At the heart of any strong rehabilitation program is a passionate, dedicated staff. Without motivated personnel, facilities and their residents are just going through the motions, rehab specialists say.By nature, the therapists and caregivers who work in rehab are in the field because they want to make a difference in their patients’ lives. Yet as with all eldercare workers, the environment can be very demanding and stressful, leading to exhaustion and disillusionment. What can administrators do to ensure a productive, consistently high morale level?
It starts with empathy for the staff, says Alan Bingham, senior product manager for Dedham, MA-based AliMed.
“The clinicians who work in rehab are people-oriented—they like people, want to help and they can communicate,” he says. “In a top rehab center, the individual disciplines utilize a team approach, working together to achieve the best possible outcome for their patients.”
Bingham says his discussions with rehab staff have revealed two main concerns: job security and increasing workloads.
“Many clinicians in long-term care tell us that the stress they face is twofold,” he says. “First, with the state of the economy and the reductions in reimbursement, they are concerned over the level of care because of cutbacks that are causing some nursing homes to close. Second, there is concern that the constant patient handling and heavier patient workloads can cause work-related injury—specifically, the ability of facilities to simplify patient handling and reduce work injury risk.”
Citing a six-year-study that correlates safe patient handling procedures with turnover, Bingham says providing workers with the right tools is integral to job satisfaction.
“A longitudinal study of six Midwest nursing homes examined pre- and post-implementation of safe patient handling equipment and culture,” he says. “The staff turnover rate dropped from over 300% to nothing in three years after implementing safe lifting. While this is just one indicator, it seems apparent that the work environment is the critical factor based on the culture and interest of management.”
Linda Kolleng, vice president of Oak Brook, IL-based Alliance Rehab, asserts that the primary source of stress is an ever-increasing volume of patients rapidly outpacing the number of professionals in the field.
“The ratio of patient-to-therapist continues to rise,” she says. “Not enough therapists are coming out of the system to meet the need, which means people have to work harder, longer and smarter.”
Technology aids
Various challenges in the rehab sector relate to staffing in some way, maintains Brian Hatch, vice president of Phoenix-based Synertx Rehab.“It’s surprising that when you peel the onion how many problems come down to not having the right staffing,” he says. “That isn’t just head count, but the right mix of therapists versus assistants, the right staff serving the right shifts and days, and the right leadership. It’s just incredible how many programs’ financial outcomes, clinical outcomes and community satisfaction ride on getting this optimized and how some of the problems are so subtle they are hidden from administration.”
Rehab centers should focus on technology as a tool to ease staff burden “because frankly, pen and paper documentation, whiteboards and informal planning just don’t cut it in today’s climate where we need to do more with less,” Hatch says.
Indeed, technology makes a huge difference in helping therapists to be more productive in their jobs, Kolleng agrees.
“Working in an environment that provides different modalities, ample supplies and high-tech interventions are what make it a pleasant experience,” she says. “Integrating different technologies into a protocol makes it more interesting and engaging.”
Sophisticated systems such as electronic stimulation, ultrasound and computer applications not only add an extra clinical dimension for coordination, balance and speech pathology, but video modules such as the Nintendo Wii also provide a valuable entertainment component for patients and staff alike, Kolleng says.
Staff empowerment
Amy Iacch, corporate director of clinical services for Arlington Heights, IL-based Lutheran Life Communities, says technology has been critical to the success of her rehab center.
“It makes therapy an exciting, cutting-edge experience for both residents and staff, and therapists feel like they are part of a progressive organization,” she says.
Rehab staff members also are included in the decision-making process, Iacch says. For example, staff members were part of the project team for the facility’s new rehab unit, offering input on design, therapy modes and other aspects of its operation.
“They feel like they are key members of our team because their opinions and participation are integral to our holistic approach to residents’ wellness,” she says.
The best rehab centers have therapy clinicians who are well-trained in the clinical conditions prevalent among skilled nursing facility residents, including cardiopulmonary problems, weakness, incontinence and pain, contends Mark Richards, vice president of clinical education for Reno, NV-based Accelerated Care Plus.
“Today, therapy clinicians generally receive more advanced-level education to help them more effectively address geriatric-specific conditions,” he says. “Overall, rehabilitation centers have done a much better job of equipping therapists so they have more tools in their clinical toolboxes to treat patients. For many years, hospital therapy departments and outpatient clinics were well equipped, while skilled nursing therapy departments were not. This is changing, as many skilled nursing facilities’ therapy departments now look like other settings.
“In addition, these centers have the equipment necessary to put evidence-based clinical education into practice, such as therapeutic exercise equipment and physical agent modalities,” he continues.
In terms of keeping morale high, both nursing and rehab professionals must have equal seats at the table, Hatch concludes.
“Usually we’ve found that problems stem from an uneven degree of communication, control and input into driving the best clinical and financial outcomes for the patients,” he says. “Finding the right ways to balance this through a combination of people, processes and technology should be a primary focus. Having a happy, functional and contributing team of administration, nursing and rehab is so critical in getting the most for both the facility and the patients.”
The Catch-22
Rehabilitation can help a facility produce more revenue, but without revenue, a rehabilitation center cannot be started. That is the Catch-22 scenario many facilities face, AliMed’s Bingham notes.
Because rehab centers are reimbursed through Medicare rather than financially beleaguered Medicaid, traditional nursing homes are looking at rehab as a credible revenue source and desirable expansion of services, he adds.
“Many states are experiencing a loss situation in Medicaid reimbursement. In Massachusetts, the deficit is between $12 and $22 per bed day, whereas Medicare enables a small profit,” he says. “This has made these facilities more rehabilitation-oriented and the success of rehabilitation versus a virtual warehousing type environment leads to better morale because of the positive outcomes that can be achieved.”
Yet the ability of facilities to make the shift to rehab isn’t always possible because substandard Medicaid funding is leaving them cash poor. So to help nursing homes initiate programs, the rehabilitation equipment supplier is working to improve homes’ financial situation, Bingham says.
“Because these facilities are really strapped financially, we are doing everything we can to reduce costs and provide the products and services they need to operate,” he says. “Right now that may mean offering smaller quantities to help facilities preserve cash flow until the economy improves. By controlling price and reducing unnecessary costs, our customers have the equipment and supplies they need to deliver the highest level of care and deliver optimal outcomes within the constraints of the economy.”
From the June 01, 2010 Issue of McKnight's Long-Term Care News
