Health Care Reform Takes Effect
Although the changes associated with health care reform have yet to occur, my facility is already tightening the belt. Cost-cutting measures are being made at all levels and the rehab department is feeling it already. We are losing staff. Well, that isn't completely correct. So far we simply haven't filled any vacant positions. But the exodus is coming because everyone else has been asked to take up the slack.
There are several reasons for the staffing issue. Everyone already knows them. Salaries are expensive. There aren't enough therapists to go around. I work in an acute-care hospital instead of an outpatient orthopedic clinic. Patients are becoming heavier. The list goes on. My repeating that doesn't change anything.
Instead I want to think about what is happening to the quality of care provided. Last weekend was a good example. Because there are fewer therapists, there are fewer people to work weekends. Although the number of patients hasn't decreased, the number of us available to treat them has. The hospital is very large. To make staffing simpler, it has been divided into areas. Instead of two therapists per area, we had one.
Naturally I worked on the neuro floors. I started the day with 16 patients and most of them were evaluations. Two support staff members were scheduled to be shared by everyone. I know I can't see 16 patients, so first I had to prioritize who I would attempt to see. At best, I could schedule one hour of tech assist. I was able to schedule help for 30 minutes, or one patient. I would have to do a bed-level or near bed-level assessment if help was required to adequately mobilize some of those patients. Even if I could get someone out of bed, I couldn't leave that person up because I can't rely on nursing to assist anyone back to bed.
What did I accomplish? I was able to evaluate the majority of my patients. In some instances, mobility was graded max assist because I couldn't mobilize the patient alone. Because I completed evaluations, I was able to make discharge recommendations for those patients. None of those patients received any treatment. There wasn't enough time to evaluate and treat if I wanted to get through the majority of my list. Evaluation is important but treatment makes the difference.
Did those patients benefit? That depends on how benefit is defined. I cleared a few for discharge home. I would say those patients benefited. I don't know about the rest. Come Monday, they will be assigned to a PTA's caseload for treatment. They will probably be seen every other day. Some will be seen even less if they are minimally responsive or have medical issues that interfere with therapy.
Last Saturday was pretty typical for a weekend. Weekdays aren't much better. Nothing will get better until more therapists and support staff are available to share the load. I can do a lot more with patients if I can spend more than 20 minutes with them. I think the same is true for everyone else. Sadly there is no staffing influx on the horizon. In anything, the opposite is brewing.
One therapist can only treat so many patients. As long as everyone pulls a fair share, the department will get by. Human nature being what it is, I can say with confidence not everyone will pull a fair share. If asked, I could identify those who will and those who won't. Eventually those willing to work will move on because they become tired of being taken advantage of. A caseload can still be overwhelming when everyone is maxed out, pulling their weight and being asked to carry more.
Today was the closest I've come to feeling overwhelmed before even starting my day. Tomorrow will be no better. I can manage a heavy schedule. Not everyone will be seen every day and no one will get anything extra. That combination doesn't lend itself to quality care, patient satisfaction or physician satisfaction. Because there isn't enough to go around, staffing will be shifted to put out the hottest fires, resulting in some patients being seen more and others less. I hope this isn't a preview of what is to come.