The Skilled Nursing Facility Conundrum
Last week I was involved in a discussion regarding membership in the APTA. For once the topic wasn't new graduates but therapists who were members but no longer are. The question was, what would it take to bring them back in? What do they value? I responded by describing how a SNF functions. Fix that chaos and they'll return.
SNFs are unique. Their purpose is to provide rehab for patients who can't tolerate three hours of therapy and can't return home. They are usually part of a nursing home because those patients also require nursing. The crux of this dilemma is for those patients, therapy is a priority and reimbursement is based on therapy.
Maybe in the beginning it worked. Now we have the bare minimum of staff doing the best they can to provide quality care. SNFs are staffed heavily with PTAs. The PT primarily does evals, re-evals and therapist summary notes. Productivity requirements hover around 90%. That doesn't leave adequate time for documentation.
Some facilities do point-of-service charting, which basically means spending time inputting data into a device rather than with the patient. Some payers don't want point-of-service documentation because they are paying for therapy time, not documentation time. I worked, briefly, at one place where the only way to meet the various demands was to work off the clock, which is illegal. Thus why I say I only worked there briefly.
Equipment in SNFs is limited. There is little capital budget for purchases. If something breaks, there often isn't money to replace it. DME for patients is also problematic. If the patient's insurance can't be billed, the patient will either receive something off the shelf or have to wait until going onto Medicare part B. No facility wants to pay for DME or equipment out of their reimbursement.
SNFs do not pay staff well. This is true of both nursing and therapy, although therapy fares a little better. Lower salaries aren't going to attract quality workers. Nursing care suffers. Medicine and medical supply levels are strictly monitored.
Changing this means changing legislation. The APTA would have to lobby, and lobby hard, for those changes and that costs money. Currently those lobbyists and that money are focused elsewhere.
The problem is SNFs are only one piece of the puzzle. Similar issues exist for home health, pediatrics, inpatient rehab and everywhere else PTs work. Thus we have one very large reason PTs and PTAs drop their membership in the APTA. They don't see any value.