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pros and cons of working in SNFas a P.T

 
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pros and cons of working in SNFas a P.T - August 5, 2004 11:59:00 AM   
ZEAL

 

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From: FLORIDA
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I wanted to know your opinions about advantages & disadvantages of choosing a SNF setting as a p.t?(ESPECIALLY SHOULD FRESH GRADUATES GO FOR IT?)
What could be anticipated by such a job.?
WHY one should or should not opt for snf?
What are the physical demands on p.t in such a job?


advice will be great help ...as i am about to make a career move.
zeal.
Post #: 1
Re: pros and cons of working in SNFas a P.T - August 5, 2004 2:08:00 PM   
tucker

 

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From: Texas
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Comparing SNF to other inpatient settings such as acute care, IP rehab, or LTAC,?my opinion.

The only advantage there is a better salary compared to the others.

Number one on the disadvantage list is the lack of learning opportunities compared to the other settings. I?ve worked at several SNFs in several states, including Florida, and could not stand that physicians would not call me back with clarifications, etc. I rarely saw the MDs. The recycling of patients can get frustrating,.. where a patient progresses, discharges to restorative, only to decline again and be picked up by therapy?couldn?t stand that! Also, I found that the therapists were generally not motivated to continue learning. I have actually never met a PT working at a SNF who was an APTA member and attended conferences (if one is out there, please prove me wrong). Most did not keep up with the literature and really had no clue about EBP. The physical demand can be high as many patients are low level requiring max to dependent lifts.

My recommendation for a new grad is acute care at a large, preferably teaching, hospital,?trauma 1 if available. The learning opportunities are endless. I have been working in this setting for 8 years and learn something new every day?There is always a resident or faculty member to sponge from and a wide variety of patient diagnoses. Sure, I could easily make 10-20K more at a SNF, but there?s no way?it would have to be twice my current salary to even make me consider it. Good luck!

(in reply to ZEAL)
Post #: 2
Re: pros and cons of working in SNFas a P.T - August 5, 2004 5:17:00 PM   
steve

 

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From: Canada
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What is SNF?

Steve

(in reply to ZEAL)
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Re: pros and cons of working in SNFas a P.T - August 5, 2004 6:00:00 PM   
tucker

 

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From: Texas
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Skilled nursing facility...most our in nursing homes.

One other downfall with working at a SNF right out of school is that it will likely work against you if you decide to move to any other setting in the future. It would require more training if you wanted to say move from SNF to acute care ICU. But acute care provides an excellent foundation for any setting in the future, whether it be inpatient rehab, SNF, or an outpatient job. An acute care therapist would have little dificulty transitioning to any inpatient PT position.

Last thing that bugs me about SNFs...you often times have nursing home administrators, who have absolutely no clue about healthcare, telling you the therapist that you need to pick up more patients, continue treating, or treat patients longer,....when there is no indication for continued skilled therapy (Ex. pt. unable to participate in therapy due to severe dementia or pt's progress plateaus). I have always worked part-time or contract for SNFs so I had no problem telling them off. Some therapists though will give in just to keep their jobs. Hope this helps.

(in reply to ZEAL)
Post #: 4
Re: pros and cons of working in SNFas a P.T - August 5, 2004 11:29:00 PM   
Karen Kohls

 

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Having worked acute care, SNF, Home Health, and pediatric postions, I assure you, bad therapists can be found in any setting. As a PT and consumer of PT services I've hunted hard to find good PT's in any setting I've sought services from, so please don't paint all SNF therapists as inept.

I wouldn't generally recommend new grads take a SNF position and most good managers don't generally hire them, unless you have a strong interest in this area because departments tend to be small and you may not have access to more experienced therapists to learn from.

Each setting has it's pros and cons. I've met very skilled SNF PT's - working to get a nearly deaf, hip fracture patient w/ cardiac, diabetes and dementia/post anesthesia issues back up on their feet to return home after they've flunked their acute care PT takes much more skill than getting the easy patient back up on their feet and can be very rewarding. My 4 year post CVA patient that just learned to toilet transfer herself required very skilled neuro re-ed to make that gain. Her more acute therapists had written her off. The look on her face when she did it made my day.

More importantly though, no one should work in a setting where they genuinely don't like the patients, so I would first ask you, "Do you like geriatric patients?" They are often complex, can be difficult to work with, and come with a lifetime of baggage, but YOU are often their last line of hope. If the therapists give up, they often have no one else to help them regain function, so they won't. They don't often have the freedom to shop for a new therapy team and you often can't send them to another therapist. Better salaries and more flexible hours won't make you like your job if you dislike the patients.

All SNF's are not alike - some function as acute rehab centers, taking patients w/ a high potential to return home and the services provided there are not unlike those that used to be provided in acute care settings 15 years ago when ortho patients stayed in the hospital long enough to gain some independence before d/c home. Other SNF's take much lower level patients. The experience working in each will be very different.

If you have an interest in geriatric rehab, I would suggest finding a therapist who is passionate about it and talking to them to see if it appeals to you.

Good luck in your decision making.

(in reply to ZEAL)
Post #: 5
Re: pros and cons of working in SNFas a P.T - August 5, 2004 11:30:00 PM   
Karen Kohls

 

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Having worked acute care, SNF, Home Health, and pediatric postions, I assure you, bad therapists can be found in any setting. As a PT and consumer of PT services I've hunted hard to find good PT's in any setting I've sought services from, so please don't paint all SNF therapists as inept.

I wouldn't generally recommend new grads take a SNF position and most good managers don't generally hire them, unless you have a strong interest in this area because departments tend to be small and you may not have access to more experienced therapists to learn from.

Each setting has it's pros and cons. I've met very skilled SNF PT's - working to get a nearly deaf, hip fracture patient w/ cardiac, diabetes and dementia/post anesthesia issues back up on their feet to return home after they've flunked their acute care PT takes much more skill than getting the easy patient back up on their feet and can be very rewarding. My 4 year post CVA patient that just learned to toilet transfer herself required very skilled neuro re-ed to make that gain. Her more acute therapists had written her off. The look on her face when she did it made my day.

More importantly though, no one should work in a setting where they genuinely don't like the patients, so I would first ask you, "Do you like geriatric patients?" They are often complex, can be difficult to work with, and come with a lifetime of baggage, but YOU are often their last line of hope. If the therapists give up, they often have no one else to help them regain function, so they won't. They don't often have the freedom to shop for a new therapy team and you often can't send them to another therapist. Better salaries and more flexible hours won't make you like your job if you dislike the patients.

All SNF's are not alike - some function as acute rehab centers, taking patients w/ a high potential to return home and the services provided there are not unlike those that used to be provided in acute care settings 15 years ago when ortho patients stayed in the hospital long enough to gain some independence before d/c home. Other SNF's take much lower level patients. The experience working in each will be very different.

If you have an interest in geriatric rehab, I would suggest finding a therapist who is passionate about it and talking to them to see if it appeals to you.

Good luck in your decision making.

(in reply to ZEAL)
Post #: 6
Re: pros and cons of working in SNFas a P.T - August 6, 2004 11:13:00 AM   
ZEAL

 

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From: FLORIDA
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wow!thanx tucker and kkpt for ur insights that was quite an eye opener....as far i can understand i think its wiser as a fresh grad. for me to look towards acute or subacute rehabilitation options....and also check out more p.ts who have worked\or are working in snf.....the only reason i wanted to consider snf was i like geriatric patients...and the fact that we are there last line of hope!

(in reply to ZEAL)
Post #: 7
Re: pros and cons of working in SNFas a P.T - August 6, 2004 11:20:00 AM   
Yogi

 

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From: San Antonio, Tx., USA
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I would hate to work in one fulltime. I have enjoyed moonlighting in one, mostly because most of the old folks can be fun, even the demented ones, and I missed them when they passed. A few can be mean. But I would recommend an inpt. rehab if you have neuro interest, or an ortho outpt. if you have ortho interest, or inpt. acute if you're drawn to that. A combination is probably a hosp. with in and outpt. clinics. SNF's will constantly holler about productivity, and paperwork doesn't count on productivity. Restorative means after you plateau them (or run out of medicare days), a NH aide is supposed to keep them going to maintain the gains; which in my experience, is more honored in the paperwork than in the reality. Acute care hospitals have downsides of managers expectations, like quitting time is when you get done. But the gist is that, unless you have spent a clinical rotation or spent time in a SNF, I wouldn't recommend it for a new grad, other than as a moonlighting job to help pay school loans.

(in reply to ZEAL)
Post #: 8
Re: pros and cons of working in SNFas a P.T - August 6, 2004 11:39:00 AM   
Yogi

 

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To add to the above, I spent time as a new grad in about four different settings, which helped me gain experience, not necessarily good experience overall, and a lawsuit came out of one of'em, turned out it was a Dr. error, but it was no fun while it lasted. Finally I got back to the field that inspired me to go to PT school in the first place. I don't regret doing the other first, but that's just me. You might. So if you really are drawn to geriatrics, SNF's can be the place. If it's stroke rehab that draws you, there are still some Rehabcare units and other subacute rehab facilities. Carole Lewis has specialized in geriatrics and her expertise and knowledge has impressed me for years. My real advice is don't make a decision like this based on advice. Consider advice, but don't base a decision on advice alone. Good luck.

(in reply to ZEAL)
Post #: 9
Re: pros and cons of working in SNFas a P.T - August 6, 2004 6:57:00 PM   
tucker

 

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From: Texas
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By the way zeal, you should look into something called an ACE unit. It stands for 'Acute Care for the Elderly'. These are specialized acute care units in hospitals specifically designed for geriatrics. We now have one at our facility and it is definately the ideal interdisciplinary approach.

If you enjoy geriatric rehab and inpatient care...this is the place to be. Hope to see more hospitals provide these type of units.

(in reply to ZEAL)
Post #: 10
Re: pros and cons of working in SNFas a P.T - August 6, 2004 7:36:00 PM   
smarshall

 

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From: havre, MT, USA
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zeal.
some great points brought up here. i also have a few recommendations, and some expansions on prior points.

i worked in a SNF as a new grad for 3 years and enjoyed it quite a bit. i had experienced therapists and good managers to help transition me. i too really enjoy geriatrics. my complaints were that outside of arthroplasties, there was very little orthopedic experience. also, therapy was the cash cow for the entire facility, so minutes were pushed in PPS.

my two bits of advice i would give you are:
1) try to find a SNF that also has a sub-acute rehab. you will see a much larger variety of acute and rehab style patients this way. with the onset of PPS in rehab, more acute patients are first sent to a sub-acute rehab to "prep" for rehab.
2) all SNF's (to my knowledge) are surveyed by the government each year and rated in terms of "deficiencies" that are noted by the surveyors. obviously, the more deficiencies, the poorer the facility. watch out for these ones. there are a few sites out there that will give you the number of deficiencies per facility, and one (can't find the address) that will describe the nature of the deficiency. i would check these sites out before even considering working in a SNF.

website:
http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=IE%7C6%7CWinXP&language=English&defaultstatus=0&pagelist=Home


good luck with your carrer...

(in reply to ZEAL)
Post #: 11
Re: pros and cons of working in SNFas a P.T - August 9, 2004 1:41:00 AM   
ptdan23

 

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From: Orlando, FL
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Zeal,
I was working in acute care for a little over a year. I did learn a lot but the work is very hard, you are the lowest guy on the totem pole (MD's and RN's think you only walk people), and the pts can be hard to deal with. It can also be very rewarding. A lot of people like the acute setting because the schedules are very flexibile. I always knew I wanted to work outpt ortho but took that job right out of school to get started (it was at the hospital where I did a clinical).
The last month I was there I worked 1/2 days in SNF and 1/2 days in outpt. I hated SNF. I always knew I would and everyone always said give it a chance, you never know. They also said that about acute care. Point here...don't listen to others if you already know your goals and what you want to do. The time I spent in the SNF was horrible. It was soooooo boring. I found it hard to get motivated to go to work.
I finally left that position and started working with another company full-time in outpt ortho - which I have wanted to do ever since I knew I wanted to become a PT (my junior year in HS).

While all areas can be a good learning experience, some run their course out before others. Some advice would be to look into a position that offers rotations. Most hospitals have multiple areas like the one I worked for (outpt, acute, rehab, and SNF). If they work on rotations, like every three months, you could work through all of them and that may help you decide what area you would like to work in.

Dan, PT.

(in reply to ZEAL)
Post #: 12
Re: pros and cons of working in SNFas a P.T - August 9, 2004 9:59:00 PM   
ZEAL

 

Posts: 10
Joined: July 29, 2004
From: FLORIDA
Status: offline
THANX PTDAN,YOGI,SMARSSHALLAND ONCE AGAIN TUCKER FOR UR REALLY REALLY HELPFUL OPINIONS....I DO LIKE GERIATRIC PATIENTS BUT REALLY DO NOT WANT TO GET STRUCK INTO SOME PATHETIC TO WORK FACILITY ....I AM ESPECIALLY DRAWN TO SUBACUTE MUSCULOSKELETAL REHAB(TKRS,THRS,...STROKE ETC.) AND ALSO ACUTE GERIATRIC CARE...BUT IT SEEMS ITS HARD TO FIND SUCH SNFS...PHEW!

WHAT KIND OF PATIENTS DO WE REALLY COME ACROSS IN MOST OF THE SNFS?

Tucker in which state u are located and how hard it is to find an ACE.?(if u dont mind)

waiting for more inputs
ZEAL.

(in reply to ZEAL)
Post #: 13
Re: pros and cons of working in SNFas a P.T - August 9, 2004 10:24:00 PM   
ptdan23

 

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From: Orlando, FL
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Zeal,
Just something I forgot to mention...some SNF's are starting to get better pts because of new Medicare guidelines saying that a subacute rehab can only have a certain percentage be ortho pts only. That means more of those pts (TKA, THA, hip #, etc) will go to a SNF instead of a subacute rehab which, in the past, is usually where they would go. That is just a trend around me that I have noticed.
Dan, PT.

(in reply to ZEAL)
Post #: 14
Re: pros and cons of working in SNFas a P.T - August 10, 2004 11:33:00 AM   
tucker

 

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From: Texas
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I'm located near Houston. Do a google on 'acute care of elders' and it will pull up several other facilities that have ACE units. I believe there are 44 total in the US at this time. You could call one of those places and ask for other facilities that have them.

"The ACE (Acute Care of Elders) concept was first described in the New England Journal of Medicine in 1995 and was shown to prevent the functional decline that typically occurs when elderly people are admitted to the acute hospital."

BTW, it functions as any other floor unit except the patient has to be over 65. Patients will go directly from the recovery room to the ACE unit post ortho surgery such as TKA or THA. A neurological patient may spend some time on the neuro floor but once medically stable, the patient is transferred to the ACE for specialized geriatric care. Some facilities, such as ours, has PT/OT/speech working only in that unit while other facilities will have a therapist that covers the unit but is a part of the acute team.
Good luck in the search.

(in reply to ZEAL)
Post #: 15
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