Speech Therapy for Skilled Nursing Facilities
Language Fundamentals provides Speech Therapy for Skilled Nursing Facilities and beyond with a philosophy of providing the highest quality of care to the residents and facilities we serve. Here at Language Fundamentals, we specialize in the implementation of a speech therapy department in a skilled nursing facility.
Speech Program Development
Language Fundamentals is an industry leader in speech program development. This is what separates us from our competition. Our mission as a stakeholder to our clients is to enhance the delivery of speech therapy services and nursing home speech services to meet the individualized swallowing and communication needs of the patients at each skilled nursing facility.
Language Fundamentals has been providing comprehensive speech therapy programming to skilled nursing facilities with a philosophy of creating the highest quality of care to the residents and facilities we serve for 19 years.
Because of our unique approach where medical speech therapy is our sole focus, the facility will gain a speech therapy department with speech program development as its main priority, not just providing personnel. Our team works both onsite and off to support the SLPs in the skilled nursing facility and provide the residents with the latest treatment procedures and highest quality of care.
Historically, speech language pathologists are siloed into small clusters, having to seek out and gain experience as individuals. 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 a protocol for our family of clinicians to present new cases and treatment ideas across our entire team, gaining the knowledge of thousands of cases on a regular basis eliminating the delay in new and innovative care. Our speech therapists for nursing homes will provide excellent services in speech therapy for skilled nursing facilities.
The Language Fundamentals’ team believes in developing a strong collaborative partnership at each facility with whom we work. This relationship begins long before we begin providing service. Our clinicians and regional manager of speech therapy meet regularly and collaborate with rehabilitation directors to discuss plans of care, discharge plans and Case Mix. We continuously review methods and streamline processes to function as part of the interdisciplinary team with all departments including rehabilitation, MDS, nursing, physicians, administration and dietary. Furthermore, we proactively seek MDS lists for screens and ensuring physician documentation and orders are in place demonstrate our organization’s expertise in post-acute care and our ability to work as a team.
It was this strong sense of collaboration that helped our SNF clients achieve a smooth transition to the Patient Driven Payment Model (PDPM) that was implemented in October of 2019.
Additionally, Skilled Nursing Facilities who choose to implement the International Dysphagia Diet Standardization Initiative (IDDSI) can count on us to extensively with the dietary and kitchen staff for a seamless transition.
Our goal is to always go beyond what we have already accomplished 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 continuously meet with the 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.
Patient & Family Counseling
Respect and dignity of an individual is paramount to Language Fundamentals’ basic culture. As speech language pathologists for SNFs working with individuals who may have lost the ability to communicate effectively, we understand the importance of treating residents in their totality. Our clinicians are specifically trained to deal with a range of specific issues and concerns that arise in the unique setting of each skilled nursing facility. Often, residents and their family members experience anxieties with end of life issues and concerns including an inability to swallow anything by mouth. Our clinicians understand that eating and the dignity associated with it play an emotional roll and are trained to not only educate but to empathize with family and caregivers through a difficult transition.
Working collaboratively with the interdisciplinary team, Language Fundamentals’ clinicians educate, support and guide clients and their families through difficult decisions surrounding altered diet selection and alternative means of nutrition and hydration. For residents with severe communication impairments, Language Fundamentals staff will be there to help facilitate issues such as decisions surrounding augmentative alternative communication devices.
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:
- Cognitive Communicative Disorders
- Traumatic Brain Injuries
- Speech Language Deficits
- Ventilator and Tracheostomy dependent residents
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).
Our speech therapists believe in attempting to successfully upgrade patients who had been on altered diets to thin liquids. Additionally, we establish a strong tube feed weaning program which has improved the quality of life for those receiving tube feeding to allow them to either have pleasure food/fluid or to have been fully weaned from the tube feeding back to fully eating by mouth again.
Furthermore, our focus on cognition and communication has enabled a large number of long-term care patients who had not previously been targeted, the opportunity to engage in therapeutic activities which improved their ability to communicate and engage throughout the day.
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.
Free SNF Speech Department Analysis
Please fill out the form below to schedule a 10 minute call prior to starting the analysis
In order for Language Fundamentals to perform the analysis, please be prepared to provide the following data:
- 3 months of SLP utilization data
- 3 months of PDPM scores
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