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COTA Thoughts

Productivity and Pay

Published July 4, 2014 11:09 AM by Tim Banish
For those who work in Long Term Care (LTC) we've all been troubled at one time or another with that nasty word productivity. I still can't believe it's expected to maintain such high numbers when the job entails dealing with people and all the things that occur during a typical day in a nursing home.

The concept of productivity came about back in 1998 after Medicare cutbacks. I remember working my first job right after productivity standards came about. My entire month of work totaled twenty two hours, and then my boss told me my productivity was 13%. Since I was the manager at the time, attending meetings and training new employees was part of my role. That didn't fly with the boss though, it was like I was expected to attend meetings and train new employees off the clock. Yes, I quit then and there.

My next job was even more surprising concerning productivity. After my first day on the job I turned in my log sheet. I'd been at the LTC facility for close to eight hours. The boss totaled up my therapy minutes and said "Well you got five and three quarters hours in today, nice job." "What?" I said. He went on to explain that the new rules meant we only got paid for actual therapy minutes completed, not hours in the building. The next day things were very hectic, having two different doctors doing quarterly visits on top of a big activity program happening. I got kicked out of three different rooms in the middle of a treatment and probably walked several miles up and down hallways trying to find an available patient for nine hours that day. Turning in my tally sheet the boss says "Not so good today, only four and a half hours." That was my last day working there.

I believe there was a group of therapists in California who sued their company for the same practice of paying only for therapy minutes completed. Expecting an employee to do paperwork, transport patients, and dodge doctors and nurses while trying to do therapy and not being paid for it is absurd.

My thoughts here? I think a new law should be approved to place productivity standards on all government workers. The budget bill needs to be passed on time, long waiting lines in government offices need to be shortened, and our veterans need the care they were promised.


Until next time, hope all your "Thoughts" are Good-


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A, PTA- you state the way things are very well. I've seen a bonus system too, and I think it's illegal. I've always wondered how some therapists always seem to have extra time to chat and text, yet still get good numbers.

Michael- Yes, productivity standards at 95% are impossible to obtain without cheating. Medicare is checking anyone who documents more than 100% productivity.

Marcie- In no other job would you be expected to work off the clock. If you are there to work, you should be getting paid. I had a boss years ago who would call almost every night to get the numbers in the facility. These calls would go on for 45-60 minutes and one night I mentioned I clocked in since this was "work". The calls went to 5 minutes tops after that.

Thanks for all the comments!

Tim Banish, COTA, Retired July 10, 2014 9:56 AM
Cincinnati OH

I am a PTA for over 23 years and am struggling with the same ridiculous productivity standards in long term care, which continue to increase and push us almost to the point of committing fraud. Not sure how similar the laws are in different states, however in PA: you CANNOT be over 100% productive (as you can only bill for point-of-service treatment, one-on-one care.  I guess there still is "group" therapy but it doesn't bring in much money so we are encouraged to never do it.). Also, you CANNOT be made to work off the clock.  As a matter of fact, employers frequently in-service therapy staff to make them understand that they cannot even voluntarily work off the clock (to catch up on paperwork or whatnot). It is a serious legal matter. If any employer TELLS you you MUST work off the clock, I would suggest immediately contacting an employment lawyer.

It is sad that the entire therapy profession has become just a money making scheme. Quite honestly, the patients do not matter (only to those of us who still care, but are almost powerless to help, or risk being fired for being unproductive). The company I work for even offers bonuses for being over the expected productivity of 88%.  Some staff members get it every paycheck, meaning somehow they treat patients, transport patients, discuss issues with nurses/doctors/etc, attend patient care planning meetings, wait for patients to receive meds, bathe, get dressed, finish meals, rearrange sessions around EVERYTHING (hair appts, family visits, activities, meals, meds and nursing treatments), encourage confused or disinterested patients into participating in therapy, oh and still finding time for going to the bathroom...and all this in only 57.6 "unproductive" minutes in an 8 hour working day. And we are supposed to build trust and rapport with all our patients for a productive working relationship. Yeah, sure. So either you cling to your personal ethics and only provide specific, pertinent therapy interventions that you feel are appropriate...OR you show up to your scheduled patient's room, and no matter what the situation, you "creatively" start treatment immediately, working on whatever is appropriate the the situation presented that day (can't tell you how many ADLs I have done, observing patients for balance and safety during this activity, because the nursing staff isn't held responsible for having anyone ready at their scheduled time).  Remember, I am a PTA, not a COTA/L).

Ok, rant over.  I have been frustrated for years.  Thinking of leaving the therapy profession completely. There must still be some way to help people and still be able to treat them like a human being instead of just a commodity.

A, PTA July 8, 2014 2:47 PM
Bethlehem PA

I was once offered to be paid by the treatment minute at a per diem position, however, it was at a higher rate so as to make it fair.

I recently left a job that wanted 95% productivity, I heard in the past that they have tried to ask for 115% productivity.

It's just a number that has nothing to do with quality of care and everything to do with making money.

Michael Wong, COTA/L July 7, 2014 11:43 PM

WOW...things can be worse than they are now. I'm new to therapy but the productivity is unattainable and I was told today to work off the clock. I know one person who works for hours each day off the clock. And of course that doesn't help anyone because that makes the rest of us "nickel and dimers" (as we were called because we want to get get paid for our time at work)  look bad and not playing as a team.

Marcie July 7, 2014 9:19 PM

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