The SNF Rehab Model Must Change
I've learned immense amounts about what my American PT colleagues are going through just to work these days. It disheartened me at first, inspired me next, and now has propelled me to think more creatively. I think it may be time to throw out the baby with the bathwater... and the tub... and the sink... heck let's just rip down the house! The SNF rehab model doesn't work! If owners can't make a profit without professionals having to work off the books, overtime, and destroying their professional lives... it is a failed business model, plain and simple.
I started thinking about this because there are very few SNF rehab facilities here in the UK. Our town (population 283,000) has one with a capacity of about 20 people. Mostly acute TBI patients, acute trauma patients, and an occasional person with a stroke occupy those beds. Care homes here are staffed mostly by CNAs with some nursing oversight. If rehab is required, it is referred out to community teams (the equivalent of home care).
Where has the American SNF model evolved from? Has it actually been changed to maximize reimbursements? With so many stories of inappropriate patients on program, I seriously doubt it has evolved from patient need or demand! I also seriously doubt the situation will improve as time goes on.
Here is where the APTA can step in and not appear to be working as a trade union! They can ask the important questions, such as: Are the patients still benefiting from this model? Who does this model serve? What possibilities exist for changing sub-acute rehab into a more workable model?
In this way they can support us as professionals, demonstrate our ability to be proactive and leaders in patient care, and have a voice in creating the care landscape of the future. If they want us all to have the respect that comes with the DPT and autonomy, then they can't let us work for free in a sweatshop environment. Who is going to respect us when we work in that fashion?