In order to compensate for escalating case loads and inadequate staffing, prioritizing who to see each day has become a way of life. Sometimes my day is easier because patients are unavailable. Generally I start every day deciding who needs therapy the most. With the exception of which doctor will complain the most, I think that's the way everyone does it. I used to think everyone defined that need the same way.
I define need as those who have the worst impairments. These are patients who aren't able to do much on their own. They're going to need more therapy when they leave the facility. They can be time consuming. The going is slow. But there are copious amounts of research suggesting the more we do with those patients and the earlier we do it, the better the outcomes. Other research suggests the patients who are doing okay already will recover no matter what we do.
I work with an OT who thinks completely opposite. She prioritizes the patients who are mobile. They aren't severely impaired so they often make big functional gains. Her rationale is she can help these patients go home. For the more severely impaired, she makes splints, does ROM and UE strengthening exercises. Would it be inappropriate to say she drives me insane? I spend numerous sessions improving trunk control while she sees them in bed.
Nonetheless, neither of us is wrong. Both groups of patients benefit. Usually we're able to see all of our patients, just not for as long as we would like. Right now this compromise works. What happens when staffing is further cut to save money? Or, more likely, no additional staff is available despite higher caseloads? Patients will be missed on a regular basis.
Who do we treat? The ones who make quick gains with minimal staff action or the ones who need time and effort? I work in an LTAC. Most of my patients go to another facility for more therapy. What if it was a SNF? Often those patients become permanent residents if they don't make progress.
There's an even bigger question. Who makes the decision? Right now it's the individual therapist. Eventually the facility could take it out of our hands by decreasing staffing and/or increasing productivity demands. I have one tech. If that position is eliminated, I can't do as much with my impaired patients. In SNFs, the decision is made by who needs the minutes. Patients with minimal potential and great potential get the same duration of therapy if the minutes say so.