Happy holiday, unless you work in a SNF

Every setting has its own complex rules and regulations, but it seems that the Skilled Nursing Facilities (SNF) get more than their fair share. Payment for therapy services rendered is dependent upon meeting a set number of minutes in a pt's week (starting on their admission). To be even more complicated, I have heard that the first week's payment actually is a prospective payment for the second week... I cannot go into that as it is far too dizzying. At any rate, a pt. must be seen for at least 15 minutes to count as a 'day' of therapy. In addition to meeting a certain number of minutes of therapy per 7 days, there are also requirements of how many 'days' of therapy a person needs.

blah blah blah paperwork.

So here's where the holidays wreak havoc. If pt. X is admitted on Wednesday the 27th (and is evaluated and treated that day, not a given), they will need 4 more 'days' of treatment for most levels. So between Saturday, Sunday, and Labor Day, this pt. will have to be seen by at least one therapy, and will likely have to make up extra time during the regular work week. So for any pt. that is in their first 14 days, there is a crush to get extra time. Also, this is why most SNFs require therapists to work weekends and many holidays. Kind of a bummer.

Another bummer from the 'days' side of things has been happening a lot at my place recently. A person cannot be discharged from the hospital and admitted to the SNF floor w/o a doctor's order. So even if all the plans have been made through case management and the SNF admission planner, if no one writes an order, the pt. sits and languishes in hospital bed limbo. Also, the therapist's wobble and wait for word on whether the pt. will come that day, night, or the next. You can wait around, have a pt. show up at 4:55 and wind up working over. Or you can wait around for naught since they won't show til 8:30. Regardless of whether they are evaluated or not, treated or not, that still starts their week and leaves only 6 more days to work. And if you just happen to have a person who is too sick to participate 1 or 2 days... it just makes it all harder.

I gave my best today to try to be extra motivating to my lil' ladies down my hallway... especially since I shant be helping the rest of the team again until Tuesday (which also starts new peds sched). I am taking an extended weekend to go home and decrease my loneliness by visiting w/ friends and family. I have been doing fair with my goals... 2 social activities this week and 1 trip to the rec center, a finished jigsaw puzzle, another load of laundry, and a nice long phone call with a friend. But the townhouse gets quiet. So posts might be less frequent than planned this weekend, but at least I'll be having fun. :)

PS- funny note: Laughed a lot the other day as an MD stalled out his manual-transmission sports car while trying to key in the password to the MD lot on a teeny tiny slope. I don't drive a stick very well, but I also didn't drop BIG BUCKS on a fancy schmancy sports car. :-P

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