ambulation, doing ADLs with the patients and providing education to families on the treatments. Needless to say, I have been getting very frustrated with these situations.
From a company stand point, it appears more cost efficient. They can pay an aide about $12/hour instead of paying an OTA $20-some. If aides were able to practice without the supervision of an OT, then OTs would be out of jobs too, since we cost inconsiderably more than aides.
Sad to say, there are many therapists who give into these companies requests, which I don't think is right. It makes the ethical therapists look non-cooperative and encourages the companies to find out what else they can get away with. As long as therapists are giving into these situations, the unethical practices and possibility to decrease the need for assistants will continue.
A piece of advice: even though a company may ask/tell you it is ok to do some of these things, do you think they will have your back when state comes in to audit? They will be the first to say that therapists use their own clinical judgment and should know the regulations and rules of the boards and insurances.
I think Medicare should have "mystery patients." Just like "mystery shoppers," Medicare should have auditors be admitted to nursing homes and find out what really goes on behind the scenes. The way the economy is going, it's only a matter of time until insurers find out what is going on and cut back again on reimbursements. With caps in place and cutbacks, we will be looking at a decreased need for OTs.
I think as a profession, OTs need to stick together and do what is right for the patients. We should not have to base our recommendations on what these companies say in order to make them bigger profits. I know that I want to be able to trust therapists because one day it may be my family or me in the nursing home and I want to make sure we are treated fairly.
I look forward to hearing the responses of other OTs who can relate, and ones who make me believe that there are more ethical and moral therapists out there than what I have seen.