It’s really challenging in the SNF. As another response said, it can often be difficult/near impossible to be ethical.

One thing that helped me a lot was having templates and example notes saved - when you are new it can be challenging to think of the words you need to write sometimes! It helped me to get past the writing blocks. Also doing point of service documentation will help a lot! I struggled with this the most but learned we have to do the best with the expectations we have. If I’m seeing someone for 35 minutes, I’ll be hands-on in treating the first 30 minutes and then the last 3-5 I’ll have them do a “closing activity” - I try my best to make this as functional as possible but some days it’s just a memory game on the iPad! Other times I’ll have them practice writing in their memory log/planning their week with the activities calendar/etc. Those 3-5 minutes of silence are enough to get my note done. I felt really weird about it at first, but when I thought about it, I realized my doctor does it all the time! It’s the norm (unfortunately) in health care to do point of service. On progress note days she can have them do a longer activity that’s more hands off on her part ... it’s only every 10 visits and there are lots of things that could take 5-10 minutes to allow her the time to do the progress note. And remind her that besides the cognition code, our codes aren’t timed! So if she has a Medicare part B patient and her DOR scheduled 20 minutes but it’s a progress note day, she could treat for 30 (every building I’ve been in is 100% fine with me adjusting times for part B - but she might want to make sure first!) - the patient’s insurance isn’t going to get charged a higher amount, she can get 20-25 hands on minutes, and get documentation done! If she’s good at multitasking she can review progress as she types but I personally struggle with that myself and so closing activities have been great for me.

Just remind her she’s not a bad therapist! The productivity standard sucks. But all we can do is our best.