Let's Use the Current State of SNF Therapy as a Springboard to More Positive Outcomes

Ian Oppel enjoys an engaging therapy session.

Therapy today in skilled nursing facilities (SNF) looks vastly different than it did before the pandemic. What is yet to be determined is whether or not these changes can result in positive outcomes for all parties involved -- patients, therapists and SNFs.

Last fall, the federal government released a $5 billion aid package to SNFs. That funding, combined with the collective will to improve therapy challenges that existed in the industry even prior to COVID-19, provides a rare opportunity for a possible total redesign of how SNFs provide therapy. I propose that that the vastly different climate in SNFs since COVID-19 hit should be a springboard for a more positive future for therapy in SNFs.

In October 2019, CMS replaced the Prospective Payment System, RUG-IV, which primarily determined payment by the number of minutes spent with the patient, with the new Patient-Driven Payment Model (PDPM). Under PDPM, therapy minutes were removed as the basis for payment in favor of resident classifications and anticipated resource needs during the course of a patient's stay.

The immediate effect of that change was that 43 percent of operators reported laying off therapists, as well as a reduction in hours. Facilities started providing more group therapy and concurrent therapy sessions, offering patients a chance to be motivated by one another as they each worked toward personal goals.

That was until COVID-19 hit in March 2020. We in the industry would still be sorting out the ripple effect of the move to PDPM this year, except that a bigger tsunami hit the skilled nursing facility industry in the form of the global pandemic.

Although vaccines hold out the promise of a return to some kind of normal, most long-term care patients are still spending the majority of time in their rooms, with limited visitation. Therapy gyms are closed or only available to a limited number of patients at a time. And skilled nursing facilities are no longer getting reimbursed by therapy minute thresholds.

Therapists are now providing therapy within patient rooms, but this is limited to the creativity, experience level and motivation of each individual therapist.

You could look at this as a disaster for the state of therapy in SKNs, but I see it as an opportunity. As an experienced occupational therapist (OT), I long ago recognized the need for a new approach to SNF therapy. The tired therapy exercises of batting at balloons and using cones or a pegboard are not enough to motivate patients to reach new goals. I despised going through the motions of cookie-cutter therapy. I knew I wasn't providing the best opportunity for healing to my patients.

The SNF therapy industry needed a shakeup, and now we have it. The change to PDPM means the number one focus is on patient outcomes. This should always be our goal as therapists and SNFs, and COVID-19 doesn't change this goal either.

Four Ways We Can Use 2020's Changes as a Springboard for Better Therapy

Focus on our ability to accelerate outcomes

Patients, therapists and SNFs are all now aligned around one goal: achieving the best outcome in the shortest, most responsible period of time. This has always been what the patient wants and what is best for the facility, but now the PDPM reimbursement aligns with that goal.

We achieve this by focusing on the patient experience. We make therapy fun and rewarding. Patients who are motivated will reach a more positive outcome in a shorter span of time. Therapists need tools they can use to make therapy more engaging. For example, our company uses therapy gaming technology and the early adopters of this kind of therapy will be among those who are best poised to achieve accelerated outcomes for their patients.

Focus on connectivity and transparency

Prior to COVID-19, SNF facilities could rely on family visits to keep families connected to their loved ones. Families could easily pop in, ask a question to a nurse or social worker and schedule a care consultation.

Now with limited visitation, facilities must proactively keep families in touch with their loved ones and informed about their care. Connectivity and transparency needed to always be a priority, but now all SNFs are forced to make this happen.

Most facilities have succeeded in scheduling Zoom and Facetime calls with families. But imagine if instead of talking from a chair or bed, families joined parts of a therapy session? Technology offers an incredible level of transparency, as families can motivate patients and celebrate their achievements as they watch. Families will recognize the value of long-term care rehab and rest assured their loved one is getting excellent treatment. Gone are the concerns about what is happening behind the walls of a SNF when the relatives aren't there.

Improve continuity of care

SNFs have always had high turnover and a constant need to hire new staff. And in therapy, the use of PRNs can mean that new therapists frequently join the care team. COVID-19 escalated this issue as SNF employees were suddenly called upon to soldier through a battle they hadn't realized they signed up for, and facilities faced more shortages than ever.

The need to standardize care for every person providing treatment has always been a priority, but now it's an absolute necessity. This is where technology comes in. With therapy technology, every therapist on the team can facilitate a similar session experience, regardless of how well they know the patient. Obviously, rapport in therapy is key to overall success, but when that's not possible, it is still essential that the patient continues to reach individual goals. Technology that tracks this progress and helps therapists facilitate the actual exercises is key.

Skilled nursing facilities that do this well will have an evidence-based practice to identify patients' needs and show progress.

Differentiate the care approach and share success stories

Competition is fierce for the same type of patient now with PDPM. It's not enough to just have an aesthetically beautiful facility. SNFs have to offer a higher quality of care than their competition and then share those stories through marketing.

Those skilled nursing facilities that differentiate themselves from their competitors by offering better therapy outcomes will be positioned to succeed in the future.

Ultimately, when it comes to creating positive outcomes for patients, all SNF employees must work as a team. This involves more than just a morning meeting. It's one where every team member realizes that they are one piece of a puzzle, working together for a greater goal that can only be achieved with all of them together.

As we continue to deal with the ripple effect of this past year, I have no doubt that more innovation and new ways of thinking about SNF therapy will develop. Those skilled nursing facilities that embrace this technology and look for ways to achieve more accelerated positive outcomes will come out on top.


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Ian Oppel, nursing home, seniors, SNF Therapy


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