Too much, too many, and I’m salty about it…

I know what you’re thinking — there is a lot to be salty about, so which thing could this be? Well for today, or at least this moment, I am salty about QM, QRP, APU, VBP, 5-star, iQies…I think I got most of them. 

So, quality measures — we have been operating in and around them for some time. It’s not new; there are new measures, but that is to be expected. I’m just newly salty. 

Are QRPs QMs? Are VBPs QMs? There are QMs that aren’t 5-stars, there are 5-stars that aren’t from QMs, there are measures that are QMs, QRPs, and VBPs all at once….Which of these costs dollars vs. stars? Why am I losing the opportunity to get 66% of the 2% back? And from where? Or is it from when? Can I get an Amen? 

It is a struggle to keep all of these things straight, know what measure pulls from where, when they start to collect data (performance year) vs. when that data results in actual reimbursement (or not) (payment year), when they quit collecting data, when they freeze and thaw data, and what is reported where and for what audience. I have created spreadsheets, I have shamelessly borrowed infographs others created, I have read countless manuals and change logs, technical reports, technical user guides, reports user manuals, and just when it seems it is all becoming clear and the light bulb is brightening, another thing comes along and the process starts all over again. 

It’s what our industry does — changes, updates, corrects, and changes some more. If you work in the healthcare industry, you become accustomed to it. We wait every year for the proposed rules, final rules, and updated manuals to come out so we can start deciphering what it all means so that we can train our partners, staff, and others how to best navigate the updates all the while still providing excellent care and trying to put the resident at the center of all things. 

We have help along the way — there is power in networking and the community of others trying to break the code and understand the same things, and for that I am truly grateful. Shout out to ADVION, NARA, AAPACN, and others who make the process at least digestible.

I know (think) the intent is good: to provide care to our post-acute population. And not just to provide care, but quality care, so that’s a good thing right? 

Yes, it is a lot;  yes, it makes my face hurt; and yes, I get salty about it. But I also guess if this was easy anyone could do it, and if anyone could do it, everyone would do it, and if that happened, who would be left to make sure anyone is doing it well? 

I digress, and I think I have all of these things straight for now:  in my head, on my spreadsheets, in my copious cliff notes and in my dreams…

If you, too, suffer from saltiness around QMs, QRPs, VBPs or other acronyms, reach out — we can help!! Send an email to Clinical@fprehab.com and the team of clinical experts at Functional Pathways will be happy to assist.

This salty SLP has been tasked with writing a blog for Better Hearing and Speech month. Why am I salty? It’s probably the day or the time or just how this hits me. I really thought maybe I was just being overly sensitive, and maybe I am.  But it seems like EVERYTHING (ok not everything, but a definite majority of things) that is public in our bidness is pediatric/child related…amiright?

Like what about better swallowing, better cog-language skills, better executive function month? How about a state association (or national one) that pays attention to those of us committed to caring for adults and (gasp) our elderly population? I’m not saying all CEUs for adults and adult-based therapy are hard to find (good ones — and there are some out there), but yes I am. 

Don’t get me wrong — I have nothing but love for my SLP siblings who treat and care for the littles….but at the same time, where’s the love for the rest of the SLPs? 

I have been increasing my experiences with things like advocacy and education of the public and even government officials as to what Speech Therapy is, who we treat, what we can offer, and the importance of access to care for ALL who need it, and that has led me to this salt box that I am standing upon. 

What better time to educate and advocate than during Better Hearing and Speech Month? What does advocacy for SLPs look like? It looks like writing letters, making hill visits, and educating on and trying to protect our reimbursement (SLP has the smallest multiplier in the PDPM world of Medicare Part A and Medicare Physician Fee Screen cuts are real on the Med B [outpatient/long term care side]).

We owe it to ourselves and our profession to learn about reimbursement — what does that look like? How much is it really? How does it differ by payer, setting, etc.? How does this affect the way therapy is administered and for how long? Should it be a factor at all? 

Before you say no — and believe me, we all want to say no — do the math, really dig in and look at all the parameters. Therapist salary + cost of benefits — you can stop there and get a pretty good idea, but then go a step further — overhead for things like the IT, billing, HR and payroll department…but I digress.

The theme for this year’s Better Hearing and Speech Month is “Building a Strong Foundation,” so let’s try and do that, even if it means jacking the house up and replacing the old foundation with new. 

I wish you all a very happy Better Hearing and Speech Month. May you build your foundation by spreading the love of this profession, and becoming more involved in the advocacy and education that is involved in keeping our profession viable and relevant no matter what setting and population you choose to call home. 

Salty SLP signing off!

Speech Therapist – /n/ – a “health professional specializing in the evaluation, diagnosis and treatment of communication disorders, cognitive communication disorders, voice disorders, and swallowing disorders” (Wikipedia); “defined as the professional who engages in professional practice in the areas of communication and swallowing across the life span. Communication and swallowing are broad terms encompassing many facets of function. Communication includes speech production and fluency, language, cognition, voice, resonance, and hearing. Swallowing includes all aspects of swallowing, including related feeding behaviors.” (ASHA)

As we navigate the waters of these unprecedented times in the world, in healthcare, and in speech therapy, we must remember why we chose this profession in the first place.  Hopefully, it was, simply put, “to help people.” To help people speak, communicate, be understood, and understand others.  To help people organize, think, plan, remember.  To help people eat, drink, swallow.  Never before has our passion and our reason been more important to acknowledge, remember, and believe.

Our patients and residents need us more now than ever before.  We are essential.  Essential to their sense of well-being, their success, their safety.  So as you go forth and provide a link, a connection, a life line to our residents, be proud of the job that you do, be proud of the services you provide and of the impact that only you as a speech-language pathologist can have on each and everyone of the residents we are fortunate enough to care for every day.

May we never lose sight of our why, may we never take for granted our who, and may we continue to improve upon our how.

It is Better Speech and Hearing Month 2020, but it is so much more this year.  Thank you, SLPs for your time, efforts, and continued care of our most vulnerable in times like these.

The good news is that most types of incontinence are treatable and improvements to quality of life through decreased incontinent episodes, or better management of episodes is possible.

There are several different types of incontinence, with different etiologies and different courses of treatment recommended for each.

Types of Incontinence include:

Urge Incontinence: this is caused by a sudden, involuntary contraction- “have to go now”. Usually large amounts of urine.

Stress Incontinence: this is caused by an increase in abdominal pressure during exercise, sneezing, or coughing. Usually small amount of urine, “leaking”.

Mixed Incontinence: this is caused by a combination of Urge and Stress

Overflow Incontinence: this is caused by an over-distention of the bladder, “dribbling”, urge or stress patterns of loss.

Functional Incontinence: this is caused by impaired mobility, dementia, communication deficits, or limited access to facilities. (Inability or unwillingness to get to the bathroom)

Some possible treatments for incontinence include Pelvic Muscle Rehab, (Pelvic Floor Exercises, Kegel Exercises, Electrical Stimulation of the Pelvic Floor Muscles to provide biofeedback), behavior modifications and compensatory strategies. Behavior modifications may include toileting programs or a voiding schedule- “void to avoid” incontinence, bladder retraining (using strategies and muscles to delay voiding and increase person’s ability to “hold it”). Occupational and Physical therapists can also target strengthening and coordination tasks/exercises to increase ability to transfer, increase mobility, and increase ability to manage clothing during toileting. Environmental modifications should also be considered in order to decrease incontinent episodes.

A review of medications and dietary habits should also be completed to determine if any medications are known to increase incontinent episodes, and to avoid foods/liquids that are known bladder irritants.

Risk factors associated with Incontinence include increased risk of falls, increased UTI’s, skin breakdown, loss of self-esteem, decreased sense of well-being and independence, decreased social engagement and depression and guilt.

Dysphagia can affect the oral, pharyngeal, esophageal or any combination of the three stages of swallowing. Swallowing difficulties can present with difficulty chewing certain foods, difficulty keeping food down after the swallow, and an inability to maintain adequate nutrition and hydration to function. Dysphagia profoundly affects quality of life; people with dysphagia experience discomfort and a drastic reduction in the quality of their lifestyles due to the inconvenience and pain of feeding tubes, which for many has been the primary treatment option for this condition. The loss of swallowing can also lead to severe depression due to the interruption of patients’ normal way of life. The goal of Safe Transitions with Dysphagia is to maximize the person’s and caregivers’ understanding of dysphagia, its treatments and any diet modifications to enhance safety, function and independence.

Speech therapists instruct individuals in use of compensatory swallowing strategies, strengthening exercises, positioning and diet texture recommendations to increase overall safety when swallowing to promote a safe, healthy, and satisfying lifestyle.

Signs that someone may be suffering from dysphagia include, but are not limited to: coughing during or after a meal, runny nose, watery eyes, poor appetite, refusal to swallow, spitting foods out, pocketing foods in the oral cavity, temperature spikes after meals, and certain pneumonias. The most common causes of dysphagia are: Stroke, Parkinson’s, ALS, Alzheimer’s, dementia, TBI, MS, CP, cancers or injuries to head, neck and throat, nerve damage and even medications. Therapists can screen for issues with swallowing using observation, and asking directed questions, including po intake, medication provision and any self-reported complaints.

While there are many modes of treatment and compensatory strategies used to increase ability and safety during intake, some of the more common treatments for dysphagia are:

Oral Motor Exercises: exercises for the lips and tongue to increase coordination and safety of swallow

Pharyngeal/Laryngeal Exercises: exercises of the pharyngeal and laryngeal musculature to promote increased coordination, decreased delay and increased effectiveness of swallow.

Compensatory Strategies: techniques to be used when eating/drinking to decrease risk of aspiration.

Diet Modification: Altering consistency of diet/viscosity of liquids to increase ability to safely consume adequate amounts of food/drink for proper nutrition/hydration while limiting risks of aspiration.