My First Rotation: The Skilled Nursing Facility
My program is unique in that we do our first full-time, 4-week rotation at the tail end of our first year. My first, along with the rest of my classmates, was in the SNF setting. "SNF" stands for skilled nursing facility, or nursing home. I greatly enjoyed my experience in my SNF, which was a 196-bed facility that had approximately 50% long-term care and 50% short-term patients.
The majority of the patients seen by the rehab department were short-term stays for diagnoses such as complicated joint replacements, falls, and neurological injuries. Many of the long-term care residents had been there for years for general failure to thrive, while others had no option to go home due to a need for care.
My biggest takeaway from my experience in the SNF was a general frustration with the setting. Many students are hesitant in the first place to work with a geriatric population. I can't deny that I wasn't thrilled, myself.
However, I enjoyed the population more than I expected. I bonded very well with a lot of the patients and my days were filled with smiles. The patients I saw ranged from 42-101; hardly a boring population! My general frustration came from the way it seems physical therapy is practiced in this setting.
My education and experience thus far have shown two major themes in helping patients see gains; specificity and overload. The majority of the patients in the SNF were given high-repetition, low-weight exercises and rarely seemed challenged. If a patient did not want to try a heavier weight, the efforts to convince them otherwise were minimal.
It seems like there is a lot of room for improvement in how PT is practiced in this setting; however, I realize that it is complicated by billing and insurance restrictions. Either way, I'd like to see changes in the setting during my career.
On the positive end, I have gotten much more comfortable working with patients and doing all sorts of psychomotor skills. I was very pleased with the experience and am excited for my upcoming clinical experiences!
Does anyone have any thoughts on the strengths and weaknesses of working in a SNF setting and how physical therapy is provided?