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Life of a PTA

So, What Time Would You Like Therapy?

Published February 28, 2014 3:31 PM by Allison Young

When I arrive to work every day, I'm faced with a list of patients and expected therapeutic minutes to achieve for the day. What's missing on my list, you might ask? Scheduled therapy times. This translates to me knocking on many of my patients' doors in the a.m. to tentatively "schedule" my day of treatments. In many cases, because I've worked with the patients on a regular basis, I know which of them prefer morning to afternoon therapy sessions. This leads me to consult with the treating OT or COTA, as overlapping schedules have a tendency to happen frequently.

Most days, my schedule falls into place and I'm able to treat most of my patients. But more often than not, I'm chasing after a patient who left for the activity room or is being given a shower by nursing. If I sound frustrated, it's because I am. As a PTA in a SNF, every minute of my day will be measured toward my productivity. Not to mention the intense pressure to secure minutes to meet the patient's RUG level. A few years ago, our rehab department attempted an hourly schedule for each patient. Unfortunately, for the exception of one or two "appointments," the patients weren't able to keep their schedules due to fatigue, illness or simply to use the bathroom.

One of my colleagues mentioned how she enjoyed the "freedom" of having the flexibility of scheduling her patients vs. a "set time." Her point was that certain patients may require a 70-minute treatment session and others can only tolerate a 40-minute session. I see this advantage, but I would still prefer a more developed framework for my day. The responsibility would focus on patients' compliance with their agreed scheduled time compared to my open-ended question of, "What time would you like to do therapy today?"

If you work or have worked in a skilled nursing setting, are your patients given hourly therapy schedules? Is this system successful for you and your patient or do you find yourself constantly rescheduling throughout the day? I suspect the more staff supporting the patients' therapy schedule (nursing, CNAs, activity dept.), the chance of participation increases as well.

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7 comments

We have schedules at my SNF for every pt. Our DOR works the schedule daily to update for appointments. Scheduling doesn't work out perfectly due to illness, refusal, late meals, etc., but I feel it helps keep us all on track and makes it easier to do our jobs. The pts. also like knowing when they are supposed to have therapy so they can be ready and have family visit at more convenient times. CNAs are given the daily schedule, which helps, but they don't always follow it or have other problems that need their attention, so delays and schedule changes still occur.

We had a rehab aide for a few months, but they put her back on the nursing side and I doubt we will be getting another one. The aide made life easier for all the therapists, especially when dealing with concurrent treatments, and definitely increased productivity. I'm hoping our new administrator will see the need/effectiveness of rehab aides.

Gabriel, , PTA SNF March 22, 2014 7:47 PM
FL

I worked exactly as you do in a SNF multiple times and noticed the staff...ALL the staff doesn't support scheduled times for patients who NEED to get their minutes in lest the facility will not be reimbursed. These residents were there for the skilled need of therapy but there was no commitment from support staff to help PT/OT. It was unbearable for me so I left to go back to acute care and acute rehab where a schedule is taken very seriously by all staff and patients get what they need, they enjoy knowing the schedule for their day and the facility gets reimbursed.

Amy , , PTA Crozer/Keystone Health System March 9, 2014 11:21 AM
Delaware County PA

As an 8 year veteran to SNFs, I find it almost impossible to have an actual therapy schedule.   There are just too many factors: showers, illnesses, MD appts, medication administration, visitors, etc...

I wish it was different and we are trying loose scheduling again in effort to get nursing staff more involved and increase productivity. ..but my hopes are not very high.

katie, SNF - PTA March 6, 2014 6:43 PM
GA

This is my frustration almost every day!   As a rotating PT, I work in  5 different SNF facilities, so I have seen every type of schedule and non-schedule.

I think OTs seem to appreciate the 'non schedule' more - as they often need to change times to accomodate ADL or reverse ADL sessions.

As the demands for high productivity increase, almost every building has also dropped their rehab aide, or given them other duties

I will say my favorite building has scheduled therapy times, and they are prominately posted in each patient's room.  The nursing staff is aware of this, and tries to get early scheduled patients ready first.   Family knows the therapy time and can schedule visits accordingly.   Social Work can check therapy times before scheduling meetings.  

For alert and oriented patients, we make them aware of the time and responsible - after all they are here for therapy.  They should respect our time as much as they would their hairdresser or dentist!

As therapists we change the time as needed.  (i.e. realizing a patient performs better at certain time of day, or really wants to attend a certain am or pm activity)

OF COURSE - every day someone is 'off' schedule - but at least you have a starting point.

I find my productivity is much higher in the building with the schedule than without..........so why do I have a scheduled times in only 1 of 5 buildings?!?!?   hmmmmm

Michelle, , PT SNF March 6, 2014 5:51 PM
PA

Amen to the Rehab Aide idea;  I do PRN for some of our referring facilities, have worked where there was, and was not, a Rehab Aide, and I can tell you in terms of increased productivity, less stress on the ptnt, and less stress on the Therapist, these employees are priceless.  One facility I worked in was going to lay off the Rehab Aides; as a group, the Therapy department went to the Administrator and offered to take up a weekly collection to pay for the Rehab Aide to keep her on staff.  Needless to say, the facility "found" the money somewhere.  There is lot's of info on the Web promoting Rehab Aides in LTC Therapy department's;  perhaps your administrator is open to making the facility more into a 21st century operation.  Good Luck.  Remember, we have to know everything the PT's know, as well as what we know, to do our jobs effectively.  

Samantha , Home Health - LPTA, None March 6, 2014 5:46 PM
Toledo OH

I have worked in a variety of SNF and what has been most effective has been when a rehab aide does all of that...goes up brings down whomever is ready for all the therapists...that allows you to do paperwork and see other pts when others are being brought down or taken back to their room...it allows you to be more productive...I have worked doing it myself and I agree w you...it is a challenge...I know a rehab aide is not always hired though.

Jennifer Clause, PT March 4, 2014 6:45 AM
Burlington KY

Sometimes we will schedule the patients.  However, it can be better to assess functional mobility at different times of the day.  If PT schedules anything it has to go around everyone else's schedule from activities to appointments to spontaneous family care conferences.  So it becomes difficult to pin down a time to treat the patient without consulting every other department head to ensure therapy will not disrupt any other scheduled event in the facility.

In a therapycentric environment the schedule works because therapy is the main focus for the patients.  A lot depends on the administration and where they place the therapy department in the hierarchy of importance.

Jason Marketti March 2, 2014 11:40 PM

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