Re: Re: [Assiting in Nursing Home

[Guest guest]

I agree with Tom in defining the specifics of " assisting with care " . I am a

physical therapist for a senior living community consisting of: SNF, Assisted

Living, Independent apartments. At times, I am called on by floor staff

regarding a problem transfer, difficult mobility issue, falls assessment. Each

of these episodes triggers a Rehab Screen and a referral for OT/PT/SLP evolves.

Many of these instances help cement relationships between floor staff and rehab

staff. Good luck Reisa.

Slocum PT

Mountain Top, PA

Re: Re: [Assiting in Nursing Home

> Hi Reisa,

It would be helpful to us to have you explain the specifics of what you

mean by " assisting with the care of other residents not actively on

caseload " .

This is important because most facilities that I am aware of encourage all

staff to help any resident in need as long as it does not interfere with

their primary responsibilities. Plus in facilities I worked at, we were

always keeping up on other residents vis nursing, via screens to see if

anyone may need a referral for therapy.

What it may come down to (and that is why specifics are needed)is the

difference between policy and cost/benefit analysis. Most therapy staff

in a SNF are expected to be productive, meaning spending a set percentage

of their time in the facility doing billable activities so to be pulled to

help out with other residents may go against this. Just let us know more

specifics of what you are being asked to do and then we can better help

you figure this out.

M Howell, PT, MPT

IPTA Payment Specialist

Meridian, ID

thowell@...

> Good Afternoon All,

>

> I am looking for input as to whether ( & if so how) your staff in SNFs

> are assiting with the care of residents not actively on caseload.

> Until now, we have been clearly 'hands-off' but are hearing that the

> national trend is to have rehab staff help with other residents. Any

> input would be welcome

>

> Thanks!

>

> Reisa Fedorchuck, PT, MPH

> Highland Health Care Center

> Cheshire CT

>

>

[Guest guest]

Hi Tom,

We are being asked to assist with things like toileting, supervising or

participating in a Hoyer transfer.  We currently assist with passing breakfast

trays on the rehab unit- primarily for rehab patients and  help pass a meal tray

if we are returning residents at the time of a meal. All of us help with quick

boosts, acknowledge call lights if passing a room and go to the nursing staff

with the request (pain medication, etc) and whenever possible respond to patient

safety alarms for high fall risk residents. 

Though we recognize the dilemma re: productivity, our overriding concerns are

regarding safety and liability.  The staff are concerned that if they have not

fully reviewed the current records as would a PT or OTR for an eval, they would

be liable if an injury occured. (For example if a resident had a hypotensive

episode transferring to the toilet) 

We have all been trained that in this environment, we are not to touch a

resident without an evaluation order or that it is at our own risk. Our screens

are " hands-off " and based on record review, dialogue and observation.  We do not

transfer new residents out of cars on arrival  as we would have to review the

records and evaluate before safely doing so. 

I understand that the trend is for rehab to help as much as possible, but as

this is new to us, and counter to what was familiar and comfortable, I was

hoping to find a precident for what we can and or shouldn't be helping with.

Reisa

________________________________

To: PTManager

Sent: Thu, March 1, 2012 4:01:45 PM

Subject: Re: Re: [Assiting in Nursing Home

> Hi Reisa,

It would be helpful to us to have you explain the specifics of what you

mean by " assisting with the care of other residents not actively on

caseload " .

This is important because most facilities that I am aware of encourage all

staff to help any resident in need as long as it does not interfere with

their primary responsibilities.  Plus in facilities I worked at, we were

always keeping up on other residents vis nursing, via screens to see if

anyone may need a referral for therapy.

What it may come down to (and that is why specifics are needed)is the

difference between policy and cost/benefit analysis.  Most therapy staff

in a SNF are expected to be productive, meaning spending a set percentage

of their time in the facility doing billable activities so to be pulled to

help out with other residents may go against this.  Just let us know more

specifics of what you are being asked to do and then we can better help

you figure this out.

M Howell, PT, MPT

IPTA Payment Specialist

Meridian, ID

thowell@...

> Good Afternoon All,

>

> I am looking for input as to whether ( & if so how) your staff in SNFs

> are  assiting with the care of residents not actively on  caseload. 

> Until now, we  have been clearly 'hands-off' but are hearing that the

> national trend is to have  rehab staff help with other residents.  Any

> input would be welcome

>

> Thanks!

>

> Reisa Fedorchuck, PT, MPH

> Highland Health Care Center

> Cheshire CT

>

>

[Guest guest]

Hi Reisa,

Thanks for your response. That does help.

You have answered the first concern and that is liability. Facility blanket

policies should cover all staff in performance of any work with residents

but, in truth, that is beyond my knowledge in the SNF setting. I know this

to be the case in a hospital. That needs to be addressed first.

If there are no liability issues and you are concerned with not knowing

residents problems before helping them outside of the rehab setting, then it

may be something as simple as communication about all residents in the way

nursing staff communicates resident needs from shift to shift.

That being said, if the liability issue is resolved, then it comes down to a

productivity issue. If these resident activities are affecting

productivity, then it is up to your manager to show the facility management

how the loss of productivity is affecting billing and income.

If productivity is not an issue, then it becomes a staffing issue that your

manager should be handling. Unfortunately if staff is not able to stay busy

and productive, then you may just be overstaffed. On the other hand, your

manager should be concerned that nursing may be way understaffed, requiring

rehab staff to be pulled for traditional nursing duties. No facility wants

this for long because it makes no sense to be paying therapists to do CNA

duties when most PT's and PTA's make at least three times as much as CNA's.

Not a well-managed facility from a financial aspect if this is the case

Finally, if all these issues are addressed, then it comes down to facility

policy and there is nothing that says that they cannot require you to do

these tasks. There was a big push 20 years ago to " cross-train " hospital

and SNF staff in multiple jobs going as far as considering to cross train

rehab staff in phlebotomy, all to maximize staff productivity and improve

the patient experience. Well that grand experiment was a big bust. It did

not improve productivity nor did it improve the patient experience.

Ultimately, the feedback from residents may be the deciding factor as to how

much rehab staff may be involved in non-rehab. Hang in there as your

facility will in time discover what most other facilities have when trying

to do this. In the meantime, if all of the issues above are discussed and

resolved, then for now be a good team player and help out the residents

whenever and wherever needed! Ultimately good care is good care no matter

who provides it!

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

From: PTManager [mailto:PTManager ] On Behalf

Of REISA FEDORCHUCH

Sent: Thursday, March 01, 2012 8:02 PM

To: PTManager

Subject: Re: Re: [Assiting in Nursing Home

Hi Tom,

We are being asked to assist with things like toileting, supervising or

participating in a Hoyer transfer. We currently assist with passing

breakfast

trays on the rehab unit- primarily for rehab patients and help pass a meal

tray

if we are returning residents at the time of a meal. All of us help with

quick

boosts, acknowledge call lights if passing a room and go to the nursing

staff

with the request (pain medication, etc) and whenever possible respond to

patient

safety alarms for high fall risk residents.

Though we recognize the dilemma re: productivity, our overriding concerns

are

regarding safety and liability. The staff are concerned that if they have

not

fully reviewed the current records as would a PT or OTR for an eval, they

would

be liable if an injury occured. (For example if a resident had a hypotensive

episode transferring to the toilet)

We have all been trained that in this environment, we are not to touch a

resident without an evaluation order or that it is at our own risk. Our

screens

are " hands-off " and based on record review, dialogue and observation. We do

not

transfer new residents out of cars on arrival as we would have to review

the

records and evaluate before safely doing so.

I understand that the trend is for rehab to help as much as possible, but as

this is new to us, and counter to what was familiar and comfortable, I was

hoping to find a precident for what we can and or shouldn't be helping with.

Reisa

________________________________

From: " Tom Howell, P.T., M.P.T. " <thowell@...

<mailto:thowell%40fiberpipe.net> >

To: PTManager <mailto:PTManager%40yahoogroups.com>

Sent: Thu, March 1, 2012 4:01:45 PM

Subject: Re: Re: [Assiting in Nursing Home

> Hi Reisa,

It would be helpful to us to have you explain the specifics of what you

mean by " assisting with the care of other residents not actively on

caseload " .

This is important because most facilities that I am aware of encourage all

staff to help any resident in need as long as it does not interfere with

their primary responsibilities. Plus in facilities I worked at, we were

always keeping up on other residents vis nursing, via screens to see if

anyone may need a referral for therapy.

What it may come down to (and that is why specifics are needed)is the

difference between policy and cost/benefit analysis. Most therapy staff

in a SNF are expected to be productive, meaning spending a set percentage

of their time in the facility doing billable activities so to be pulled to

help out with other residents may go against this. Just let us know more

specifics of what you are being asked to do and then we can better help

you figure this out.

M Howell, PT, MPT

IPTA Payment Specialist

Meridian, ID

thowell@... <mailto:thowell%40fiberpipe.net>

> Good Afternoon All,

>

> I am looking for input as to whether ( & if so how) your staff in SNFs

> are assiting with the care of residents not actively on caseload.

> Until now, we have been clearly 'hands-off' but are hearing that the

> national trend is to have rehab staff help with other residents. Any

> input would be welcome

>

> Thanks!

>

> Reisa Fedorchuck, PT, MPH

> Highland Health Care Center

> Cheshire CT

>

>

[Guest guest]

Hi Reisa,

Thanks for your response. That does help.

You have answered the first concern and that is liability. Facility blanket

policies should cover all staff in performance of any work with residents

but, in truth, that is beyond my knowledge in the SNF setting. I know this

to be the case in a hospital. That needs to be addressed first.

If there are no liability issues and you are concerned with not knowing

residents problems before helping them outside of the rehab setting, then it

may be something as simple as communication about all residents in the way

nursing staff communicates resident needs from shift to shift.

That being said, if the liability issue is resolved, then it comes down to a

productivity issue. If these resident activities are affecting

productivity, then it is up to your manager to show the facility management

how the loss of productivity is affecting billing and income.

If productivity is not an issue, then it becomes a staffing issue that your

manager should be handling. Unfortunately if staff is not able to stay busy

and productive, then you may just be overstaffed. On the other hand, your

manager should be concerned that nursing may be way understaffed, requiring

rehab staff to be pulled for traditional nursing duties. No facility wants

this for long because it makes no sense to be paying therapists to do CNA

duties when most PT's and PTA's make at least three times as much as CNA's.

Not a well-managed facility from a financial aspect if this is the case

Finally, if all these issues are addressed, then it comes down to facility

policy and there is nothing that says that they cannot require you to do

these tasks. There was a big push 20 years ago to " cross-train " hospital

and SNF staff in multiple jobs going as far as considering to cross train

rehab staff in phlebotomy, all to maximize staff productivity and improve

the patient experience. Well that grand experiment was a big bust. It did

not improve productivity nor did it improve the patient experience.

Ultimately, the feedback from residents may be the deciding factor as to how

much rehab staff may be involved in non-rehab. Hang in there as your

facility will in time discover what most other facilities have when trying

to do this. In the meantime, if all of the issues above are discussed and

resolved, then for now be a good team player and help out the residents

whenever and wherever needed! Ultimately good care is good care no matter

who provides it!

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

From: PTManager [mailto:PTManager ] On Behalf

Of REISA FEDORCHUCH

Sent: Thursday, March 01, 2012 8:02 PM

To: PTManager

Subject: Re: Re: [Assiting in Nursing Home

Hi Tom,

We are being asked to assist with things like toileting, supervising or

participating in a Hoyer transfer. We currently assist with passing

breakfast

trays on the rehab unit- primarily for rehab patients and help pass a meal

tray

if we are returning residents at the time of a meal. All of us help with

quick

boosts, acknowledge call lights if passing a room and go to the nursing

staff

with the request (pain medication, etc) and whenever possible respond to

patient

safety alarms for high fall risk residents.

Though we recognize the dilemma re: productivity, our overriding concerns

are

regarding safety and liability. The staff are concerned that if they have

not

fully reviewed the current records as would a PT or OTR for an eval, they

would

be liable if an injury occured. (For example if a resident had a hypotensive

episode transferring to the toilet)

We have all been trained that in this environment, we are not to touch a

resident without an evaluation order or that it is at our own risk. Our

screens

are " hands-off " and based on record review, dialogue and observation. We do

not

transfer new residents out of cars on arrival as we would have to review

the

records and evaluate before safely doing so.

I understand that the trend is for rehab to help as much as possible, but as

this is new to us, and counter to what was familiar and comfortable, I was

hoping to find a precident for what we can and or shouldn't be helping with.

Reisa

________________________________

From: " Tom Howell, P.T., M.P.T. " <thowell@...

<mailto:thowell%40fiberpipe.net> >

To: PTManager <mailto:PTManager%40yahoogroups.com>

Sent: Thu, March 1, 2012 4:01:45 PM

Subject: Re: Re: [Assiting in Nursing Home

> Hi Reisa,

It would be helpful to us to have you explain the specifics of what you

mean by " assisting with the care of other residents not actively on

caseload " .

This is important because most facilities that I am aware of encourage all

staff to help any resident in need as long as it does not interfere with

their primary responsibilities. Plus in facilities I worked at, we were

always keeping up on other residents vis nursing, via screens to see if

anyone may need a referral for therapy.

What it may come down to (and that is why specifics are needed)is the

difference between policy and cost/benefit analysis. Most therapy staff

in a SNF are expected to be productive, meaning spending a set percentage

of their time in the facility doing billable activities so to be pulled to

help out with other residents may go against this. Just let us know more

specifics of what you are being asked to do and then we can better help

you figure this out.

M Howell, PT, MPT

IPTA Payment Specialist

Meridian, ID

thowell@... <mailto:thowell%40fiberpipe.net>

> Good Afternoon All,

>

> I am looking for input as to whether ( & if so how) your staff in SNFs

> are assiting with the care of residents not actively on caseload.

> Until now, we have been clearly 'hands-off' but are hearing that the

> national trend is to have rehab staff help with other residents. Any

> input would be welcome

>

> Thanks!

>

> Reisa Fedorchuck, PT, MPH

> Highland Health Care Center

> Cheshire CT

>

>