[mel1977]

I am getting my LPN right now, but have worked in a well known rehab facility for seven years as a rehab tech and love it so much. I may stay after I get my LPN, but after this last back surgery, I don't know if I can do it. See, nurses where I work either 1. Team Lead (some take a small patient assignment like my mom CRRN and others just focus on their nursing duties while helping the techs), 2. Pass medication 3. Tech on the floor doing total patient care.
we house very heavy patients-TBI, SCI, CVA, and general disability. My "specialty" as well as my mom's is TBI. LOVE IT. Anyway-I kind of wanted to know if the medicare and medicaid stuff was hurting any of your census numbers. We hold 60 beds and during the Holidays we dropped to 28. It isn't unusual to drop during that time, but this was bad. I am unit clerking right now bc of my lifting restriction-and instead of 10 hours a day for two days I worked a total of 8 hours the whole weekend.
I graduate in July.
It was really nice to see this forum bc so many nurses don't understand rehab or know what it is about. My particular facility is not a nursing home, it is a rehab center and there is one in atleast every state and major city-but I get suprised as to how little known it is. I almost wrote a book about four years ago from a tech point of view to the nursing student, kinda as a introduction to bring more into the profession. I got stuck though and couldn't do it. Anyway, I am blabbing. Glad to have found this one!

[rncrrncws]

Yes the CMS-13/75% rule is having a hugh impact on census. So facilities will end up closing when they have to follow the 75% rule. Right now for most Rehabs it is 60%, then 65 next year and the following year 75. Unless the requlation changes you will see Rehabs closing.

[mel1977]

It is such a maddening thing. Now we have to discharge our patients regardless of how they are doing unless we know in advanced. YEAH RIGHT. Anyone knows that these patients change day to day and it is impossible to know what they will be like in two weeks much less two days. We haven't topped barely over 50 since before the holidays, and I can't remember the last time we were full since the summer.

[takenbyjoy]

Hello there, I've worked rehab for the last 23 yrs. I've really seen it change over the years. When I first started, we kept our SCI pts sometimes 3 months or longer. Now we're lucky if we get 3 weeks. The Medicare 75% rule is hurting all rehab facilities. We are a 25 bed rehab that is only 3 yrs old and are currently under a 100% review by Trispan....the agency that administers Medicare for MS, LA and AR (i think....). We are admitting mostly SCI, TBI, CVAs now. As long as rehabs can get these kinds of referrals, they'll be able to stay open. It's still rehab, we're just not getting all of the ortho pts that we used to get. It's still a great field to work in and wouldn't want to work at anything else.

[Sueilp]

OUr Rehab facility is a 90 bedded facility and we have one unit shut and we are lucky if we hit 60, most of the time we are at 50 over 2 units.

[Sapphy]

I work in a freestanding rehab... the only one of its kind in the tri state (NY,PA, OH) area. We get patients from Pittsburgh, Cleveland Clinic...all over the place. Our census has definitely been affected. I talked to the RN who works admissions now and we had to turn down 47 hip patients in January just because they only had one hip done and Medicare won't pay for that anymore. We are continually being lectured on our nurses notes. Being told that they really have to reflect WHY our patients need us rather than a nursing home or outpatient therapy.
As a result of what has been going on we have lost several really good RN's to the point that today they could not find someone to do charge! They were getting tired of being flexed off because our census was down and getting lectured because their documentation was not perfect so they moved on.
I must admit that some days it is nice to not have such a large assignment but on other days, I will be the only RN for the whole floor (usually 25-35 pts) Definitely makes the days go by faster but man am I exhausted when I get home!!
I managed to do 33 assessments in 8 hours the other day. I went to my charge nurse and supervisor and said "Look these assessment forms are filled out and done but I will not promise you that I didn't miss something or that I did the best assessments I have ever done. And I most certainly did not write 33 nurses notes!"

[Graffinius]

Originally Posted by Sapphy

I work in a freestanding rehab... the only one of its kind in the tri state (NY,PA, OH) area. We get patients from Pittsburgh, Cleveland Clinic...all over the place. Our census has definitely been affected. I talked to the RN who works admissions now and we had to turn down 47 hip patients in January just because they only had one hip done and Medicare won't pay for that anymore. We are continually being lectured on our nurses notes. Being told that they really have to reflect WHY our patients need us rather than a nursing home or outpatient therapy.
As a result of what has been going on we have lost several really good RN's to the point that today they could not find someone to do charge! They were getting tired of being flexed off because our census was down and getting lectured because their documentation was not perfect so they moved on.
I must admit that some days it is nice to not have such a large assignment but on other days, I will be the only RN for the whole floor (usually 25-35 pts) Definitely makes the days go by faster but man am I exhausted when I get home!!
I managed to do 33 assessments in 8 hours the other day. I went to my charge nurse and supervisor and said "Look these assessment forms are filled out and done but I will not promise you that I didn't miss something or that I did the best assessments I have ever done. And I most certainly did not write 33 nurses notes!"

Working with recovering addicts/alcoholics is a great way to be of service. Keep up the good work and stick with it!!

[sutton06]

Hi, I am a CRRN working in a 58 bed Acute Rehabilitation facility.
In my 29 years of Rehab Nursing I have seen a dramatic change in our field with the implementation of prospective payment system in Rehab.
Unfortunately the patients and thier families are the losers.

Our biggest challenge is to create an efficient documentation sytem that identifies the burden of care, captures the need for Rehab Nursing, and measures a patients progress.
Our facility utilizes the MEDITECH electronic documentation sytem.
I have created a Nursing documentation module based on the descision trees used in the "IRF-PAI" tool. It is somewhat more time consuming, but does reflect how much assistance the patient required.
The down side is that based on this documentation our patient outcomes in the "FIM's" system are dropping.
Is anyone else experiencing this?

[ashdun0324]

i might be interviewing soon for a nurses assistant for a rehab unit.
i haven't heard a lot of good things in regards to rehab units in hospitals on this forum.
i have no experience, just got done with my cna class, and have had a few days of clinicals in long term facility.
is this a good unit to start out on? i don't to have my first experience a bad one!
any advice, your opinion on accepting a job offer on another unit, or etc?
anyone know exactly what I will be responsible for as a nurse aide on this unit?

[sutton06]

Yes I think a Rehab will be a very good experience for you. The opportunity to work with patients who are learning to become more independant in caring for themselves is very rewarding. You get to share in thier progress and and feel good about making a difference in someones life.