I find that working as a Physical Therapist (PT) in Skilled Nursing Facility (SNF) can be very rewarding. As therapists in this setting, we often see significant improvement our patients’ quality of life. Helping a patient move back home can be some of the most rewarding moments in your PT career. Skilled Nursing Facilities can be beautiful, with local art and cool things like waterfalls and live birds, and they often work hard at offering a home-like environment to their residents. However, some SNF settings can also be the opposite.
Working as a therapist in a Skilled Nursing Facility can be downright frustrating with significant swings in patient loads and various levels of autonomy. Some facilities are downright dreary and depressing. Interviews for SNF travel therapy assignments can be difficult to navigate. At times, facilities over promise autonomy and under report productivity requirements to make a job sound appealing. The following 5 questions summarize my advice about interviewing for a job in a skilled nursing facility.
These are the questions I ask before taking SNF placements. With experience and practice, I have found these questions can help me decide if a facility is going to be good match for me. Below is my list with explanations. Enjoy.
How many therapists will I be working with?
Sometimes, as a travel therapist, you are presented with an opportunity to be the only therapist in a facility. Your level of comfort with this situation generally depends on experience. Many times in rural settings the patient load only requires one therapist. However, having colleagues present to help with documentation standards is helpful, as well as being able to ask for advice on difficult patients and situations. The benefits of learning from experienced clinicians in an environment compatible with collegial discussion and interaction cannot be overstated. As a travel therapist, knowing who you can count on to discuss important issues will make your traveling experience less stressful, so be sure to investigate who your co-workers will be and what their experience levels are.
What is your “payer” mix?
By payer mix I refer to the ratio of Medicare/private insurance vs indigent care or Medicaid. From experience, I have found that facilities with a majority of patients covered by a Medicaid benefit (or another type of safety net insurance) tend to be a less desirable work environment. On the other hand, when a facility has a good ratio of Medicare and private insurance to Medicaid, the facilities tend to have more desirable work environments.
The bottom line is that Medicare and private insurances pay more money to the facilities, so the facilities have more money to spend for upgrades on gym equipment, food, wheel chairs, and to make the patient’s lives more pleasant. I once worked (briefly) for a facility that had a gym so small it looked more like a closet. Every one deserves adequate therapy services, but the reality is that some facilities have more money to devote to these services than others. Before you take a travel assignment or a permanent therapy job with a facility, you should find out what kind of payers your facility works with. If you decide to work in a facility with a majority of safety net payers, you will have realistic expectations that come from an understanding of your facility’s circumstances.
What are your productivity expectations?
Productivity. Where do I even begin? I will not work for a company that expects 90% productivity. I believe that it doesn’t work and it encourages false documentation and fraud. The more therapists refuse to work for companies who expect 90% productivity the better. That is what I think.
Who sets your RUG levels?
Medicare currently provides reimbursement for rehabilitation based on the number of minutes of physical, occupational, and speech therapy that are logged each week at a facility. Patients are assigned a certain Resource Utilization Groups (RUG) level by the facility. This RUG level determines how many minutes of therapy a patient may receive each day. Medicare RUG Levels have recently come under scrutiny in the skilled nursing Rehabilitation Industry. For a more in-depth analysis, check out this summary of Wall Street Journal’s coverage of this topic.
As As a therapist, being included in RUG level decision making is important to me because it enables me to avoid many of these controversies. Some facilities actually have their secretary set a patient’s RUG levels. I do not find this appropriate. RUG levels should be set by the therapist and the manager to meet the needs of every individual. Therapists who provide direct patient care to the individual should be setting the RUG expectation levels. Always ask who sets the RUG levels and ask how much input the treating therapist has in determining that level.
Who attends your care conferences?
The trend in SNF settings has been that managers go to care conferences. This can either be positive or negative. On the negative side, managers commonly do not treat your patients, therefore, they tend to have a poor understanding of the progress, barriers and social situations that affect a discharge plan (or lack of discharge plan). Every therapist can tell stories about patients who were ready for discharge and had been kept on therapy services too long. On the positive side, I have worked with managers who do treat patients daily and are aware of their specific situation. This tends to work well. I find care conferences to be one of the most valuable services we participate in, even when there is bad news to share. Being the treating therapist creates a special relationship with the patient. If the manager is going to be the one attending care conferences, then they should also be treating patients. Again, this is my personal view.These are just a few suggestions I have for therapists considering taking a travel therapy job at skilled nursing facilities. For more information on this setting,
These are just a few suggestions I have for therapists considering taking a travel therapy job at Skilled Nursing Facilities. For more information on this setting, check out this overview of working as therapist in the Skilled Nursing Facility setting or this interview from a SNF Director of Rehabilitation (DOR) who really loves his job. Or, maybe you have a few thoughts of your own on in a skilled nursing facility.
Please share your thoughts in the comments section. Thanks!
Justin Johnson is currently living and working in Bellingham, WA. Justin graduated from Central Michigan University with his DPT in 2008 and earned his GCS designation in 2011. Justin has worked for large trauma 1 and teaching hospitals along with diverse settings as a travel PT for many years. During the winters Justin can be found sliding up and down mountains on his skis or at Mt. Baker where he is a volunteer ski patroller. During the months where there is no snow he can be found on two wheels. You can reach him at JMJohnsonDPT@gmail.com.