Ethics VS Productivity

Anon OT-

Sorry to hear you've been though all the "pc" issues too. Medicare has become nothing more than a bank account for so many LTC facilities it's ridiculous. The worst part is so many low level patients can't handle such long sessions demanded by greedy companies and sometimes lose ground from being so worn out. I miss the days when the therapists set the minutes, not some nose in the book accountant.

thanks so much for the article..so close to home. I had been an inhouse ot in a nursing home for nearly 11 years. then last year we (rehab dept) were outsourced to a contract company. I have worked so hard this past year and done so many off the clock (illegal I know. Oh well) hours to do documentation. But still I couldn't get to their numbers. This week I was fired. (my avg the last two weeks was 3% points below the company average which is 3% points below their required average). It hurts to the core to be kicked out of serving a population I love due to money minded folks. Fingers crossed I get another job soon, I am looking for a hospital type.

But believe me. I am going to be writing something to medicare,etc about this- the ridiculous minutes game,etc. Our elderly deserve better than to be pawns in this business model. In a way I am relieved, it is finally over. (I have 30 days or it could be a week if I am not at their ballpark requirement at week's end)..sigh. My hope is PT, OT and ST and others can come together to demand change regarding this issue.

I look forward to regaining my emotional, physical and spiritual health after this past year of harassment and constant stress and threats from the company. (i had a stress induced illness for a few days due to the work stress- and I am one who is rarely sick).

One comforting thing in this is finding blogs and message boards that all utter the same thing about the often unrealistic prod requirements, as like the gal above said, so many other things come up.

And it was comforting to me to have a patients family come down the other dayafter this happened and request me and another PT coworker (who was likewise just let go for the same productivity reason) to be her loved one's therapists. Her loved one, a long term resident of our place, had been hospitalized for a few weeks and had just returned to the building. And she came to request from the supervisor me and the PT to work w/her loved one, as we'd worked w/her loved one in the past and she and her other family member wanted us specifically. As that family member also is in healthcare, so I knew she understood. I told her the true scoop of the truth. (unprofessional of me I know) I was so touched she and her family wanted us to serve her loved one as a therapist. It was cathartic to me. But I told her we'd be out of there within the month, possibly by next week. She was so unhappy to hear this. She wanted to contact someone. I said at this point it doesn't matter, but that I'd be writing something as it got closer. (though it is pretty close now). And I assured her the other therapists are good and caring, that they will do a good job for her loved one, just that everyone is pressured w/this productivity stuff. (or can I make up an acronym and call it pc= productivity crap). And  I think of the wife of another patient who gave me a thankyou note before she took her husband home. She said were it not for me and the pt who worked w/her husband that she would  have moved him to another facility weeks earlier.

Anyway. THank you Tim for your blog. I hope your blog can help get the needed change in this system. And sorry to write so much- it has been one of the most difficult and painful years of my life to have this constant stress.

I am looking forward to finding a position where I can focus on my patients and helping them improve w/o worrying about job loss on a daily basis. thanks again.

Diane, you are correct about abuses to the system at some places. The worst part is they are difficult to catch, but guaranteed records will get checked at places that have a higher than average caseload of Ultra-High pt's.

As a registry therapist, I have seen horrendous abuses in different facilities  I have worked in, and many I won't return to because it would put my license at risk to even be there.  Eventually, these therapists will be caught, especially the ones that see more than one medicare pt at a time and bill individual minutes.  Some call it "the game".  I just call it unethical.  Yes there is a way to work smart and still stay ethical, but it is almost impossible to do.  85% is so do able compared to the 90% most rehab contract companies/SNFs require to keep their CEO's in their Mercedes, lexus, you name it.  Gee do I sound bitter, yes I guess I do, but until we get these high salaries in line with the reality of what truly is making health care costs go up, we will never be able to get a handle on rising health care.    The RUGs to begin with are ridiculous.  Have any of these people ever tried what it would be like to have 75 min OT, 75 PT per day?  Most healthy individuals over can't withstand that much.   In reality, our patients can maybe withstand 45 each.  I hate to say it, but the adjustment needs to come with how much therapy per day these patients can REALLY withstand.

Thanks Nikki and Angela for your comments. One more thing that intereferes with productivity as a prn is finding patients you've never seen. If they're not in their room it is difficult to locate them.

This is my main complaint when I work per diem in SNFs. I am  constantly reminded that I need to make all minutes and remain productive. There are so many factors that can affect productivity (pt refusals, pts not ready, pts being seen by other disciplines, etc.). that are out of your control. There are also many breaches of ethics. The system needs to be more patient centered and less financially driven.

Thank you writing about this subject. I currently work in a nursing home setting and this bothers me daily. Got to make the minutes. Can't miss the category.  A caseload of 10 patients a day. No overtime. I'm thinking about applying to hospitals just for this very reason. Thanks again.