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The Rewards & Realities of Working as a Therapist in a Skilled Nursing Facility

Did you know?

  • The systems and processes on skilled rehabilitation units allow for dynamic and interactive collaboration within interdisciplinary teams. This includes PT, OT, ST, nursing, social services, dietary, activities, physician/physician assistant/nurse practitioner, and restorative nursing who all work together to ensure coordinated patient care.

  • Short-Term Skilled rehabilitation patients have excellent rehab potential. While most are there to meet their goals of greater independence and to return home, the patients are clinically challenging, with multiple conditions, allowing for a broad range of experiences as a therapist.

  • As a therapist or assistant, you get the opportunity to evaluate and collaborate as well as treat the patient from a relatively acute phase of their condition all the way through to a greater level of independence and a transition to their home environment, including a home assessment.

  • The goal for long-term residents is to optimize their quality of life while reducing the risk for permanent life altering declines in their functional abilities. The role of a therapist this process and often involves working closely to provide education and training to their daily caregivers.

  • For therapists working in a CCRC (Continuing Care Retirement Community), there are additional opportunities to treat more of an outpatient caseload in their Assisted Living and Independent Living Facilities.

Frequently asked questions from our students

Q: Am I expected to meet a productivity standard in skilled nursing?

A: Yes. Actually, all disciplines in healthcare, including physicians, have productivity expectations, just as they do in other professions and industries. It’s the business of healthcare and it’s a reality of the working world to manage efficient and effective care. Healthcare is evolving to a value-based, patient-centered care system rather than a volume-based system. It will ultimately be important to achieve positive patient outcomes as efficiently as feasible.

Q: Are there limited things I can do for a patient in skilled nursing?

A: No. In reality, the skilled nursing patient is very complex and diverse in their symptoms and presentation, giving therapists the opportunity to challenge their clinical skills. It is encouraged to conduct a comprehensive evaluation, identify all functional problem areas that impact that patient’s wellbeing, and address them in your plan of care. Most physicians rely on you as the subject matter expert and, more often than not, defer to your expertise in treating the patient.

Q: Do all nursing home patients have dementia?

A: No. Most skilled nursing patients do not have dementia and are lucid, intelligent, and high functioning individuals who are motivated to collaborate on a rehabilitation plan with you. There are some patients who do have dementia and you are expected to treat those as well as any other patient types. Remember, dementia is a set of symptoms caused by a condition and the condition causing dementia can create a complex array of needs to be met. There is much that can be done for these patients and their symptoms so it is up to you whether you are willing to meet the challenge and gain the education and training available to address these patient’s needs. It is very rewarding to watch a patient with dementia thrive because of the intervention that you put in place.

Q: Will my company make me do things I don’t want to do?

A: No. Most therapy contract companies operate very ethically within compliance standards. In all industries there might be some companies whose motivations aren’t pure and it is up to you to select a company whose philosophy and core values align with your own. Just because a company asks you to do something you don’t understand, it does not mean they are asking you to do something unethical. Many of the Medicare/Medicaid regulations are updated or clarified on a regular basis. If you have questions, or don’t understand, it’s important to have an open mind and ask questions objectively. Don’t assume the company is trying to force you to do things that are unethical. Ultimately, it is in the company’s best interest to establish policies and procedures that meet the high standards of the industry and protect the employees who provide the care.



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