Some further thoughts on OT practice in the SNF. However critical and
disappointed some of us who don't work in SNF feel about the pracitices of
those who do, keep in mind that each practice setting has its own unique
challenges and limitations.
The PPS system has the RUG system where the highest reinbursment is for
those patient who participate in as much as 360 minutes of OT a week.. That's
6 days of 60 minute sessions, so if a person stays for a month they receive 24
hours ( 1440 minutes) of OT in a month. And this process is multiplied got each
OT practitioner by a caseload (lets say for average) 7 patients per day. Each
minute of each session is structured and guided by the therapist while
navigating a complex system of all the other therapies, nursing care, and
scheduling taking place within the facility.
This means there is a lot of therapy being provided and therefore a lot of
designing and implementing and documenting interventions. Making every minute
of every session wonderful, meaningful, enjoyable, and occupational is quite a
challenge. I venture to predict that rehab professional in SNF spend more time
with their clients than any other professionals in the whole healthcare system!
Other posts on this list have also observed that the SNF rehab client is not
always the most motivated of clients either and clients are often unable to
identify meaningful occupations on which to base treatments.
Due to reasons explained previously in my other recent post, and the
factors above, some patients might have incidences of "bad OT". Given the
shear abount of time spent in treatment, the odds of having some
non-meaningful or bad experiences are pretty high.
I think any of us can identify unsatisfactory experiences with healthcare
and other professionals on occasion. I personally have had occasional
frustration and disappointment at the dentist, doctor, optometrist, or even
with the waiter at a restaurant. I think on average there are a lot of hard
working OTs in SNF doing a great job! Of course we always hear about the worst
and best therapy experiences that people have.
While all the criticism, judgement and discussion ongoing in the OT community
may be necessary to encourage us to focus on occupation, there is no shortage
of equal scrutiny by our administrations and regulators who have there own
definition of what expected and required of OTs. Keeping everyone satisfied in
no easy task and I think "bad OT "is more a function of being overwhelmed than
being lazy. Let us find a way to support and encourage eachother!
Brent C
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