Shelly Mesure, MS, OTR/L
Shelly Mesure, MS, OTR/L

 When the Centers for Medicare & Medicaid Services implemented its latest rounds of new and stricter regulations, the groan was heard throughout nursing homes across the country. The biggest impact is the emphasis on providing therapy services on an individual basis.

This sounds pretty good in theory, but nursing homes are very difficult to keep to a schedule, and there are many external factors that can impact the treatment sessions throughout the day. But, I have good news: It is possible to keep an efficient schedule and here’s how …

During the summer of 2010, I worked diligently with all of my clients to prepare them for a seamless transition to MDS 3.0. One of the major operational changes we added was developing a therapy schedule and actually making it work.

The typical response I have heard for years is, “We (therapy) put one together, and it may work for a week, but then no one (nursing) follows it, and it’s a waste of time.” So I started thinking: Why is “no one” following it? I do not believe that nursing and rehab should have a love-hate relationship. It’s time to stop playing the blame game, and start thinking of solutions.

Through a collaborative effort, I encouraged the rehab manager and the nursing unit supervisors and director of nursing to have weekly meetings to develop, discuss and implement an effective scheduling system. Every facility had its own unique issues.

By collaborating with nursing, rehab was able to gain an inside view on what responsibilities must be provided by nursing prior to coming to therapy. Many facilities started providing morning activities of daily living, at 6 a.m., using the nightshift CNAs. Upon admission, residents were given a choice of: 1) Would you like to get dressed and ready before breakfast? 2) Do you prefer your showers in the morning or evening? And so forth. This promoted resident choice and helped to even out the workload across multiple shifts.

The next question was, “What are all of the other factors that may interfere with a resident being ready for therapy on time?” I had each facility develop a list of these external factors, such as: activities (You don’t want to interfere with bingo!), the hairdresser (Therapy is always the lesser priority to a resident), medication passes (One facility scheduled its rehab times by room number to accommodate the med pass cycle); appointments (Get a list in advance, check the 24-hour report daily, give a quick phone call to the person in charge of scheduling each day), and the list continues.

Once you’ve identified the issues, develop the therapy schedule and begin tracking lateness. I developed a very simple form, the “THERAPY SCHEDULE TRACKING TOOL,” and asked the rehab department to set up the guidelines. For example, a resident would be tracked only if she showed up beyond 10 minutes late for the scheduled time. Some facilities chose five minutes, while others chose 15 minutes. You know what will work the best for you.

This tracking tool allowed rehab departments to identify trends, such as, “I noticed all the residents that were late this week were from the same unit, caregiver, etc.” The tracking tool is then provided to the DON and administrator on a daily or weekly basis. (This will depend on the size of your department and number of offenses.) Because you worked collaboratively with the DON and the unit supervisors, they will support your schedule, provide feedback if any adjustments need to be made, and hold staff accountable if they have not been following the new system.

If the DON is not as supportive as you need, some facilities have used the support of the administrator to achieve the desired results. If your administrator realizes that therapy sessions are cut short or missed — therefore, reducing reimbursement — she is very likely to support the therapy schedule.

If we are going to continue providing the same level of care to our residents, our workday efficiency must be a main priority. If you would like a copy of the “THERAPY SCHEDULE TRACKING TOOL,” please email me at [email protected].

Shelly Mesure (“Measure”), MS, OTR/L, is the president and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a much sought after speaker and writer on therapy and reimbursement issues.