In past posts, I've expressed frustration at volunteering for various opportunities within the APTA and the Neurology Section. A few months ago, I was nominated for a position on the nominating committee for the stroke special interest group. The results arrived today. I wasn't elected. I wasn't surprised. One of the questions nominees were asked ...

Last week in his post, fellow ADVANCE blogger Dean Metz shared some good news. CMS has ruled the need for skilled intervention, not functional improvement, makes therapy reimbursable. This means, as he pointed out, patients with chronic conditions can receive treatment without first experiencing an exacerbation. This will undoubtedly result in an ...

If I had any doubt that patient-focused healthcare was a thing of the past, I don't anymore. Last weekend, a situation arose that showed me charging for services was more important than patient care. I work full-time at one facility and help out at another. The second facility is an hour drive away by highway. It fell to me because I'm the only ...

Last week I described being warned not to make trouble by reporting the nurses watching the baby camera while at work. I've been thinking about that. Why would I be the troublemaker for reporting someone else doing something wrong? Shouldn't it be the other way around? You would think the person bringing it to attention would be thanked. I ...

The positive influence of animals on healing is well known. Caring Critters now make regular visits to various facilities within the Houston area. Dogs can be certified as therapy animals. Horses are used for hippotherapy with great results. Now I'm going to try to combine the two. Last Friday, my horse Expsychment (pronounced ''excitement'') ...

Anyone who reads my blog with regularity knows the last year has been a struggle for me. I lost my beloved job. I was fired for being ethical. I encountered more than my share of unethical and self-serving people. During all of that, I hung on and kept going to work. Every so often I made a difference to someone, which kept me going. For the ...

This morning while I was walking a patient, I overheard another patient walking behind us. She was telling the CNA taking her to the dining room that she recognized me from the weekend. She was upset with me because I came to take her to therapy and she refused. Her daughter was coming later that day and she didn't want to get up. I don't know ...

Last week I questioned what the definition of skilled therapy was. I had worked with several patients the previous weekend whose only deficit was the need for supervision. I've realized I wasn't clear in describing those patients. All of them had been on caseload for a while. Previous safety issues, such as Berg and Tinetti scores, had been ...

I've been noticing a disturbing trend lately. More and more facilities are considering the need for supervision as a need for skilled therapy. Back in the day, patients referred to SNFs and outpatient had an obvious need. They had trouble walking. They couldn't transfer. They'd recently undergone total joint replacement. The knowledge and skill of ...

Now that I'm home from CSM, I've had an opportunity to process all of the information. Most of the presentations were excellent. Those that weren't purely theoretical had a common theme. We have to maximize what we do because we're spending less and less time with patients. We have less time to spend because there isn't money to pay for our ...