Let’s Use the State of SNF Remedy At the moment as a Springboard for Extra Optimistic Outcomes

By IAN OPPEL, CCO RESTORE, OTR, MBA, DCCT

There’s no query that remedy immediately in expert nursing services appears to be like vastly totally different than it did a number of months in the past (and for a few years earlier than that). What’s but to be decided is whether or not or not these adjustments may end up in constructive outcomes for all events concerned — sufferers, after all, therapists and expert nursing services.

Only recently, the federal authorities launched a much-needed $5 billion help package deal to SNFs –one which got here on the heels of the trade’s first-ever decline in margins reported since 1999. That funding, mixed with the collective will to enhance remedy challenges that existed within the trade even previous to COVID-19, is a uncommon alternative.

After all, COVID-19 exacerbated challenges SNFs have been already dealing with. It’s also a possibility for a complete redesign of how SNFs present remedy. I wish to suggest that the vastly totally different local weather in SNFs this summer season and fall 2020 must be a springboard for a extra constructive future for remedy in expert nursing services. 

Transferring from RUG-IV Reimbursement to PDPM for Remedy

Final October 2019 when the federal authorities entered a brand new fiscal yr, the brand new Affected person-Pushed Cost Mannequin (PDPM) changed the long-held Potential Cost System, RUG-IV method to billing for remedy primarily based on time spent per affected person. The instant impact of that change was that 43 % of operators reported shedding therapists to a Expert Nursing Information SNF ballot, in addition to a discount in hours. Services began offering extra group remedy and concurrent remedy periods, providing sufferers an opportunity to be motivated by each other as they every labored towards private targets.

That was till COVID-19 hit in March 2020.  

We within the trade would nonetheless be checking out the ripple impact of the transfer to PDPM this yr, besides {that a} larger tsunami hit the expert nursing facility trade within the type of a world pandemic. 

COVID-19 Ends in Greater Adjustments for Remedy

5 months into the COVID-19 pandemic, and most long run care sufferers are nonetheless spending nearly all of time of their rooms, with little to no outdoors guests. Remedy gyms are closed or solely accessible to a restricted variety of sufferers at a time – at a social distance. And expert nursing services are not getting reimbursed by remedy minute thresholds.

Therapists are actually offering remedy inside affected person rooms, however this may be restricted to the creativity, expertise degree and motivation of every particular person therapist.

You can have a look at this as a catastrophe for the state of remedy in expert nursing services, however I see it as a possibility. As an skilled occupational therapist, I way back acknowledged the necessity for a brand new method to SNF remedy. The drained remedy workout routines of batting at balloons and utilizing cones or a pegboard should not sufficient to encourage sufferers to succeed in new targets. I despised going by means of the motions of cookie-cutter remedy. I knew I wasn’t offering the perfect alternative for therapeutic to my sufferers.

The SNF remedy trade wanted a shakeup, and now we now have it. 

The change to PDPM means the primary focus is on affected person outcomes. This could at all times be our purpose as therapists and SNFs, and COVID-19 doesn’t change this purpose both.

4 Methods We Can Take 2020’s Adjustments & Use as a Springboard for Higher Remedy & Extra Optimistic Outcomes

Give attention to our potential to speed up outcomes

Sufferers, therapists and SNFs are all now aligned round one purpose each time: reaching the perfect final result within the shortest, most accountable time frame. This has at all times been what the affected person needs and what’s finest for the power, however now the PDPM reimbursement aligns with that purpose. 

How will we obtain this? By specializing in the affected person expertise. We make remedy enjoyable, participating and rewarding. Sufferers who’re motivated in remedy will obtain a extra constructive final result in a shorter span of time. After all, each therapist appreciates the uncommon affected person who’s motivated and agreeable, however this isn’t at all times the case when sufferers can have a complete host of difficult causes that depart them much less motivated in remedy. Therapists want instruments they’ll use that make remedy efficient and interesting. The know-how exists to do that. I work for a leading edge firm that’s main the way in which on this space with remedy gaming know-how, and the early adopters of this type of remedy can be amongst those that are finest poised to realize accelerated outcomes for his or her sufferers. 

Give attention to connectivity and transparency

Previous to COVID-19, SNF services might depend on household visits to maintain households linked to their family members. Households might simply pop in and ask a query to a nurse or social employee throughout these visits and, after all, schedule a care session.

Now with restricted visitation for the foreseeable future as a consequence of COVID-19, services should proactively hold households in contact with their family members and knowledgeable about their care. Connectivity and transparency wanted to at all times be a precedence, however now all SNFs are compelled to make this occur.

Most services have succeeded in scheduling Zoom and Facetime calls with households. Some services are mandated to take action by their state. However think about if as a substitute of speaking from a chair or mattress, households joined elements of a remedy session? Expertise gives an unbelievable degree of transparency, as households can encourage sufferers and have a good time their achievements as they watch. Households will acknowledge the worth of long run care rehab and relaxation assured their cherished one is getting glorious remedy. Gone are the issues about what is occurring behind the partitions of a SNF when the kin aren’t there. 

Enhance continuity of care

SNFs have at all times had excessive turnover and a continuing must aggressively rent new workers. And in remedy, using PRNs can imply that new therapists ceaselessly be a part of the care group. COVID-19 escalated this difficulty as SNF workers have been out of the blue known as upon to soldier by means of a battle they hadn’t realized they signed up for, and services confronted extra shortages than ever.

The necessity to standardize care for each particular person offering remedy has at all times been a precedence, however now it’s an absolute necessity. That is the place know-how is available in. With remedy know-how, each therapist on the group can facilitate an analogous session expertise, no matter how nicely they know the affected person. Clearly, rapport in remedy is essential to general success, however when that’s not a risk, it’s nonetheless important that the affected person continues to succeed in particular person targets. Expertise that tracks this progress and helps therapists facilitate the precise workout routines is essential.

Expert nursing services that do that nicely may have an evidence-based observe to determine sufferers’ wants and present progress.

Differentiate the care method and share success tales

Competitors is fierce for a similar kind of affected person now with PDPM. It’s not sufficient to simply have an aesthetically lovely facility. SNFs have to supply the next high quality of care than their competitors after which share these tales by means of advertising. 

These expert nursing services that differentiate themselves from their opponents by providing higher remedy outcomes can be positioned to achieve the longer term.

Finally, to realize all of those enhancements, SNF workers must work as a group. With regards to creating constructive outcomes for sufferers, not one of the targets of SNF workers may be particular person or exist in a silo. For instance, I can’t handle to succeed with a affected person in OT if he didn’t get the diet he wants or a superb evening sleep as a result of his roommate stored him up. SNFs want extra collective management to truly obtain the integrative care method. That is greater than only a morning assembly. It’s one the place each group member realizes that they’re one piece of a puzzle, working collectively for a better purpose that may solely be achieved with all of them collectively. 

I left my place after 25 years as a remedy supplier, medical specialist and a number of senior care operator as a result of I noticed in my place as CCO at RESTORE Expertise a possibility to impression the entire trade. I acknowledge how new methods of serious about remedy in SNFs can have a better impression on sufferers and on the services and their workers as nicely. As we proceed to cope with the ripple impact of those previous few months, I’ve little question that extra innovation and new methods of serious about SNF remedy will develop. These expert nursing services that embrace this know-how and search for methods to realize extra accelerated constructive outcomes will come out on high.


Ian Oppel is a healthcare govt with over 25 years of post-acute healthcare management expertise offering experience in rehabilitation, fiscal and medical operations, reminiscence care, senior residing, reimbursement, and regulatory compliance. Ian is at present the co-founder and chief medical officer for RESTORE Expertise, a vanguard therapeutic gamification and telehealth firm.

RESTORE helps present significant digital visits to assist keep away from the sentiments of isolation of nursing residence sufferers. As a next-gen affected person expertise firm, RESTORE motivates sufferers to speed up outcomes within the remedy health club, with care companions for out-of-gym actions and at residence. It’s at present the one remedy software program accessible available on the market that permits customers to make use of a conventional laptop computer to succeed in remedy targets. In a time the place we’re all craving human connection, RESTORE works to boost experiences for these in nursing houses.

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