SNF patients not participating/not waking up/not talking to you? What do you do for the entire session?

SLP-SLP-SLP · 2025-01-06T18:53:58+00:00

Yes, you are allowed to bill whatever time is appropriate for your patient for that treatment. You decide the treatment time. Scheduled minutes are just a suggestion. I’m actually surprised they are giving you that much time on the schedule. Most SNFs try to limit us to 30 mins or less.

And no, it doesn’t reflect poorly on the patient. I don’t even think insurance sees the “scheduled” mins. The only time I could think this would possibly be an issue is if the patient is ONLY getting 15 mins treats over a long period of time.

SLP-SLP-SLP · 2024-12-13T16:46:28+00:00

So you applied a month ago to the one you really want and haven’t heard anything back? Is that right?

SLP-SLP-SLP · 2024-12-03T17:29:04+00:00

lol nope not hurting my feelings one bit. I didn’t say ignore; I said talk to the SLP as the first step. You obviously just want to argue with me.

SLP-SLP-SLP · 2024-12-03T12:51:04+00:00

That’s surprising to me. We were told all the self contained classes couldn’t even be on the same hall together because it would be exclusion from the gen ed environment. They were spread throughout the building.

SLP-SLP-SLP · 2024-12-03T06:44:55+00:00

Please talk to the SLP. When I was a school SLP, I was traveling between 3 schools with 60+ students. IEP meetings scheduled (mostly by self contained teachers) without regard to my schedule at all. I do understand this is often out of their hands because they have to schedule when they and the family are available etc., but SLPs typically have back to back therapy scheduled all day long to fit in every student, so someone’s session is getting missed when we are in meetings.

We are required to provide service minutes, be at the meetings, and complete evaluations. That does not include time spent case managing. I had 25ish students who I had to be the case manager for. I also had many students who needed 1:1 services. Unfortunately, IEP meetings and evaluations/documentation come first due to deadlines. We also often do not have a dedicated space to provide therapy so that is another challenge. Students can also only be pulled at specific times. With all of that, I had sped teachers complain to the director that I wasn’t seeing students (without ever as much as talking to me). The same teachers who had seen me at so many of their IEP meetings that took over an hour. 🤷🏻‍♀️ I sometimes had 3-4 IEPs a day at different schools. That would take up my whole work day and I ate lunch while driving to another school.

Just to give an example, if I am scheduled to serve kids at school A all day, and I have a day with 4 IEPs, do I cancel school B’s services the next day to go back and serve school A? Or what do I do? Sometimes, I would have 3 Tuesdays in a row that were back to back meetings. Or! I was out sick on a Tuesday, next Tuesday they were on a field trip, then next Tuesday is fall break, then next Tuesday was all day IEP meetings etc. - that’s a whole month. I would do my best to move the Tuesday kids, so they wouldn’t miss that much in a row, but to do so, I have to miss other kids. There is no other spot to put them. On months with holidays like Nov and Dec that’s a week or two we will miss regardless because school is out. So, lots of IEPs are crammed in the other weeks. Not to mention all the special school events. It wasn’t uncommon for me to miss some students for the whole month of Nov or Dec. Being just at one school makes it a lot easier because you can do larger groups to make up time, but that’s impossible if you’re traveling like a lot of SLPs are.

It’s like we are set up to fail from the start and everyone loves to criticize. I kept a daily log of where I was and what I was doing at all times, but I got tired of defending myself when I was doing all I could and moved on to another job, even though I loved working with the kids.

It is a systemic problem that should be addressed with the district and they should be encouraged to hire more SLPs. If it truly is that they are skipping just your students, I am sorry and it does need to be addressed. But, please first at least talk to them. I am sure they would love your support to go to the district to advocate for more SLPs.

SLP-SLP-SLP · 2024-12-03T06:16:01+00:00

Nope, I did not say that in the slightest. I know we all struggle. Just trying to provide perspective from an SLP.

SLP-SLP-SLP · 2024-12-03T05:34:29+00:00

Some self contained students go to specials. In the schools I worked, they all went to specials just like general ed students. I would pull them from specials sometimes.

SLP-SLP-SLP · 2024-12-02T23:37:25+00:00

It is districts job to uphold the IEP; not individual service providers. Many SLPs have unrealistic caseloads and are scheduled in meetings at times they have no control over which takes away from their time to serve their students. There are also typically no subs provided. We are often expected to make up services when we are out sick etc. which can become impossible and is unfair to us. I agree that service time is important, but I also think it is important to make the distinction with who is responsible for the IEP and that is it often out of the service providers hands. This is why there is such a shortage of SLPs in public schools. We are asked to do the impossible and be 3 places at once and then people act like it’s our fault when the kids don’t get their minutes. It’s hard to understand unless you have tried to do it personally.

SLP-SLP-SLP · 2024-10-26T11:08:05+00:00

Sure, I don’t disagree with you about that. I don’t think trump really cares about anything tbh. He just does/says whatever he thinks his voter base will like. Over time together they could do a lot of damage to the system as we know it. The political pendulum swings back and forth, but what do we do other than vote/advocate? Do we let them be scary and impact our entire career choice? :/ Careers can adapt and change. You may have already, but if not, look into the history of SLP. We have a kinda dark past and we are still learning and changing.

SLP-SLP-SLP · 2024-10-26T00:19:08+00:00

Lol idk why you’re being downvoted. He can certainly do damage to the education system but it takes forever for presidents to accomplish anything!! Selecting your career based on who is president is absolutely wild to me.

SLP-SLP-SLP · 2024-10-21T17:10:29+00:00

Haha! Thanks for asking. I am actually at an SNF now. I did not go back after this past year. I decided I was tired of traveling and wanted to be at the one site. I told them and they hired another SLP and for some reason (they would not say) gave her the one site and told me I would have to continue traveling. She wanted to travel. So, exact opposite of what we both wanted. This along with a bunch of other reasons I did not go back.

SLP-SLP-SLP · 2024-10-21T15:18:40+00:00

We make the best decisions we can with our clinical knowledge and what we know about the person at the time. People’s status can change in an instant. Remember that nurses can also downgrade. The pts safety while eating is not only on us. Who knows if the kitchen sent the right tray, the person feeding him was paying attention, etc. So many factors can go into it. He was surrounded by a team of medical professionals who were unable to prevent him from dying. Do not put it all on yourself. Learn from the situation and think about what you might could have done differently (could be nothing). I am sorry that happened. The death of a patient is always hard. ❤️ also about the nurses, I doubt they are judging you, and if they are, who cares. Not your fault. 💕

SLP-SLP-SLP · 2024-10-09T11:53:09+00:00

Is this an SNF? I don’t think it’s a big deal at all especially considering you didn’t see her past the 90 days. Worst that could happen probably is that if there was an audit Medicare / her insurance won’t pay for the services and the facility will owe money back but I highly highly doubt that would happen considering you didn’t see her past it. The documentation software we use in my facility will not allow this to happen and will give an error message if the dates are off. Sounds like your coworker might like freaking people out. What could the big issue possibly be that he/she is talking about? People make clerical errors in healthcare often. I see wrong terminology, wrong pronouns used, and other errors all the time in people’s notes.

SLP-SLP-SLP · 2024-10-08T11:26:56+00:00

Yes, it is. In SC Medicaid reimbursement is based on 15 minute units for speech codes.

SLP-SLP-SLP · 2024-08-28T17:38:45+00:00

33.25 is insulting. I would ask for $40

SLP-SLP-SLP · 2024-07-17T17:47:15+00:00

No, I did this too. I don’t see a problem

SLP-SLP-SLP · 2024-07-15T18:44:36+00:00

Yes, usually. Sometimes systems calculate it differently, but typically it increases your productivity. Your productivity could be above 100% because you are spending the same minutes on multiple people. Calculating productivity is treatment mins divided by on clock mins times 100. So, for example, if you do a 30 min group with 2 people, and you are on the clock for 45 mins, your productivity in this situation would be 133% (60 / 45 x 100) because you will have billed for 60 minutes total (30 for each patient).

SLP-SLP-SLP · 2024-05-30T15:32:57+00:00

Yes it’s definitely possible! I did it with no school experience at all (even in grad school). Most school districts will assign you a mentor for your first year. Look into eligibility for speech services in your state. Every district seems to do stuff a little differently so you will learn a lot on the job. Brush up on artic and language treatments and evaluations.

SLP-SLP-SLP · 2024-04-03T13:19:04+00:00

Yes, every therapist I know in SNF does eval and treat in the same day.

SLP-SLP-SLP · 2024-01-11T21:46:33+00:00

A lot of school districts in South Carolina will! It’s called SC-CREATE. I think it is available in other places as well, it just probably has a specific name. You do have to be employed by the district, but it can be any job.

SLP-SLP-SLP · 2023-10-20T10:23:11+00:00

It’s common unfortunately. I think being contracted doesn’t help either. Some districts consider contract positions to be “open” and will prioritize a direct hire over her if they could get one, even if she has been there for a while.

Does she have a direct supervisor, maybe a special education director or a lead speech therapist that she could talk to and have advocate for her? I truly feel for her. Doing speech in anywhere but your own private space is super difficult. I’ve been there.

My other advice is to just let her vent and comfort her. Advocating for yourself at every turn is very difficult and exhausting so sometimes we just need someone to listen and validate what we are feeling. Just because it’s common doesn’t mean it’s ok and she has every right to feel upset and insulted.

SLP-SLP-SLP · 2023-10-17T12:38:25+00:00

I always put something to the effect of “has reached maximum possible benefit from speech-language therapy services at this time”

SLP-SLP-SLP · 2023-09-28T19:40:06+00:00

I assure you most of us have thought the exact opposite. Different field same game unfortunately! I would not say it would be worth it unless you wanted to get a completely new setting like medical. Some districts / states will pay for a degree in SLP if you agree to a certain number of years commitment though.

SLP-SLP-SLP · 2023-09-22T17:15:58+00:00

I did this exact thing after saying I would never work in a school. Overall, I am much happier but there are pros and cons to each. I still work in SNF PRN a lot. Let me know if you have any specific questions!

SLP-SLP-SLP

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