Sell me on working SNF (PTA)

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mako47

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Hey guys! I am a new PTA grad working in OP right now. I love OP, but I feel like I cheated myself in rounding my skill set and exp out. I know SNF pays more (want to knock out heavy undergrad student loan debt), but I never have done it or shadowed it. My comfort zone lucked out because I had all of my clinical rotationsin OP. I know it gets a bad rep because pt's are much more difficult to work with. That said, I want to get an idea of how people involved in SNF work it.

I know that sounds silly, but how do you attack the day? What are the pro's and cons?

I interviewed for an SNF job to see the place, but the facility overwhelmed me (the second I walked in, a patient noticed me, I said hi to him, he flipped me off, said "hey f*ck you," and then wheeled away in his wheel chair . . . ) when I went to meet with one of the interviewing PT's. So yeah . . .

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My first internship/rotation in PT school was a SNF and it made me rethink wanting to be a physical therapist. I hated every second of it.

Stay outpatient and get a couple of home health visits per week for extra income.
 
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Most SNF's suck, but some of them are really good, with short lengths-of-stay, high standards, and good management. SNF's are either great or terrible.
 
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I had a good experience at a SNF. First, I LOVED the flexible schedule. I could basically see patients when I wanted to. My days started later because everyone wanted to eat breakfast first. I usually worked 8:30am to 4pm. There are no set appointment times so sometimes I worked with someone 15 mins and sometimes 60 mins just depending on how they were feeling, my goals and other stuff. I loved that I could vary my days for the patient (like if they were feeling great one day, we could do more, no problem.). Generally, my patients enjoyed working with me, especially once I got to know them. I always talked with them about the future plan ("when I see you this afternoon, I"m thinking we will do X, Y, and Z. What are your goals?"). I rarely had patients turn me down once they knew me.

Also, I really liked the functional focus of my therapy. I really hate taking goniometer measurements all the time or doing a billion quad sets. Most of what I did in SNF was standing, walking, getting in and out of chairs, stairs. It all felt much more "real" to me than OP. I felt like there wasn't much limit on the therapy either. I could really tailor it to the activities the patient liked to do and wanted to get back to (cooking, fishing, walking the neighborhood).

I loved the family interaction too. I was a familiar face the families saw everyday. I often became the one they talked to, or asked questions or shared important concerns. I quickly built a very clear picture of the patient and was often able to share that with other members of the medical team. I felt like I was a critical discharge piece not only for mobility but because I knew the patient so well.
 
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starrsgirl - was your gig at a private-pay SNF, or one that accepts mostly Medicaid patients? I have personal experience with 2 SNFs: one where the monthly cost was around $7K (in 2011, not sure what it is now). The environment there was very nice, the patients were well-to-do and mostly very educated, and a pleasure to work with. They also tended to be, or wanted to remain, active. The second SNF had mostly Medicaid patients and was the diametrical opposite: run-down facilities, patients who stayed in their rooms or wheelchairs most of the day staring into space and uninterested in any type of activity. As a PT, I'd love to work in the first SNF, and not in the second one. But I think most SNFs fall into the second category.
 
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Most SNF's fall into jblil's second category: run-down, long lengths-of-stay, poor patient quality, poor management, and the stench of urine everywhere you go. Don't work in those facilities. I did an internship in one of these facilities and I knew I didn't want to work there. Fortunately I had good CI's. I've also worked in a SNF that was part of a retirement community and it was the exact opposite. A good SNF is not a bad job and I'd rather work there than do home health.

I do like the flexibility of SNFs, where you can make your own schedule and see patients in any order you want. It's not as rigid as OP.
 
New Testament - I think you're doing Travel PT now; since most of your gigs would be in SNFs, can you get an idea of the environment before you accept the job? I mean, it'd be hard to detect "the stench of urine" (very true, BTW) over a phone interview... I am in home-health now, but may switch to Travel PT for my next gig.
 
New Testament - I think you're doing Travel PT now; since most of your gigs would be in SNFs, can you get an idea of the environment before you accept the job? I mean, it'd be hard to detect "the stench of urine" (very true, BTW) over a phone interview... I am in home-health now, but may switch to Travel PT for my next gig.

Obviously I can't see and smell the facility before the contract. If I ask the right questions, I can get an idea of what the facility is like. I had a director of rehab tell me specifically that the place didn't smell like urine, and admitted that most SNF's were horrible. Also, most gigs aren't SNF's. I've seen a lot of openings for HH, inpatient, outpatient, and a few acute. I've even seen a couple for pelvic floor PT.
 
starrsgirl - was your gig at a private-pay SNF, or one that accepts mostly Medicaid patients? I have personal experience with 2 SNFs: one where the monthly cost was around $7K (in 2011, not sure what it is now). The environment there was very nice, the patients were well-to-do and mostly very educated, and a pleasure to work with. They also tended to be, or wanted to remain, active. The second SNF had mostly Medicaid patients and was the diametrical opposite: run-down facilities, patients who stayed in their rooms or wheelchairs most of the day staring into space and uninterested in any type of activity. As a PT, I'd love to work in the first SNF, and not in the second one. But I think most SNFs fall into the second category.
Mine did accept Medicaid patients....but it was a good mix of insurances. However, there were some important other factors. 1) this was a rural setting. It very much had the small town vibe of most people being connected somehow. The head PT knew many of the patients too. 2) this was a short term SNF only. At most, they kept patients 3 weeks. They they either had to be well enough to go home or transfer to a long term care place.
 
can't sell you, sorry. You can make the experience whatever you want but changing most SNF's procedures and dealing with RUGS and nurses and CNAs that don't care (some, not all) will be the hardest part. I would avoid working for a company where you cover 3 or 4 facilities and do evaluation only and pass everything off to PTAs. I would also avoid working at a place that has a ridiculous productivity standard (some are 90% which is outrageous). Your skills will become what you demand of them.
 
can't sell you, sorry. You can make the experience whatever you want but changing most SNF's procedures and dealing with RUGS and nurses and CNAs that don't care (some, not all) will be the hardest part. I would avoid working for a company where you cover 3 or 4 facilities and do evaluation only and pass everything off to PTAs. I would also avoid working at a place that has a ridiculous productivity standard (some are 90% which is outrageous). Your skills will become what you demand of them.

One SNF is bad enough but three or four SNF's would be horrible. If you're not treating your own patients at least part of the time, then the SNF values productivity over quality of care. Most SNF's have at least 85% productivity standards these days, but with point-of-care documentation, that shouldn't be impossible to achieve. But higher productivity demands mean less time with patient. Make sure you ask the SNF if they expect you to finish documentation before you go home. I have a friend who spent two hours each night doing notes to meet productivity standards.
 
I have had patients that have come from one of those SNFs and been discharged home then followed up with me as an OP. They were very put off by the point of care documentation. No or very little engagement between the PT and the patient.
 
I love my nursing home job currently but worked in a facility for several years as a new grad which was absolutely horrible. The 'stench of urine' really wasn't what got me although that was present also... The biggest issue was the drama. I have never worked at any place of employment with more backstabbing, bickering, and crappy management in my life. The crap just kept getting deeper the farther up the chain you got and the unhappiness filtered down through all the underlings who were underpaid, overworked, expected to have 90% productivity while having no STNAs on the floor to get the patients up, dressed, toileted, etc. so the therapy staff had to do most of the STNA work (the people working there were good people - just not enough of them. They would cut back so far that everyone constantly felt stressed). You would be given 20 patients, told to get 72 min with most of them, and get out in an 8 hour day - which of course is impossible.. then get written up for having overtime. I would ask other employees who work there for an honest evaluation of the place before signing any contract. I work at another nursing home now and it is like night and day. My manager is wonderful and painstakingly calculates out the minutes with each patient and what patients prefer to work during what time of day so it fits easily into the hours I am available to work. The nursing home staff has 2 aides per hall in a smaller nursing home than the awful one I started out in (which had 1 aide on the hall per every 40 residents - they counted office staff as STNAs but they were never actually on the hall to help). The patients where I am now are bathed 2 times per day, showered at least 1 time per week (unless they can't for medical reasons) and more often if the patient wants. Sure there are times when you walk down the hall and walk into an "invisible wall" of stink - you will get that at any nursing home you work at, but it is cleared up quickly and it doesn't have that body odor stench that some nursing homes have permeating the place from unwashed bodies and festering wounds. Where I am now has wonderful activities staff who actually take the residents outside, on outings, do all kinds of creative activities, etc. There is a wonderful restorative staff who keep people from constantly being referred back to therapy for inactivity. The thing I love the most about my nursing home job, though, is the residents. At the end of the day, you will become part of a family and you will feel much more rewarded than you do in your outpatient position because you have so much more of a positive impact on the patient's lives. Taking someone who comes in nearly paralyzed and has to look forward to spending the rest of their life in a nursing home and working with them until they walk out the door and climb into the car to go home is the best feeling in the world. If you can find a good facility, a nursing home job can be one of the best jobs you could ever have.
 
"... bathed 2x per day" - where is that SNF? I want to reserve my spot now!
 
One SNF is bad enough but three or four SNF's would be horrible. If you're not treating your own patients at least part of the time, then the SNF values productivity over quality of care. Most SNF's have at least 85% productivity standards these days, but with point-of-care documentation, that shouldn't be impossible to achieve. But higher productivity demands mean less time with patient. Make sure you ask the SNF if they expect you to finish documentation before you go home. I have a friend who spent two hours each night doing notes to meet productivity standards.

How does higher productivity mean less time with the patients to you? If anything it is more time with patient because you get less down time in your day and it is more time you are expected to be with patients.

Yeah point of care documentation is a sort of necessary evil. I cant remember the last time I went to a doctors appointment and the doctor wasnt on the computer as I was talking to him. If you are a good PT you wont make the patient feel like they arent getting attention or become all consumed by the documentation.

Documentation is required to be done before you leave each day at our company. If the therapists cant get this done before they leave something isnt quite going right and we help them through it. How does spending 2 hours on documentation each night help your friends productivity? Unless he is doing it off the clock? We do not allow that at our company, as we dont expect therapists to have to do anything off the clock, again we help them get more efficient with documentation throughout the day.

I hope your friend isnt billing for documentation for those two hours and that is what you mean by it helping his/her productivity. You cannot under any circumstances bill for any documentation. Only if you are with the patient and obviously then you are having them do ther ex or some other activity and arent billing for the documentation.

I have worked in great SNFs and some crappy ones, but even the crappy ones are tolerable if you put your mind to helping your patients and you work for a good company and have good co-workers. Even the nicest best SNF will be miserable if you have a crappy manager, work for a bad or unethical company, etc.
 
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