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In this week’s post, Brian Hurley, SLP and Advanced New Grad Mentor, shares his experience and common questions he’s come across in medical settings. Make sure to follow him on Instagram here!

I learned about speech therapy from a young age through witnessing my best friend growing up receive it. He has been deaf since birth and has received countless years of speech therapy that has positively impacted his life. Even though my interest initially was with children, after receiving my undergraduate and master’s degrees in communication disorders I knew I wanted to work in the medical settings treating adults with speech-language deficits. I’ve been practicing for the past 5 years and been mentoring new graduates and travelers for Advanced for the past 3 years. During those years I have grown as a clinician and worked in the following settings; acute, skilled nursing, and outpatient. I have fielded many questions from graduates entering the skilled nursing setting through being a mentor and I’d like to share some common questions and answers I’ve come across. 

How do you manage meeting productivity for facilities with ridiculous expectations?

This comes down to an ethical dilemma. On the one side this is a business after all and our billing in the end is what generates revenue to pay our salaries. On the other side anything above 80% productivity expectations tends to embark on unethical practices and demands from facilities. I try to manage my documentation as best I can by spreading out dates that I have progress notes due, and allow myself the grace period of having documentation due within 2 days of starting it if I am behind on a certain day. Something else to consider is if you are doing your best to help patients and working within ethical standards then most facilities will not harp on what your actual productivity numbers are as long as they are within reason. 

What type of questions are important to you when you are interviewing for a contract?

For myself the main questions I am concerned about are accessibility to instrumental assessments, productivity expectations, and how many facilities are expected to be covered. If a facility does not have onsite instrumental assessments or a provider they use, I want to be sure that the facility is open to sending a patient for an outpatient assessment. As stated above I try not to put unrealistic demands on myself when it comes to productivity and I want to make sure the rehab directors’ expectations are in line with my own. Lastly If I am covering a facility and they have 2 or 3 sister facilities in the area I want to be sure that it is not expected for me to cover all 3 facilities. This comes down to being stretched thin and I will either request there be verbiage in the contract to limit being over worked or taken advantage of.

How do you go about setting up instrumental services within the facility?

First, I establish a need for the services, create a patient profile of people within the facility who require them, then approach administration. I initiate the conversation with nursing, then rehab directors, then ask to have a meeting with administrators capable of signing contracts with third party providers. This approach has been successful for myself in the past and it makes sure that all parties involved are on board. Come to the table with the facts, best practice, and local providers that you wish to work with. Preparation and organized presentation of your requests goes a long way and reduces further frustration. 

What’s the biggest hurdle or frustration you have come across in the skilled setting? 

Staff education in the more rural settings with reduced funding and poor family participation. Some of these facilities that have contracts are simply because they are hard to staff with therapists. In this scenario you can feel like it’s a constant uphill battle, which in some sense it is. For contracts like this, it’s important to remember that it’s short term there is an end in sight and it’s not permanent. Go in each day with the patient’s best interest and document, document, document. I typically like to give staff about 3 chances to follow through on recommendations charting the education provided then brining it to supervisor’s attention if people are blatantly ignoring your recommendations at that point its not your fault or lack of effort. Using staff education forms that are signed can sometimes be effective and is something I will try to implement if basic communication doesn’t seem to be getting the job done. 

What’s your favorite part about working with the geriatric population?

I enjoy going to work everyday improving the quality of life of this population, because typically they are grateful and you can see the real difference made. This population has been around a lot longer than I have and for that I typically learn something new every day, whether it be a new phrase that people no longer use, or some historical fact. Another rewarding aspect to working with this population is bringing comfort to the patient and family in the last days of their lives when for instance, they need to transition to hospice because they are in the end stages of dementia and no longer tolerating p.o. intake. In this case we play a pivotal role in helping family and staff understand the risks associated with various diets and practical interventions for increased quality of life and comfort. 

Do you have any other questions about working in a skilled setting or with a geriatric population? Let us know in the comments or contact us!

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