>> Rachel Wynn: This is a very challenging but important discussion for speech language pathologists to have. We have a few goals for today, but the overarching goal is to feel more confident and empowered to advocate for ethical care. We will achieve this through the following goals:
- Describe common ethical dilemmas in the skilled nursing facility (SNF) setting.
- Utilize your company’s internal documents in order to advocate for ethical care.
- Utilize external documents provided by the government and other resources in order to advocate for ethical care.
- Understand your role and responsibilities in advocating for ethical, quality eldercare.
Who am I?
I am an SLP. I am early in my career. I graduated in 2011, but speech pathology is not my first career. My first career was working in a university admission’s office and it was very inspiring, as I was given a great deal of responsibility and autonomy. Through enrollment counseling, I built my counseling skills and began to enjoy that part of my job. I worked with an incredible team and together we accomplished some amazing things. Then a time came and I decided that I wanted to go back to graduate school to study speech pathology. I love the problem solving portion associated with my SLP career. I initially did not think that I would be interested in working with the adult population, but I challenged myself to complete observation hours across the scope of practice. I fell in love with adult rehab, and worked initially in the inpatient rehabilitation hospital and outpatient settings.
I started working in the SNF setting after graduation and really enjoyed working with geriatric patients. It caught me by complete surprise. The lack of autonomy caught me by surprise too. I hopped around in multiple jobs in three large rehab companies in two different states during the first two years of my career as an SLP. I went from feeling like I was the problem -- why could I not achieve the high productivity expectation and why was this person with poor rehab potential getting better? -- to understanding the problem was much bigger than me. I discovered what I now call the prevailing model of therapy delivery. The prevailing model is profit-centered rather than person-centered. The prevailing model thrives on micromanagement rather than clinical autonomy.
I began talking to SLPs via social media about ethics in the SNF setting in the summer of 2013. In the beginning, the commiseration felt great. It was good to feel that I was not alone. After a while, I was ready to see some action as a bigger group. I organized a letter writing campaign to ASHA. Previously, I felt my individual conversations with my state and national associations were not very successful. They did not seem to understand how large this problem was. I hoped a group of SLPs acting together would achieve my goal of ASHA validating the concerns SLPs had about care in the SNF setting. I believe the letter writing campaign was successful because ASHA began to have dialogue with us. Since the campaign, ASHA has addressed SNF ethics issues via the ASHA Leader, the National Convention, through several web chats, and through collaboration with the American Occupational Therapy Association (AOTA) and American Physical Therapy Association (APTA), which resulted in the consensus statement on clinical judgment in healthcare settings and numerous other activities. I have been pleased with their involvement so far. ASHA is involved, but that is just one piece of the puzzle. Even with their involvement, I continue to be an advocate and urge others to be an advocate also.
