Not All Patients Work on the Weekend

Toni, I've been working in this field for 30 years. 10 of them in SNF, 6 as a rehab manager. I'd like to respond to your essay and perhaps give some idea's to help your patients own their therapy.

1) Patients are usually placed in an SNF due to an illness or injury they had no control over. What is the first thing they lose in a SNF? Control. They may get a 5 min speech from their hospital case manager as to where they are being placed after their hospital stay, most are not told just what to expect. Some do come in well versed and know that to recover they need to get the rehab time in. If they are residents they need to know why they are having therapy, what the goals are and we need to respect that we are working in their HOME. They have every right to tell us to go fly a kite. And they have a right to know what may happen if we do fly that kite.

2) I would encourage you to use family and visitor support to your advantage. Family IS a priority to these patients. Those visits may be the thing that helps them not dive in to depression of which no amount of "motivated" therapy can help with. Invite the family to walk with you, invite them with the patient's permission to go over the exercises and have the patient demonstrate what they have learned. You can bill for that.

3) Invite the patient to own their program. Have them set the goals for the next day. "What walking distance today would make you feel successful? Can you see how this helps attain your goal of returning home?" "How would it feel to increase those reps knowing they are strengthening your legs?" I noticed you were having difficulty with your balance. We could try one of these exercises ..which of these would you like to try today. I think this one is very effective etc.

4) Cell phone. Make sure you set a good example and respect their need to have the cell by them if a family member they don't often hear from may call. They will resent you otherwise. Most of my patients will tell the caller they are in PT and will call back.

5) If they have worked all week, been to numerous appointments and have the notion in mind that they have Saturday's free that should be honored unless they are in a Ultimate high rug rate for all the right reasons. The body, mind and spirit do better with adequate amounts rest/work. We are one of the few industries that don't follow or practice what a healthy life style looks like.

6) Just a pet peeve of mine. NEVER, EVER see a patient just to get "minutes" in when seeing them on weekend is not appropriate. This is fraud and does not promote good practice. Also, don't say to the patient "I have to work with you 60 minutes today so I want you to do x,y,z. " Instead review the goals the patient has set with you and say "We have 60 minutes we can work TOGETHER today, how do you think we can best utilize them to reach your goals?".

When the patient owns their progress your job is a snap and fun and productive. Its not about us. Its about them, how they feel, and hold them accountable to their goals through our education.

Hope this helps. KJ