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Expert offers a how-to for contracts
Rehab providers can provide some obvious benefits to long-term care facilities by providing a service that will increase residents’ independence, such as in an assisted-living facility, to help nursing home residents improve their mobility and strength. However, arranging a contract with a long-term care facility requires some planning and knowledge about how the system works, says Brent Campbell, director of health care marketing for Seroka Healthcare Marketing of Seroka & Associates Inc. of Waukesha, WI.
For instance, a rehab provider should know how many staff hours are allocated to a specific long-term care facility, he suggests. "Allocate the fewest number of hours possible for the greatest number of patients," Campbell says.
Set up parameters before you sign
Rehab providers should decide before signing the contract whether they prefer being paid for a set number of hours per week or on a per-patient basis, he adds. "When you are going into the contract, sign with the understanding that those parameters will change from time to time, but the contract has set the guidelines," Campbell explains.
Another aspect to consider is whether the facility has a high turnover rate and a high acuity level, he says. "Perhaps if a long-term care facility has a higher acuity level of residents, then there will be a higher turnover rate of residents," Campbell notes. "So if you are a rehab facility, you might contract on a per-patient basis rather than hourly."
On the other hand, if the facility appears to have residents who are more stable, then the rehab contract might be for strength training and wellness programs to extend the residents’ quality of life, he explains. In this case, the rehab provider might offer to visit the facility three times a week for an hour each time, providing a program for all of the residents, Campbell says.
Rehab providers should make it clear to staff what the rules are for the facility and what the responsibilities are for each rehab employee, he says. "Be clear as to draw the line, showing the chain of command and support structure for all personnel," Campbell points out. "Staff should know that everything that happens in the facility is the responsibility of the administrator solely."
From the long-term care facility administrator’s perspective, he or she still is held responsible if anything goes wrong, even if the problem was related to a contracting rehab provider, he adds. "Rehab providers need to put parameters in place to protect their employees, as well," says Campbell. For example, one rule is that when a long-term care facility’s residents are evacuated in the case of a fire alarm, there must be a facility staff member present, so it would be wrong for a rehab therapist to begin the evacuation of a wing where no staff member is present, he explains. "They can’t allow people they contract with to escort people out of their building," Campbell continues. "So those types of issues need to be addressed."
Also, rehab providers should discuss with long-term care facilities who will handle the paperwork and report the incident if a resident falls in the company of a rehab therapist, he suggests. "There needs to be a system in place for communicating between the rehab staff, the assisted-living team, and the resident’s family," Campbell says.
Likewise, problems will arise if the contracting rehab therapist doesn’t share information with the long-term care facility’s staff. For example, the therapist hands the resident a list of exercises that need to be done, including strength conditioning exercises, he says.
And perhaps the therapist has discussed these exercises with the family because the family happened to be visiting while the therapist was working with the resident, Campbell adds. But if the therapist then completes the work and leaves the facility without communicating the same information to the staff, there is a documentation and communication problem, he says. "This happens from time to time, so there needs to be a system put into place addressing this," Campbell says.