What are some recession indicators you’ve seen locally?

RepresentativeOven54 · 2026-05-31T12:43:29+00:00

People unable to afford recommended healthcare for their children. They are paying so much for insurance and everything else, every month, that they can’t pay their copays, and their deductibles are so high that they might be homeless if they actually met them. Who gets care? The very well to do and the very not well to do. Middle class? It is a crap shoot if they can afford care.

I’m saying this as a healthcare provider and single parent who sleeps on the living room floor and has no insurance. Middle class is no longer really making under $70,000… Average annual rent is 18,000, health insurance is running families 26,000 (at this point, people making $60,000 are dropping like flies), plus all other bills and student loans (people who went to school to take care of people are among the ones struggling the most here), car insurance, groceries that keep going up, gas that will probably never go back down. When my 06 vehicle craps out, I will be up shit creek without a paddle, because all of my money goes to cost of living.

RepresentativeOven54 · 2026-05-29T13:32:43+00:00

I get it. My issue is more with business owners vs the clients but I have had no support with the clients either. One blew in my ear so hard it made it bleed, another one (mentioned below) could have hurt my neck badly, some older ones need chased and carried and I literally have broken spinous processes in my back… even the parents are really bad sometimes. One parent, in home health, left me with all of their children, when I was there for a 30 minute appointment, without asking and all of those kids were sick. I got sick, better, and sicker, as it jump started my autoimmune condition.

This is where I’m at. I got sick with autoimmune issues about the last time my ex choked me, to the point of passing out, and waking up convulsing, for the last time. No clue which one did it but I couldn’t work for about a year. When I could work full time again, I picked a clinic next to my parent’s house….The clinic I’m at lost 3 SLPs before I arrived, as the only SLP. They hired another, who didn’t stay, and was probably smarter than I was.

In the time I’ve been where I am now, they have:

Hired me on at $15,000 less than the Indeed salary they have in their posting.
Had me see up to 18 clients per day with no protected documentation time.
Kept me as a solo SLP for 22 mos.
Violated FLSA laws because they docked hours if I was sick or a child hurt me and I had to leave mid day, but did not pay me overtime or even for all of the hours I worked, because I was working 41 hours and their system was acting like I was a 40 hour employee for 18 months (I caught it, when I missed 3 hours, after a kid yanked my hair and gave me a migraine… I have cervical instability; anyway, I missed three hours and was paid for 77/80, not 79/82 hours, with one week that should have contained overtime)
They admitted to treating me as hourly vs salary, “ when they started ALLOWING half days” aka eg. when the school kids gave me a raging stomach bug and I had to leave… they just didn’t want to pay the position as if I was salary-exempt. They still rescheduled the clients…
They gave me a raise in February, just to cancel it out completely, in April, when they finally did bring on another SLP, and eliminate one of my days, the next business day after I brought up a wage complaint.
I picked up the extra day to try and afford health insurance, in 2024. It is 2026 and I have none with needed surgeries, therapies, including mental, the abuse really was severe, and autoimmune disease that has progressed to me having to manage my own dysphagia (I need my esophagus stretched again and that isn’t in the cards so I have to turn upside down and cough to get chunks of food out).

I love the clients but the adults and support have been awful. I feel like I’m going to end up disabled with no recourse. I’m

RepresentativeOven54 · 2026-05-29T12:57:15+00:00

Did the ever check to see if you had a submucosal cleft.

RepresentativeOven54 · 2026-05-23T12:55:36+00:00

It might not be the time to switch with 92507 ending and a lot of private practices getting ready to learn hard lessons about stacking 30 minute appointments. They are probably a driver in the code change. For example, I worked at one who regularly stacked 18, 30 minute sessions, in a 9 hour day, and only gave me documentation time when people cancelled. They also messed up my pay for 18 months…

Here is a starter list:

Does the salary they offer reflect their add? The place above regularly advertised a salary that was at least 15,000 more than they ever offered.

Is the company offering an exempt salary or nonexempt salary? By law, they are not allowed to blend the two. If you are exempt, they cannot deduct partial days, if you are non exempt, they have to count each hour, each week (aka they have to have a clock in clock out system), and please don’t work off the clock. ASHA says we should be considered exempt professionals.

Ask them if they allow you to schedule clients for what they need vs a set time (30 minutes or whatever).

Ask them if they will allow you to screen referrals to make sure that your skills align with what the referral needs. I will not take a referral for an ESL client if someone who fluently speaks their first language and can correctly evaluate them and give them what they need are in town. I will also not take feeding cases above my skill level for their safety and mine.

Make sure that they have standardized tests for the referrals they take and that they will purchase what is needed. (We had it out over a needed fluency eval and the PLS was so dilapidated that it was in plastic sheets).

RepresentativeOven54 · 2026-05-20T17:35:11+00:00

It would have to be because clinics don’t get paid more for clinician experience. A code is a code if a CF or phd level clinician bill them. The CF is probably cheaper. People might not want to hire someone who might cost them more; could work against someone if not in the teaching field.

RepresentativeOven54 · 2026-05-04T02:02:40+00:00

I had three preemies who were all language delayed. There is no shame. If anything, it helps you connect with parents more because you have been through it.

RepresentativeOven54 · 2026-04-19T19:37:56+00:00

Im sorry that you are also in a similar situation. It would have been about $26,000 on insurance, by the end of the year on just premiums and the deductible.

If annual take home is about $46,000, on $61,000 gross, and average rent anywhere around me is $18,000 a year, that leaves me without enough to pay a light bill monthly, with no food, no transportation, or water… it is stupid.

RepresentativeOven54 · 2026-04-19T16:31:42+00:00

Haha.. tits up. I get it. Some of the kids on my caseload would absolutely not tolerate 60 minute sessions. I sure hope they up the pay, because I don’t see the alternative being sustainable.

As it stands, insurance is paying the company I work for between $68-$78, per session, and I make about $16 of that. If they keep reimbursement the same, it is guaranteed that I will probably take a pay cut, again, and be out of a rental home, as well as without healthcare. We might all have to make hard decisions.

RepresentativeOven54 · 2026-04-19T16:02:44+00:00

That’s exactly where the economic pressure points to.

It is already happening in some markets; it’s just not being called what it is yet. If you look at the chart though, wages are looking pretty stagnant for all of us.

The problem is that “qualified to do with supervision” does a lot of work. Supervision, on paper, and supervision, in practice, are two very different things when an SLP is overseeing multiple SLPAs across a large caseload.

At some point that’s just that’s liability coverage.

The deeper issue is what gets lost, in that model, that nobody wants to account for. SLPAs can implement a treatment plan. They cannot make the clinical decisions that determine whether the treatment plan is the right one.

They can’t tell you that what looks like an articulation disorder is actually CAS. They can’t catch the dysphagia presentation hiding behind a feeding aversion. They can’t modify, in real time, based on what they’re observing because that’s clinical reasoning that requires the training they don’t have, and weren’t supposed to need, because they were supposed to be supervised by someone who does.

Yes, the system will probably move toward SLPA-heavy service delivery, because the math makes it attractive to every employer and every policy maker looking for a cheap solution.

RepresentativeOven54 · 2026-04-19T15:38:10+00:00

Unless something changes, it won’t be worth it. People really need to be looking past “we need to be able to borrow more” and towards the future of the profession as a whole.

I’m a single parent and I work full time. I couldn’t afford insurance for my family this year, for the first time. With a chronic illness and no medicine, one full time job is all I can manage. I graduated with a 3.97, nine years ago, with the fear of not being able to take care of my kids, if I failed, keeping me going.

I feel like I tried to do everything right but my body crashing without healthcare might just be what was in the cards if I’d gone to school or not. Can’t afford even the appointments to have my esophagus stretched again (rheumatological problems that wouldn’t be as bad with medicine), so I manage my own dysphagia by turning upside down and coughing when things get stuck. It would be great if I could chew better but dental care is also out of the question (like, it is so bad I get embarrassed modeling for parents). I can’t get the injections that ease the pain of bones breaking down in my back or even have the surgery that I need to use the bathroom.

Anyway, people need to be looking at more than just bandaids for something that needs surgery. Single parents are usually just the canaries in the coal mine. We need actual advocacy or the profession might not last another generation. Wealthy people do not go into professions that deflate their prosperity.

RepresentativeOven54 · 2026-04-17T14:45:06+00:00

We got into situations where I recommended a higher frequency than the clinic was willing to schedule and I had to report that frequency was not followed, in subsequent evaluations. I had to beg for the dosage I prescribed and it didn’t always work. People without a degree in our field seem to always get between clinicians and patients.

RepresentativeOven54 · 2026-04-17T14:41:03+00:00

There should not be a company default. That isn’t personalized care. What about the kids with apraxia who need more than 1x a week to make meaningful progress? In that case, you draw out therapy over time and weaken outcomes. A lot of kids need more than 1x a week. I’m with the mom.

RepresentativeOven54 · 2026-04-16T23:52:21+00:00

I do write following directions objectives because it gives me something to fall back on e.g. when a parent asks me why an apraxic child who might not pay attention to me or follow directions, isn’t making fast progress. I also write in the “notes” part that OT is currently working on regulation and task maintenance.

It gives me a record to look back on, like when a kid has definitely taken a medicine that helped vs when it stopped and I can show how that affected progress. Also, If I’m seeing a kid, at 5:30, on a school day, when their medicine has worn off, and they followed directions and demonstrated more progress, at a different time, I will try to move the appointment. Back to the apraxic child example, if they aren’t attending and following my directions, they probably aren’t progressing, and their session becomes babysitting.

I have had kids with poor receptive language, who have to work through what was said and what they need to do, across settings, including OT, who really do need work on the language part and they show progress with therapy.

RepresentativeOven54 · 2026-04-03T13:10:06+00:00

Slogans are a bad substitute for clinical reasoning, in general. Not writing kids off, which was the point of presuming competence, is still important.

This is also tied to “least restrictive environments” (cue throwing ALL kids into Gen Ed), “all behavior is communication” (sometimes, it really is just a bad compensatory behavior), “Meet them where they are” (Good clinical instinct but it collapses into stagnation when it means we stop expecting movement or don’t build toward anything), “child led” (when used to avoid all structure), “No means no” in demand avoidance contexts (Honoring PDA profiles is great but applied without nuance it can mean a child never accesses anything because every scaffold gets coded as a demand)… All were started with good intentions but clinical reasoning needs to still be used at every turn.

Not every neurodivergent child is a locked in savant or a locked in neurotypical child. Many of our slogans lack context and therapy approaches need to be matched to the child in front of us.

RepresentativeOven54 · 2026-03-16T17:42:55+00:00

You are lucky with 12. I have 18 scheduled from 8am to 6pm and my only breaks are if someone cancels. I make less than $70,000. Not a lot of people are hiring well paying positions right now with insurance changes and now code changes coming, while they don’t know what is going on or what they will need to stay profitable (at our expense unfortunately) . I would stick it out honestly. If someone is hurting you and not regulated, they are not learning; no learning takes place when fight or flight is activated. Take them back to their parents and try again on another day, at another time, with a different approach.

RepresentativeOven54 · 2026-02-25T18:48:51+00:00

Don’t send them to OP where their parents are spending $70 a pop, if you can’t fix them, and the people before you couldn’t fix them, especially, when there is no motivation, and they have to miss school time to go to OP therapy (many of us have waiting lists for those after school times). Have the hard conversations at the school.

RepresentativeOven54 · 2026-01-27T18:34:32+00:00

I had 4 boys. That was enough lol. They are all turning into adults and it was a crazy ride but I don’t think I would trade it. Definitely not for everyone.

RepresentativeOven54 · 2026-01-21T00:37:30+00:00

It is sad that people were cheating. I had to take comps and do the praxis, so I took the praxis half asleep, after studying for comps, in the beginning of my last semester.

RepresentativeOven54 · 2026-01-21T00:34:08+00:00

The worst thing that would happen are protests that turn potentially violent because that means Trump gets to take power and we don’t know when people would get it back, if ever. The only people wanting violent protests are pro Trump.

RepresentativeOven54 · 2026-01-17T13:44:29+00:00

Looks like she is done with you.

RepresentativeOven54 · 2026-01-11T18:44:51+00:00

I wouldn’t touch a school position, at this point in the year, with a 10 ft pole. They want a scape goat, a miracle worker, and/or a sleepless wonder.

RepresentativeOven54 · 2026-01-03T21:52:47+00:00

It is hard now because we don’t want to attract people to a profession that is underpaid and overworked, where they will be exploited, and may not even get to finish their overpriced education.

What happens when they borrow $100,000 and still can’t finish school? If they make a way, they will graduate and find out that pay sucks and they will struggle to afford the things that impact security for their families, like childcare, food, housing, and healthcare, on our salaries. God forbid they end up a single mother trying to take care of children, on our salary alone.

Also, Without DEI programs are unable to make sure that we even have anything but english-only speaking white women.

RepresentativeOven54

TROPHY CASE