Restart rehabilitation- McKnight’s Long-Term Care News


I’ve been a physical therapist for a very long time, and as I prepare to renew my license for the four millionth time, I reflect on how my profession has changed. All of our professions have changed in the last few decades, and even more so in the last three years. 

PT has evolved from a non-licensed, early 20th century, military-based, experience-based, on-the-job trained skill to one that now requires a doctorate. My first job out of college was in an osteopathic hospital whose rehab director was a WWII navy veteran with no specific training, and turned to me, a brand-new graduate, for physiology and treatment advice. 

Like my fellow students, I aspired to be a PT because of the adventure of helping, healing and improving lives. As the years progressed, my focus shifted to economics, financial dynamics and insurance outcomes. Because of the ways our efforts changed, so many of the PTs, OTs and SLPs who worked with and for me believed that our job was done when the patient’s progress “plateaued,” and that it was against our ethics and expectations to continue treating when that false measure was met. 

So much of my time has been spent explaining that “plateau” isn’t a thing, there is a specific legal measure that explains that, and that treatment dictated by a third party algorithm is in no one’s best interests and isn’t mandated. 

I recently attended a SNF care plan meeting for a distant family member, where the social worker said that since the patient’s progress had stopped, even though she would benefit from continued skilled care, they would be discharging her. I had to (gently) provide her with a Jimmo vs. Sebelius fact sheet. Imagine how many people she has misled with that pervasive mythology. Imagine how many people were discharged before they were ready. 

The nationwide shortage of therapists has changed the way we do therapy too. When I graduated, I had no trouble finding a job. At that time there were more empty PT positions in Ohio than there were licensed therapists. My inbox is still populated with job offers every day: near, far and travel. 

With the higher and more stringent requirements for PTs, and the longer path of tuition and subsequent student debt, the shortage is worse than ever. But paying a therapist the wage they deserve to continue their student loan payments seems to be beyond what some facilities and agencies can manage. And the 2024 proposed 3.4% cut in the Physicians Fee Schedule for therapy isn’t helping the landscape. The employers are at the mercy of the insurers, the therapists want to treat patients as they need and deserve, and the clients find themselves on a months-long wait list to get in. 

What’s the solution? A family member is the associate dean of the college of health at a nearby university, and though they have trouble finding students for the nursing program and the social work program, the therapy seats are still filling up. Where are those students going after graduation? 

COVID changed the landscape of healthcare in more ways than improved infection control. COVID also drove many healthcare workers into other careers because none of us had ever seen a horizon where we did everything right, but people didn’t get better. As fast as they’re graduating, positions are opening as veteran therapists leave us to become realtors, copy editors, retailers, mechanics or consultants. The “nobody wants to work anymore” fallacy we keep hearing is just that healthcare is not the same career we aspired to. In 2021, over 20,000 therapists nationwide left the profession in response to the pandemic. It kicked our buts, and for some, the trauma persists. 

What’s the solution? Our SNFs and HHAs can’t continue without physical, occupational and speech therapists. It’s our duty and obligation as caregivers to ensure the best possible treatment for those entrusted to our care, but before we can do that, we have to get staff and pay them properly. 

We need to write letters to our representatives, lobby, and talk to our legislatures to let them know how important it is to our elderly to stop the proposed cuts in order to keep our therapists. We did it successfully in 2018 to repeal the Part B therapy cap. We can do it again. As we get older, and as they get older, these services will be more important than ever. Spread the word and get our therapists back to the jobs they were meant to do.

Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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