Skilled Nursing Facilities

Speech Therapy for Skilled Nursing Facilities

For over 20 years, Language Fundamentals has been providing comprehensive speech therapy services to skilled nursing facilities with a philosophy of providing the highest quality of care to the residents and facilities we serve.

Operating a SNF Speech Therapy Department presents unique challenges compared to those in physical & occupational therapy.  Therefore, having a specialist in medical speech therapy can provide an enhanced level of expertise to the patients served in your SNF.

Are you ready to find out why having a top-notch speech therapy service is the right move for your Skilled Nursing Facility?

Historically, speech language pathologists find themselves working independently, having to seek out and gain experience on their own.  At Language Fundamentals, we not only attend, but present at, local and national speech, nursing home and regulatory compliance conferences to gain new insights into treatment modalities and new/evidence-based practices.

Additionally, we have created an educational forum for our family of speech-language pathologists to present new cases and treatment ideas to our entire team. Our team approach provides our SLPs with the knowledge of thousands of cases on a regular basis eliminating the delay in new and innovative care. Delivering this level of education allows our speech therapists for nursing homes  to have the necessary tools to provide excellent services in speech therapy for skilled nursing facilities.

Our goal is to always go above and beyond  by increasing communication with rehabilitation directors, doctors and other staff, as well as meeting on a corporate level no less than monthly to assess facility needs and how we may better address them. In addition, we collaborate with dietary departments to review diets, consistencies, and likes/dislike of food preferences whenever possible to better deliver appropriate foods and consistencies to residents with dysphagia that may also suffer from unplanned weight loss.

Prevention And Wellness

As speech language pathologists working in skilled nursing facilities, our goal is not only to return people to their prior level of function but also educate them on the best way possible to maintain their new abilities and live as independently as possible. The risk of aspiration pneumonia is six times greater in patients over the age of 75 and mortality rates associated with aspiration pneumonia is about 5% Pneumonia, Aspiration (Buckley & Cabrera 2012). Having a proficient, knowledgeable SLP department who is able to reduce the risk of aspiration pneumonia, help return the patient to regular foods and fluids, and treat patients within the SNF is imperative to reduce their hospital readmission rate.

The use of standard generalization, carry-over training, education and materials are commonly provided to residents, family members and staff by Language Fundamentals SLPs. Language Fundamentals also employs the use of our additional speech resources including newsletters, blog articles, and web videos to educate residents, therapy community, family and staff on the importance of safe eating habits, communication and vocal hygiene.

Screening, Assessment, and Treatment

Screening, evaluation and treating residents with speech, language or swallowing difficulties is the basis of who we are as a company, as clinicians and the heart of what we do. It is important to understand that not every speech language pathologist is drawn to gerontology and skilled nursing. The U.S. Bureau of labor Statistics breakdown of where Speech Language Pathologists are employed. Only 5% of the currently employed speech language pathologists have experience in skilled nursing facilities and as such, the pool of SLPs with the appropriate clinical experience is limited. This is one key difference that sets Language Fundamentals apart. Our team of over 160 skilled and trained speech language pathologists have the same care and calling to treat this population.

Language Fundamentals’ speech-language pathologists, especially those currently providing service in skilled nursing facilities, are specially trained in screening, assessing, and treating:

• Dysphagia
• Cognitive Communicative Disorders
• Dysarthria
• Aphasia
• Apraxia
• Traumatic Brain Injuries
• Speech Language Deficits
• Ventilator and Tracheostomy dependent residents

SLP in Skilled Nursing Facility

Language Fundamentals has effectively guided all our post-acute care facility clients through the transition to the new SLP Component of the Patient Driven Payment Model. Under the Patient Driven Payment Model (PDPM), the newly developed SLP component has 12 distinct levels of reimbursement which are then aggregated into one score. These levels are the result of the speech language pathologist performing a detailed assessment to determine:

• Patient’s primary diagnosis (acute neurologic or non-neurologic)
• Patients SLP related comorbidity
• Patients cognitive status (moderate to severe cognitive impairment)
• Patient’s swallow function
• Patient’s diet status

It is critically important that a Skilled Nursing Facility has a speech language pathology department is highly proficient in working with the long-term care population.

When we begin working with a new facility, we examine the resident population closely to look for those who are overdue for a screen/assessment. Given the nature of the SNF population, delays in service can increase the risk of aspiration, aspiration pneumonia and has the potential to decrease the resident’s overall ability to be an active part of his/her own activities of daily living (ADLs).

Non-instrumental Assessement for Diagnosis

Non-instrumental assessment requires a skilled and proficient speech language pathologist with a keen understanding of cognition, speech, language and swallowing disorders. At Language Fundamentals we stress the importance of honing those diagnostic skills, teaching new clinicians to become more proficient and always striving to improve clinical skills. Language Fundamentals has created and implemented a decision matrix that aides in our clinicians’ ability to identify swallowing and communication problems. We instruct our clinicians in the use of cervical auscultation as well as hyo-crico palpation to help identify specific swallowing impairments that may be overlooked by other clinicians

Beyond addressing short-term and subacute residents, we are committed to enhancing the quality of life of the long-term residents as well. After identifying possible candidates (through the screening and evaluation process) our speech language pathologists work to reduce rehospitalization secondary to dehydration and aspiration, increase safe eating, and help bring residents back to their highest level of function to increase quality of life. Our clinicians work to enhance the residents’ strengths to promote success.

Beyond dysphagia intervention, Language Fundamentals is a leader in cognitive communicative rehabilitation. Using person centered goals, interventions, and activities our clinicians will work with residents, family members and staff to increase functional language. Implementation of cognitive linguistic groups are an additional way to increase communication and facilitate generalization of specific skills worked on during individual sessions. Vocational, memory and orientation groups are all available to be implemented at all the skilled nursing facilities with whom we partner

THE IMPORTANCE OF REDUCING RE-HOSPITALIZATIONS

Language Fundamentals’ speech-language pathologists play a critical role in reducing re-hospitalizations. According to research conducted by Buckley and Cabrera, aspiration pneumonia represents more than 15% of all cases of community-associated pneumonias (CAP). The risk of aspiration pneumonia is six times greater in patients over the age of 75 and mortality rates associated with aspiration pneumonia is about 5% Pneumonia, Aspiration (Buckley & Cabrera 2012).

Language Fundamentals provides a proficient, knowledgeable speech department with well-established protocols designed to reduce the risk of aspiration pneumonia and rehospitalization through the evaluation and comprehensive treatment program. As part of the interdisciplinary team, we will continue to educate nursing/CNA staff of proper feeding strategies to reduce the risk of aspiration and aspiration pneumonia. In addition, we will actively screen and assess the long-term population, placing patients on the safest yet least-restrictive diets, utilizing instrumental testing such as FEES to visually assess the swallow at the bedside. Language Fundamentals will continue to monitor speech related rehospitalization statistics and provide QAPI reports.

SPEECH THERAPY’S ROLE IN REVENUE, AND COMPLIANCE

Many SNFs underestimate the role of speech therapy in revenue maintenance and compliance. However, a proactive and efficient speech therapy department is a true asset to the SNF in the area of reimbursement and an active participant in the organization’s compliance plan. Language Fundamentals as an organization believes that accuracy of reimbursement and optimal compliance go hand-in-hand and that the following elements must be present:

• Delivering clinically appropriate therapy independent of payor source

• Accuracy of CPT & ICD-10 coding

• Supportive documentation & adherence to physician orders

• Internal audit mechanism in place to review the care delivered

MEDICARE PART A / PATIENT DRIVEN PAYMENT MODEL

In the post-acute setting, Medicare Part A reimbursement underwent a significant change in October 2019 due to the transition to the Patient Driven Payment Model (PDPM). The Speech Language Pathology (SLP) Component underscores the importance unique skill set of the speech therapist in assessing the new admissions and re-admissions.

Language Fundamentals has effectively guided all our Skilled Nursing Facility clients through the transition to the new SLP Component of PDPM. Under PDPM, the newly developed SLP component has 12 distinct levels of reimbursement which are then aggregated into one score. These levels are the result of the speech language pathologist performing assessment to determine the:

• Patient’s primary diagnosis (acute neurologic or non-neurologic)

• Patients SLP related comorbidity

• Patients cognitive status (moderate to severe cognitive impairment)

• Patient’s swallow function

• Patient’s diet status

The difference in having speech-language pathologists who are highly trained in accurately coding swallowing disorders and altered diets can mean upwards of $62 per patient day under PDPM.

MEDICARE PART B & MEDICAID CASE MIX

A speech therapy department operated by Language Fundamentals is passionate about treating the long-term care population, will provide revenue opportunities from Medicare Part B, and improve the Case Mix Index of the facility. As an organization, Language Fundamentals places great value in treating these patients to promote their recovery, maintain their current functional level and prevent decline. Because these services also contribute directly to the facility’s financial health, we actively teach & train our SLP staff on regulatory changes from both the state and federal levels.

ICD-10 CODING ACCURACY / SUPPORTIVE DOCUMENTATION

Regardless of payor source, it has become critical for therapists to place a great deal of importance on the accuracy of ICD-10 coding, and speech therapy is no exception. ICD-10 coding must be accurate and consistent with medical record documentation. As an organization, Language Fundamentals places a great deal importance on accuracy of ICD-10 coding by regularly teaching and training our SLPs on ICD-10 coding strategies.

On a daily basis, our team of experienced post-acute SLPs document their care in a fashion that supports the skilled intervention and is consistent with the order written by the physician.