Thanks so much to Janet for sharing her journey and passion for improving elder care on the blog today. Support her big risk of starting her own rehab company and get in touch with her if you are in the Massachusetts area.
I’ve heard about defining moments in a person’s life, but I never imagined I would experience one. But I did. Almost three years ago. Since then I’ve committed my heart and soul to making a difference, but, not just in the lives of my patients but in the lives of the therapists who serve them.
My a-ha moment came one afternoon while I was working as a rehab manager in a SNF. A month earlier, a right MCA CVA patient was admitted for short term rehab. Upon admission he had no functional use of his left upper extremity, left lower extremity, severe dysphagia, and a g-tube. The patient and family desperately wanted him home despite the severity of the CVA. All three disciplines began working intensely with him and by the end of that first month, he’d made unbelievable progress. He was able to brush his teeth, walk with assistance, and successfully tolerate small portions of puree with no signs of aspiration. The patient was thrilled, the family was thrilled, and a meeting was scheduled to discuss early discharge preparations. Then, I got a phone call from my boss.
“I was looking at your planner in SMART and I saw that you were way over on the minutes for Smith.”
“Well, what are you going to do about it? Your gonna miss your margin.”
“I know, but he’s very involved. And he’s making fabulous progress. He’s even tolerating puree and speech firmly believes he will get off that g-tube. He’s starting to walk and feed himself.”
“Those minutes need to be cut.”
“But if I cut down on the minutes, he’ll lose ground.”
“Well, you’re gonna need to have a discussion with his family about limiting the minutes. And ask him to choose the most important therapy to him.”
There was dead silence. Most important? I have to ask this man to choose between eating, walking, and feeding himself? And I have to tell the family about a fictitious limit on minutes because the added therapy time was eating into the company’s profit margin? I hung up the phone and hung my head.
Then I did something of which I’m not proud. I went to the family meeting and explained the “limit” on minutes and that we needed to cut back on their father’s and husband’s rehab time. Oh, I must have explained the fictitious minute limit very well because after the meeting the family was thanking me. Thanking me? I felt sick. What had I become?
The following Sunday morning, I woke up and said to my husband, “How do you initiate change?” Armed with only my vision of what I thought was right, I started a Facebook page. SNF Rehab Therapists for Change (SNFRTC), now American Association of Rehabilitation Therapists (AART), was born from my frustration, disappointment, and quite frankly fear of the direction rehab was going in the SNF environment. I dedicated the page to the SNF therapists whose daily work offered frequent moral and ethical challenges because of an industry that soullessly placed revenue generation demands above patient’s actual needs.
I began a letter writing campaign to every presidential candidate, every local and state representative in the New England area, and every New England state’s senator. I called the Boston Globe, the Wall Street Journal, Healthcare Finance News, Channel 5 news, Channel 7 news, the APTA, the AOTA, ASHA, the APTA lobbyist, President Obama, the National Nurses Union, the AFL-CIO, and even Occupy Wall Street. What I got back was a few form letters thanking me for my concerns and a call from my representative’s office telling me they didn’t know what to recommend.
Slowly, over time as the Facebook page grew and therapists all over the country joined in the discussion, I began to understand that a page to post reactions and lend support, although immensely helpful, wouldn’t attain industry change. The page provided the ingredients, but it needed a catalyst.
On December 5th, 2013 my catalyst, Arete Rehabilitation, was born. The old saying of, if you can’t beat them, join them? I changed to, if you can’t beat them, join them and then beat them. What if I could start a rehab company and take away the incentives to push minutes? What if I could offer therapists a work environment that valued their clinical decision making and respected them as professionals? What if I could offer SNF’s quality rehab services, do what’s right for the patient, treat therapists with the professional respect they deserve and still make money? So that’s what I did.
Arete offers therapists salaried positions or guaranteed hours with no productivity requirements and an expectation to teach and train the facility staff and participate in company paid lifelong learning. This allow SNFs to be charged a flat, fixed monthly rate that doesn’t change based upon RUGs levels or by a high Med B caseload. The therapists can attend meetings, assist in marketing, and speak to family and other team members, without the constant productivity worry. It’s by combining these two critical components that Arete promotes quality, ethical, and cost effective treatment. By focusing on what each patient needs, the financials will follow.
Will the big companies stand up and notice? Will they ignore me and assume one PT in Massachusetts couldn’t possibly affect change across an entire industry? I hope so because the one thing I’ve discovered…I like being the underdog.
Guest blogger bio
Dr. Janet Mahoney is a physical therapist who advises her colleagues and customers on how to provide quality rehabilitation services in skilled nursing facilities. She established the grassroots organization, American Association of Rehabilitation Therapists, in 2011 which supports therapists who struggle to maintain ethical patient care practices in skilled nursing facilities. Prior to that time, she spent 20 years in skilled nursing rehabilitation management and in 2013 established Arete Rehabilitation, a contract rehabilitation services company which offers SNF’s and therapists a unique choice.
Dr. Mahoney attended Simmons College in Boston, MA where she graduated with a BS in physical therapy. She recently received her doctorate in physical therapy from A. T. Still University in Mesa, AZ. In her spare time, she loves to read and write mystery novels, walking along the New Hampshire shore, and spending time with her family. She currently lives in Amesbury, MA with her husband, three children, and three dogs.
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