Tag: slp-a

When Rehab Came to Long-Term Care

When Rehab Came to Long-Term Care

For this entry of REFLECTIONS, the founders of this website decided to take a moment to reflect on our own careers in the field of Speech Language Pathology, particularly that portion that brought us together.

Way back in the very late 1980s/very early 1990s, we were both moonlighting as contractors in long-term care.  We had both come from in-patient rehab settings working with brain-injured adults and were looking to expand our skills.  Back then, SLP’s were required only on an ‘as needed’ basis in nursing homes. PT’s were required 6 hours a month and OTs were regulated to 4 hours.  There were no rehab teams, because rehab didn’t happen in nursing homes.  Nursing homes were for custodial nursing care.  If a patient had a problem, the home would call us. We would swoop in, do an evaluation and leave a long (sometimes very long) list of recommendations for the nurses to carry out.  We didn’t treat the problem.  Follow up was PRN – at the request of the nurse – if the problem didn’t resolve, given our extensive recommendations.  Thinking back, it is shocking how much we didn’t do.  Even more surprising was the fact that the head injury facility where one of us worked full time (in a department that included two other full time SLPs and two full-time SLP-As) actually occupied three wings of a four wing long-term care facility, and in five years of providing full time care, our department was called to the nursing home wing only once.

Then things changed.  In order to cut costs and defer care away from high priced hospitals, insurance companies and the federal government’s medical insurance plan, Medicare, began to reimburse nursing homes for rehabilitative care.  It was pretty much a pass through arrangement which allowed nursing homes to charge a fee for rehabilitation services which Medicare then paid.  This opened up huge opportunities for nursing homes and contract rehabilitation companies that provided rehab staff
(PTs, OTs and SLPs) to nursing homes.  This was now the mid 1990s and we found ourselves setting up departments and policies and feeding programs and language therapy in facilities that had never had them.

A population we always thought we’d just dabble in, in a setting no one ever liked, we began to love.  And then we started to teach other people (students and CFYs) to love it.  Senior citizens are awesome.  They are wise and hilarious and generous and aggravating. They allowed us into their home (the nursing facility) so that we could care for them.  It was a joy to see them improve, heartbreaking when they didn’t and an honor to shepherd them through difficult times as they approached the end of life.  The process transformed traditional nursing homes where people went to die into skilled care facilities where people lived, got better, sometimes went home or stayed and lived their lives in a place they could call home.

Then came more change.  Enter the Balanced Budget Act of 1997.  The Balanced Budget Act of 1997 was an omnibus legislative package enacted to balance the federal budget by 2002.  The Act resulted in $160 billion in spending reductions between 1998 and 2002 with Medicare cuts responsible for $112 billion of that total.  This became the real test of our love of long-term care.  We now of course, had to do more with less, but this is also when our programs started to grow and coordinate with nursing and our fellow rehab professionals.  We were a smaller more mobile band of therapists working hard to treat a population that viewed the nursing home as a short-term stop on their road to recovery. Before our entry into rehab in long-term care, no one would have ever thought that a patient would return to the community once they entered a nursing home.  Now today, most rehabilitation following surgery, strokes or general hospitalization happens in nursing homes for people over 55.

As we look back/reflect on this part of our careers, we are pleased to have been a part of the group of professionals who changed how healthcare was provided in the US. Our work extended care to millions of neglected older Americans warehoused in institutions. We improved their lives in terms of survival and opportunities to return home. In fact, you would be hard pressed to find a nursing home in the U.S., accepting Medicare dollars that does not have an SLP as part of their team. It has been our privilege to participate in this leap forward in service delivery to provide a better quality of life for our Nation’s most valuable living treasures: our parents and grandparents.

About the Authors

Marguerite Mullaney was born and raised in and around the Boston area. She continues to make her home in the Commonweath and rarely finds it necessary to travel beyond the 128 belt. Her undergraduate program was completed at Bridgewater State College and she attended Northeastern University for graduate school. Adult neurological disorders has been the primary focus of her clinical practice. Her vast knowledge of the field, thoughtful, pragmatic approach and incredible sense of humor have enlightened and inspired her patients, staff and colleagues for over 20 years.  Contact Marguerite at mullaneycccslp@comcast.net.

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com.

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How may I assist you?  Life as an SLP-A

How may I assist you? Life as an SLP-A

by Christine Botelho, BA

I have been a Speech Language Pathology Assistant for over 20 years, licensed in Massachusetts for 4 years (not all states require licensure). Use of Speech Language Pathology Assistants is not allowed in all areas of the Speech and Language field and it is not an easy position to acquire. I have been fortunate to have met Speech Language Pathologists who have given me the opportunities that I have had. I have worked in acute rehab settings, nursing homes, day hab programs, schools and private practice.

As an SLP-A , I have always worked with Speech Language Pathologists. Initially it is difficult to work with a new, unfamiliar SLP because of different treatment styles and expectations. I have found that the speech and language field can be extremely subjective.  A patient, given the same tests and acquiring the same results may have different goals and objectives created by different therapists.  The therapists may desire the same outcome yet approach the treatment from different directions.  Having had the opportunity to work with numerous Speech Language Pathologists has given me countless treatment strategies to refer to while I am working my patients.  Every SLP has their own style of treatment and each patient is an individual- what works for one patient may not work for the other.  It has been helpful to have multiple strategies to try.

My overall responsibility as an SLP-A is to comprehend the recommendations, goals and objectives of the supervising SLP and implement the treatment to maximize the patient’s success. An SLP-A needs to have a basic understanding of the disabilities they are working with. However, their greatest strength is in knowing what materials are available, with an ability to modify and create novel ones in order to motivate their patients.  I feel the optimal use of an SLP-A is to accomplish the “drill work” needed to attain the goals the SLP created.  Therefore, the needs of the patient and their rate of progress determines the ratio of SLP to SLP-A treatment.   ASHA has guidelines for supervision of SLP-A’s and I believe it is important to adhere to these in order to assure the best outcomes. In addition, as this website shows, it’s lonely out there! We need SLPs to bounce ideas off of and to make sure we are on the right track. Our training and experience only gets us so far. The SLP has the education and the responsibility to drive the treatment plan.

Often I look back over my career and remember my patients from the early days and think how much more I could help them, knowing what I know now. If my career has taught me anything it’s that we have to have an appreciation for what we don’t know with the courage to ask questions and continue to search for answers even in the most challenging situations. It is becoming too easy to blame the patients and families for a lack of progress instead confronting our own limitations. I enjoy learning new things in order to help my patients. One reason I like being an SLP-A is that you always have someone to consult and brainstorm with. It is harder to feel defeated when you are part of a team. My best experiences have been working with SLPs that share my ideology and philosophy.

As our field continues to grow and change, I would like to see SLP-A’s working with SLP’s all settings with services reimbursed by all insurances in order to reach as many patients as possible. After all, I bet everyone could use a little assistance.

About the Author

Christine Botelho is an SLP-A with a Bachelor’s Degree in Communication Disorders from Bridgewater State College. When not amazing her school based caseload with a variety of original materials, fun reinforcers and tireless energy, Chris can be found in southeastern Massachusets enjoying time with her family and learning archery.
Contact Chris at sb01@comcast.net.

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R-E-S-P-E-C-T

R-E-S-P-E-C-T

By Lisa Yauch-Cadden

“R-E-S-P-E-C-T”

As someone who grew up in Motown, I know a little bit about Aretha Franklin and her mantra. As a clinician who has been around awhile, I know a lot about why it is so important.

In our business, we deal with all kinds of people: patients, families, physicians, nurses, therapists, case managers, social workers, insurance representatives, students, etc. Like any business that involves personal interaction, everyone has a perspective, an agenda, a point of view. In our role as a diagnostician/therapist, we may need to bring all of these perspectives together, and if we can’t bring them all together, we certainly need to appreciate them. Every person that works with/interacts with our patient has a perspective about that patient, and those perspectives may be important to us. When I evaluate a patient, I always try to ask them what they think the nature of their problem is. I also ask their family members: “What problems do you see?” “Why do you think they are occurring?” I canvas the nurses and the CNAs. I consult with the physician. I ask the treating clinician (CFY, SLP-A) who may be working with them. All of these people invariably know the patient better than I do and their insights are important to me and to the patient. When I come to a conclusion, I let patients/families know, “Here’s what I think”. I seek confirmation, when I can, (e.g., “Does this make sense with what you see at home?”). It provides for a better recommendation, usually leading to one the patient can live with (think: modified diet/thickened liquids).

I also have used this approach as a manager and find that staff generally do a better job when you treat them with respect. I know, novel concept. Having worked for managers that don’t share this philosophy, however, makes me think that this is may not be an intuitive strategy for some people. The concept, however, is simple. People have their own opinions and perspective, as do you, and like you, people think that they are right. As a manager, you need to appreciate that, and sometimes solicit that perspective, in order to come to a shared conclusion. Like you, people need to be validated. Once you let them know that their perspective has value, they are much more likely to hear your side of the story. And when that side doesn’t necessarily agree with theirs, or doesn’t give them what they want, you are less likely to have problems afterward, as long as you’ve told them the truth.

And that’s the second part of the equation: Tell the truth. Respect the person you are dealing with enough to let them know the truth. If they know you are being truthful, even if they don’t like what they are hearing, they are more likely to accept it. Isn’t that how you would like to be treated? Imagine what a world it would be if everyone acted this way.

About the author

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com. .

If you have something to say, please submit your article for consideration to lycslp@gmail.com. .…

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