Changes in Long Term Care Funding
Changes in Medicare funding for skilled nursing facilities happened just a few days ago on October 1st. These changes will cut deeper into the budgets of all Skilled Nursing Facilities (SNF's), but the impact will be felt more in smaller SNF's. With strained budgets, it will more than likely affect the quality of care our senior citizens receive. The current changes are significant, but changes set to take effect in October 2010 may bring a devastating blow to long term care, even more so than PPS.
Current changes in funding appear to have actually increased. The daily rate for a skilled ultra high patient went up, slightly. With this increase though, came assigned cost directives that place all costs for all care on the SNF. For instance, if a patient needs a new wheelchair it's up to the SNF to provide it. Yes, this has always been true but now this also includes specialized chairs. Do you see a small 70 bed rural SNF being able to afford a wheelchair that costs several thousand dollars for one resident?
I don't know how your facility is equipped presently, but in my SNF we are always looking for bargains on rehab needs. Ask for a $150 pressure reducing cushion for one of our long term residents who has had problems with pressure areas for months, but the budget says no you have to make do with this less efficient $90 one. We are constantly being asked if we have something in the department or storage that would work rather than buying (99% of the time the answer is NO, but they continue to ask). My OTR goes to Goodwill at least once a month, and will buy any DME she thinks will benefit the residents. Well, this helps in our job too because now we don't have to go begging for a piece of equipment. Over the years my favorite saying has become; "We have done so much with so little for so long, we are now qualified to do anything with nothing".
But as I mentioned, the changes that are set to take effect on October 01, 2010 could prove to be more destructive to LTC than PPS itself. This new change makes multiple patient treatments a thing of the past. Concurrent therapy will still be allowed, but the time must be evenly split between the patients. Essentially this means one on one therapy again, like in the pre-PPS days. The difference is back then we were paid for every hour we were on the premises. Now we are only paid for each treatment minute we deliver. With treatment minutes reduced per therapist to the minimal 80% standards, companies will need to hire more therapists to complete the same amount of work being done by the current and smaller staff now. Smells like a pay cut to me.
Even delivering the minimal minutes per day having to do one on one treatments will be difficult in some facilities. Scheduling patients is something I have always found to be more effort than reward. Any time the doctor comes in they get preferential access to the patient. Then there are meals, activities, med passes, specialists, and of course the most important is how the patient is feeling and moving today. If any of these things occur or go wrong, then your schedule is out the window for the rest of the day.
The only good thing that will come out of this will be the end (hopefully) of stories about some therapists being given 800 minutes of treatment a day. Companies will run the risk of being fined for over production of therapy minutes, and a simple check of the employee hours versus therapy minutes delivered will suffice for enough proof.
Until next time, hope all your "Thoughts" are Good-
Tim