My life as a rehab director
This is story of a young physical therapy assistant with big dreams, good morals, strong ethics and not much of a clue as to where the world of skilled rehab was headed. Some things can only be taught in the real world.
I graduated and received my license in 1995: Finally I was a PTA! For the first couple of years I worked at my local hospital, which I loved. I got to help people and gain experience in just about every aspect of physical therapy that you could do, from inpatient acute, outpatient, wound care, home health and skilled nursing.
One day, BOOM. I came in to find out my company lost the contract. In 30 days, I would be unemployed. The administration at the hospital said they “felt really bad about it and they would have loved to keep me, but they couldn't due to non-compete clause.” The current company also said they didn't have anything in my area.
Eventually, I got into management, becoming a rehab director at different skilled nursing facilities. But it seemed as if as soon as I got comfortable and settled in, BOOM. Contract talks would begin. At one point, I was part of a hostile takeover by a group of angry ortho docs, but that's a story for another time.
I started thinking — was it me? Everytime I left, building staff and my company would say “I wish we could keep you, but …” You get the picture.
Everyone has a “dream job.” After years of work, I got it. It was a beautiful new outpatient client, 20 minutes from my home, with great coworkers, good benefits, fancy equipment and a boss that cared about more than your license. I even met my husband there.
Yet there was another BOOM. This time, it was when I returned from lunch. I got out of my car and slipped on the ice, fracturing my radius. Many of you know, therapists make terrible patients. I returned to work showing off everything I could do left-handed, and BOOM. I ruptured tendons in my left arm. Four surgeries later, I had two very weak, painful elbows. One doctor told me, “You will never work as a therapist again. Your arms just can't do it.”
So I moved to being a rehab director, which could keep me in the field that I loved. I found a job at a non-profit facility I had always loved, as it was on a beautiful campus and put residents first. It was an hour from my home, but I was excited and up to the challenge.
On the first day, the outgoing rehab director met me, although no one had told her I would be coming. She was not thrilled - to say the least — at having to train me. By the second day, I was flying solo with only a slight clue of what I was supposed to be doing. I got a call from my regional person telling me that the PRN PT would be in to co-sign notes and that I was “ “not let her out of my sight.” I was told she would be escorted out of the building. I was lost, with little support from my company, and I tried to act as if I knew what I was doing.
From the best boss ever, Phil, I had learned to work and show respect for those working for you because without them you are nothing. I brushed back up on my RUG levels, figured out Case Mix Index, and spent many long hours at home pouring over information, learning as much as I could about how this system works.
That was seven years ago, and by early 2016 we had a full-time staff of nine therapists and assistants. Many of them I hired, and are some of the best therapists I've ever worked with. Several of us have long drives to get to work but we don't care — we love our jobs. We are now also part of starting up and running a home health company.
But while I have always understood that healthcare and therapy is a business, it seems as if caring for the elderly and disabled properly is growing harder every day. All rehab directors are struggling with unrealistic productivity goals. We all want to pick up Part B patients, but it's not fun to hear, “Don't overtreat, don't break any laws, but keep the numbers up.” Many directors are pushed to pick up Medicaid patients for therapy and not to discharge them at the end of the quarter. Skilled patients are pushed into ultra and if not, you have to explain why. If you feel they should be discharged, if insurance gave you another week, you are supposed to keep seeing them. Then three years later you get an ADR. Meanwhile, only one discipline at a time can see Part B patients. Rehab folks are expected to be in care conferences and meetings, for which they cannot bill.
We also struggle with government policies around sick days for patients. If Mr. Smith has his knee replaced, then gets the flu and can't do his therapy, there's only a small fraction of reimbursement, even though Mr. Smith needed more nursing care, couldn't get out of bed by himself, toilet himself or dress himself. Those are costs the nursing home eats. Not to mention the government therapy caps on therapy.
So now I sit here, with 21 years of experience, seven of them as a rehab director. When contract negotiations started, we were told we had nothing to worry about. We then found out seven of nine of us would not be retained. The two that were retained are good solid therapists - but they were also the cheapest.
As we face unemployment, I am more unsure than ever about being in this field. It's harder and harder to survive while upholding one's morals and standards. If I leave the field, I can do it knowing I've kept those ethics. I have never picked someone up for therapy that didn't need it. I have treated patients to the best of my abilities. I built up a department of almost nothing into something that I am proud of.
I have been blessed in meeting many wonderful people along the day, but therapy management is something I may be too worn out and disappointed to do anymore.
Cathy Spearman-Tudor, PTA, is a rehab director.