Do you ever have a recurrent dream? One that comes up every so often but in the moment seems to be on repeat.

One I have had for the past 20 years goes something like this …

I am ready to graduate, walk across the stage and start an official occupation as a speech-language pathologist, when someone at the university realizes I neglected to take a prerequisite course and my dreams are put on hold.

All my friends walk across the stage, smiles on their faces, and I am left, sitting in my seat wondering, thinking to myself, how did I miss a key experience needed to graduate? How in the world did a foundational course slip through the cracks?

Well, thankfully, I graduated on time. I have also been overly fortunate in my career to have mentors, colleagues and friends to guide my path, including a student rotation and an experience at a local VA nursing facility.

That experience, and its foundational impact, has had lifelong effects on my career path. 

What I recall most about that rotation compared to others is that there was an emphasis on the fact for many patients that we are guests in their home, we are here to support their journeys based on their disease process and separate from other settings we have the opportunity to develop solid relationships with patients, along with their family members and loved ones.

The purpose of this blog is to remind all of you out there to welcome students back into your skilled nursing facilities, back into patients’ homes, allow them into your life plan communities, and support them with the experiences they need to ensure the long-term successes of these unique settings we all love so much.

In our rapidly evolving healthcare environment, the role of therapists remains undeniably vital. The distinct nature of long-term care means that therapists aren’t just passing through a patient’s healing journey — they become an integral part of it. Unlike the more episodic interactions in hospitals or outpatient clinics, therapists in these settings can watch and assist as their patients evolve over extended periods. This continuity translates into more than just a working therapist-patient relationship; it blossoms into trust, understanding, and mutual respect.

Beyond the clinical benefits, the environment of life plan communities offers a precious glimpse into a patient’s daily world. Therapists gain an in-depth appreciation of the intricacies of their patient’s lives, from their favorite morning routines to the challenges they face every evening. Such insights prove invaluable when crafting therapeutic interventions that are not merely clinically appropriate, but also deeply personal and relevant.

A common obstacle to integrating students into skilled nursing facilities is the perceived web of regulations. To foster a more student-friendly environment, it is crucial to understand and communicate these regulations clearly. While communities should review local and state guidance a logical place to start is the Resident Assessment Instrument (RAI) Manual Section O guidance as follows:

Medicare Part A:

Therapy students are not required to be in line-of-sight of the professional supervising therapist/assistant (Federal Register, August 8, 2011). Within individual facilities, supervising therapists/assistants must make the determination as to whether or not a student is ready to treat patients without line-of-sight supervision. 

Additionally, all state and professional practice guidelines for student supervision must be followed. 

Time may be coded on the MDS when the therapist provides skilled services and direction to a student who is participating in the provision of therapy. All time that the student spends with patients should be documented. 

Medicare Part B:

The following criteria must be met in order for services provided by a student to be billed by the long-term care facility: 

  • The qualified professional is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment and is responsible for the assessment and treatment.
  •  The practitioner is not engaged in treating another patient or doing other tasks at the same time.
  • The qualified professional is the person responsible for the services and, as such, signs all documentation. (A student may, of course, also sign but it is not necessary because the Part B payment is for the clinician’s service, not for the student’s services.) 
  • Physical therapy assistants and occupational therapy assistants are not precluded from serving as clinical instructors for therapy assistant students while providing services within their scope of work and performed under the direction and supervision of a qualified physical or occupational therapist.

In conclusion, nurturing the next wave of therapists via mentorship and placements is an investment in the future quality of care within skilled nursing facilities and life plan communities. With a clear understanding of regulatory directives, these institutions can not only offer a rich learning landscape for students but also tap into the fresh vigor, innovative perspectives, and boundless enthusiasm that these emerging professionals bring. 

With this peace of mind we can all rest well and dream big that there is a bright future in therapy for ours and the next generation to come. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab. Additionally, she serves as a member of the American Speech Language Hearing Association’s (ASHA) Healthcare and Economics Committee and is a member of the University of Kentucky College of Medicine community faculty, a member of the American Medical Association’s (AMA) Digital Medicine Payment Advisory Group (DMPAG), and an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected].

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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