The Skilled Nursing Rehab Team: A Q&A for Families

As a new admit to a skilled nursing facility, the patient and involved family members will be professionally bombarded by many healthcare providers from multiple departments: social work, nursing, psychiatry, recreational therapy, nutrition, respiratory therapy, rehabilitation, and administration to name a few.

Let’s hone in on and breakdown one department: the rehabilitation (or rehab) team.

This team typically involves three specialties: occupational therapy (OT), physical therapy (PT), and speech and language pathology (SLP).

Since the patient will be spending a good chunk of time with potentially all three therapies, it is very natural for the patient and their family to have questions about what these providers do.

Here are few commonly asked questions, followed by summarized answers in order to assist families and patients who might draw a blank when approached by therapy:

What is OT? PT? SLP?

Therapists love getting asked this question because they get to talk about themselves and promote their profession. Here are some basic descriptions:

OT, specifically in skilled nursing settings, offers education, restoration, and adaptive techniques to increase independence in daily living tasks such as showering, toileting, dressing, hygiene completion, cooking, household cleaning, medication management, community reintegration, and driving to name a few. 

PT will take a primary focus on ambulation (walking), functional mobility (bed mobility, wheelchair use, transfers, etc.), body strengthening and activity tolerance through therapeutic exercise, and ambulation device training (i.e. crutches, walkers, wheelchairs, scooters, etc.). 

SLP hones in on speech or language related needs as well as cognitive and swallowing deficits.  Unlike PT and OT, SLP is certified to diagnose swallowing deficits (i.e. dysphagia), set up feeding precautions, and order scans or tests to confirm or rule out swallowing difficulties.

Do I have to have all three?

Not necessarily, and that will be determined by each initial evaluation. Each therapist will separately meet the patient soon after admission into the facility, conduct evaluations made up of standardized assessments and clinical observations.  After the evaluation is completed, the therapists will consult with the team as well as the rehab director about whether or not the patient is clinically appropriate for all three.

How much time will I be spending with each therapist?

This is determined by two factors, depending on which facility you are staying in: clinical appropriateness and insurance. Based on initial evaluation, each therapist submits an order to be signed by the overseeing primary physician recommending a certain number of visits.  The duration of each treatment is determined by a combination: what your insurance is willing to pay for and the number of minutes you can physically tolerate.  Sometimes, therapists will break up treatments, maybe seeing a patient for half of their time in the morning and the rest of their time in the afternoon.

Do I get to pick my therapist?

Don’t worry about hurting anyone’s feelings. As a patient, it is common to develop better rapport with one therapist over another.  Feel free to suggest that you would like to see a particular therapist. Keep in mind, however, that if you are consistently seeing a therapy assistant (OTA or a PTA) your sessions will be interrupted every few days by a visiting OT or PT who is qualified to update your plan-of-care.

Can I schedule my therapy around other appointments and visits from family?

Yes, to a certain degree. If your family plans to visit you all day, then it might be near to impossible to NOT interrupt visitation.  Family members who are privy to your medical information, or are those you approve of, are welcome to attend your therapy sessions.  Medical appointments outside of your facility that take up the whole day may require postponing therapy until the next day.

 What if I don’t want therapy?

Unfortunately, part of the reason you are admitted to a skilled nursing facility is to receive rehab services. If this is a problem, contact administration about your dilemma while keeping in mind that your insurance might not pay for your stay if you avoid rehab

When can I go home?

This can be a difficult question because the answer is rarely clean-cut. Discharge from skilled nursing is determined by the interdisciplinary team as a whole.  The rehab team offers the rest of the facility updates about the patient’s progress and whether or not they feel they can safely return home.  Patients and relevant family members are encouraged to attend these meetings to offer their own input about discharge.

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