Roosters do not lay eggs. I would say that is a fact that we can all agree on.

They do, however, protect their young. The roosters that do not play by traditional standards and rules protect their young, that is.

Our family has been on a bit of a roller coaster ride with chickens this summer.

We started with six sweet, precious, silkie chicks in the spring. Two suffered death secondary to flight lessons on the trampoline, and three others were mauled in the night with the culprit still a mystery.

That left us with one “chicken” — a rooster named “Cluck-Strut” by the kids.

We are not supposed to have a rooster in city limits. But, again, shifting course from historical practices and standards is not always a bad thing … even when you feel like you are “breaking the rules.” (Like starting a sentence with the word “but”.)

Cluck-Strut was not the biggest chicken in our original group, he was not the fastest, but he what he was, by far, the most confident, hence the strut, and he was the loudest. 

The only problem was roosters do not lay eggs.

Therefore, we decided to try again with six new baby silkies arriving in early July.

Four have survived, and Cluck-Strut, bless his heart, has a new responsibility that he did not sign up for, or that nature says he could not be trusted to complete. But I will tell you that his obligation to the young flock is as final as the SNF ruling we all feverishly read this week. 

So, to all the therapists out there, I want you to learn some lessons from the book of Cluck-Strut. Time to join the flock, or otherwise risk suffering the fallout for fear of going against the historical grain. 

Lesson 1: Challenge the old “rules”

Thankfully, when I decided to place a rooster in the same brooder setting with baby chicks. I didn’t read the rule book. I have since learned that roosters have potential to be violent and aggressive with chicks. Cluck- Strut however immediately took the little ones under his wings, literally, allowing them to nest and sleep underneath him.

In a similar sense, the current RUGs-IV model has created an unfortunate plethora of myths, occasionally presented as “rules” surrounding clinical practice. We have all heard them … “Medicare Part A does not cover eval time,” “Speech pathology alone cannot skill a patient,” “We can’t provide group,” and unfortunate messaging referring to individuals by RUG levels, “The number of RUs or RVs.”

The beauty of the Patient-Driven Payment Model therapy case mix group structure is that we initiate care considerations based on clinical presentation, allowing us to challenge old myths and develop and implement creative new ideas to better serve our patients. 

Lesson 2: We are better together

Baby chicks require a certain level of temperature regulation to survive. Most new chicken owners will achieve this regulation via the use of heating plates or lamps within the brooder. This works, but it has always seemed a bit unnatural to me. Cluck-Strut has taken over the responsibility of keeping his new flock warm and cozy, and he does so willingly every evening.

Consider how we practice as teams in SNFs. Is it natural? 

We have mastered the interdisciplinary team (IDT) approach. Patient at the center with all team members, nursing, therapy, social services, families, having their own goals and objectives to meet the patient needs. 

Seems a bit broken to me. Seems that we have created a culture of silos with everyone in their own circle.

Interprofessional practice (IPP) and education are where we need to be and PDPM allows us a clear path to achieve this level of care as defined by the World Health Organization.

IPP occurs when multiple service providers from different professional backgrounds provide comprehensive healthcare or educational services by working with individuals and their families, caregivers and communities to deliver the highest quality of care across settings. 

IPP achieves this level of silo-busting integration via creation of person centered, collaborative goals and objectives, across teams with all team members understanding fully the scope of practice and treatments of other disciplines. 

Lesson 3: Know your voice and USE it accordingly

Cluck-Strut has one loud mouth. He starts first thing in the morning and isn’t afraid to use his voice if he feels that a predator is in the midst, or if he needs food or water.

Therapist, in your loudest IPP voice (because tone does matter and silos should not be welcome): Speak up for yourself! 

You play such an important, integral role in ensuring your communities are successful during the upcoming changes. 

You impact data for length of stay, spend per beneficiary and rehospitalization; you can impact MDS coding and case mix accuracy for PDPM; you influence outcomes, transitions in care and potential discharge to lesser level of care for QRP.

Finally, do not forget the service you can provide to individuals who reside in our communities as their homes. Engage in CASPER analytics, participate in CAT reviews and CAAs development, and achieve a greater understanding for care teams between restorative versus maintenance levels of care. 

Lesson 4: There is no shame in eating last

To be frank, we don’t always have to be right and we don’t always have to speak first. 

The most surprising behavior I have seen from Cluck-Strut is that he doesn’t overpower the baby chicks when I feed them. I have even observed him allowing them to eat first, knowing that there will be plenty left over for him when they are satisfied. 

PDPM, similarly, satisfies the clinical hunger for care teams through distinct case mix groups being assigned for each discipline — PT, OT, SLP, Nursing and Non-Ancillary. Each with data driven, and uniquely defined clinical areas, allowing all to contribute and feel satisfied that their skill sets contribute to patient goals. 

Final, and most important lesson: Protecting the flock is as important as laying the eggs

Roosters don’t lay eggs. That is a fact. 

My hope for my four young chicks is that I have at least two hens in the mix with the potential for fresh eggs in the future. 

The group will soon be moving out of their indoor brooder and into the outdoor coop. They will not spend their evenings eternally sleeping under a rooster’s wings. Eventually they must learn to survive on their own. 

We know, however, that there is a danger skill lurking in the neighborhood, like a chronic condition in a patient with poor health literacy and care management. I will be looking toward Cluck-Strut for protection, and for his voice when he senses danger. 

Protecting the flock is vital across all phases of development. 

Consider what we, as care teams, are doing to promote safety and protect our patients during care transitions. Many of them present with risks associated with chronic conditions. PDPM allows us to capture and plan for these areas within NTA, SLP co-morbidities, and a general increased focus on ICD-10 accuracy and specificity. 

We can use these areas to incorporate increased elements of health literacy, communicate more efficiently across care settings, and allow for improved understanding of chronic conditions for patients and their families. 

Here’s to challenging old standards, working better together, listening to everyone’s voice, and providing protecting during and after care to those we serve daily! 

PDPM, we are ready for you — confident and loud, Cluck-Strut style. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Encore Rehabilitation and 2019 APEX Award of Excellence winner in Writing–Regular Departments & Columns category for her “Rehab Realities” McKnight’s blog. Additionally, she serves as Gerontology Professional Development Manager for the American-Speech-Language-Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).