ChChChanges

Our SNF floor recently had auditors come in and evaluate what we were doing and how we could improve our care and (I assume) finances. We are still waiting on their report, but at this point, I think everyone knows that there will be changes and there's considerable tension, worries, and defensiveness in the water now. I am not totally alarmed by this prospect however, and am hopeful that we will make some good improvements. I think that I welcome the outside influence more than the others, as they've all been working on the floor for 10-30 years, and let things wear a bit of a rut. Don't get me wrong, we all work very hard at getting our pt's better and more independent, but there is more that could be done. I think that it is also a bit harder on our floor, since we are connected to a rural hospital and do not have a lot of pt's willing to pursue acute rehab. We get a lot of pt's that are sicker and more complex than I think the average community SNF gets, which makes it hard to do more advanced treatments, such as IADLs and endurance draining activities. Also, our OT staff is limited to 1.5-2.5 therapists for the skilled floor (16 beds) in addition to the rest of the hospital acute care. Since our outpatient practice is in a separate building, this limits the amount of help those therapists can lend.

I feel the constraints of this situation, but I always have a push to do more, and really hope that we will make some improvements. I would like to see pt's out of their rooms more, get more help from nursing, and make home visits. I am looking for suggestions for what others do to keep their SNF therapy fresh, interesting, and therapeutic for their pt's. I'd love to hear about it- except for comments related to 'wiihab.' There is no funding for it at our hospital, and our pt base is really not at a level to actively benefit. Also, no way to secure it safely. But anyway, let me know about the awesome things you're doing to take your pt's from SNF to home.

Also- how many people working in a SNF or rehab facility frequently recommend home health therapy upon discharge? I was taught to do this for most pts as a CYA measure, but our MDS director thinks that this is a sign we're not keeping our pts long enough. Thoughts?