I was just wondering how most rehab. departments in SNF's schedule therapy services.  Do you have a fixed or flexible schedule.  We are currently having a debate with our nursing dept. on which to use.

Thank you.

Every facility is different, and there has to be a certain amount of 'go with the flow', but in general the ones I've worked in tried to adhere to a fixed schedule. Most patients want to know what time therapy will be so they can plan family visits, leisure acts, even naps and when to ask for pain meds. They may also simply have a preference about whether they prefer morning, after lunch, etc. I know this sometimes causes problems, especially if your facility is short-staffed in terms of CNA's. It's best to work with them and make sure you see them as the trained professionals they are. They will be much more likely to want to work with you on the schedule if they feel part of the team rather than feel treated like glorified maids, which I have seen some therapists do (not saying you guys do!) Thnk about where you're putting people on the schedule, and how reasonable your request for that time is. It's usually best to avoid putting someone really heavy duty on first thing in the morning; the CNA's may have to let 5 others wait to get dressed in the time it takes to bathe and dress the heavy-duty person, and will end up getting flack for it. I have compromised in the past by saying to the CNA 'if you can bathe her, I'll go in and help her get dressed'. Then you will get the person early if that's how they're scheduled, you'll be doing a perfect OT activity, and nursing will see you as someone who works with them as a team. Hope that helps!

i have been contracting several years in multiple SNF and all of them do not have scheduled therapy sessions. usually you get a list of patients to treat and attempt to treat patients that are already dressed, unless you want to do ADL's with them. some patients do prefer a scheduled time and i try to see them at the same time everyday.

As much as we would all like to adhere to a routine, just remember, the 'go with the flow'. We don't schedule for time per se, but we do try to adhere to the residents preference of morning or afternoon. Things happen (life happens) the doc shows up, the lab tech arrives just as you have gotten the resident started with an activity in the gym/clinic, staff shortages, it's shower day, etc! We also we split an ADL with the CNA. Ask nursing about giving pain meds prior to tx and then schedule the resident 30 minutes after the Rx is given. Try to come to a compromise with your nsg staff, and remember, life happens, even in a SNF.

Good louck!

Kathy

After working in over 30 nursing homes I have found that nursing wants us to have schedules, yet buck any schedules that we come up with because their staff won't live up to their part. If they do their part we then have the problem of what to do if the patient refuses. With a free schedule we can go back and offer the session again. A free schedule has worked the best in my experience. My company is forcing the scheduling bit right now, and my manager has decided to go with a fairly loose scedule. We will be scheduling for a 2 hour block at a time. Patients will be seen during the 8-10 time period, for instance, instead of at 9:00. We'll see how this works. Initially it seems like a good middle of the road concept.

We make a schedule for pt's to be seen by PT and OT (both on the same sheet).  We have had an issue with nursing not checking the schedule, the schedule conflicting with a pt's bathing schedule, or other appts.  We basically use it as a guideline and try to get the pt's down to therapy around their scheduled time.  It doesn't always work, but at least it lets the pt's know when they're expected.