Meeting Focuses on Skilled Nursing Facility Concerns ASHA representatives recently met with leaders of the National Association for the Support of Long-Term Care (NASL) to discuss concerns about delivering appropriate care in nursing homes. ASHA asked for the meeting after hearing concerns from speech-language pathologists working in skilled nursing facilities about pressure from employers to engage in ... ASHA News
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ASHA News  |   April 01, 2010
Meeting Focuses on Skilled Nursing Facility Concerns
Author Notes
  • Janet Brown, MA, CCC-SLP, director of health care services in speech-language pathology, can be reached at jbrown@asha.org.
    Janet Brown, MA, CCC-SLP, director of health care services in speech-language pathology, can be reached at jbrown@asha.org.×
Article Information
Special Populations / Older Adults & Aging / Healthcare Settings / ASHA News
ASHA News   |   April 01, 2010
Meeting Focuses on Skilled Nursing Facility Concerns
The ASHA Leader, April 2010, Vol. 15, 17. doi:10.1044/leader.AN.15042010.17
The ASHA Leader, April 2010, Vol. 15, 17. doi:10.1044/leader.AN.15042010.17
ASHA representatives recently met with leaders of the National Association for the Support of Long-Term Care (NASL) to discuss concerns about delivering appropriate care in nursing homes. ASHA asked for the meeting after hearing concerns from speech-language pathologists working in skilled nursing facilities about pressure from employers to engage in unethical practices.
NASL represents the legislative and regulatory interests of companies providing therapy, other services, and supplies in long-term, post-acute, and home care settings. NASL’s leadership includes SLPs who serve in administrative or supervisory roles in rehabilitation companies.
SLPs reported in ASHA’s 2009 Health Care Survey that they experienced pressure from employers to engage in unethical practice (The ASHA Leader, Nov. 3, 2009). The percentage of respondents working in skilled nursing facilities who experienced pressure was 41%, compared to 14% working in clinics and 17% working in hospitals. The most common pressures were to provide inappropriate frequency or intensity of services (11%) and to deliver services that are not clinically appropriate (6%).
ASHA provided examples to NASL of additional issues, such as administrators’ resistance to authorizing videofluoroscopic swallowing studies and 15-minute limits for patient assessments.
NASL leaders urged SLPs to take their concerns to administrators at the facility or corporate level. They also noted that rehabilitation companies and many independent facilities have corporate integrity plans that protect whistle-blowers. They acknowledged that the long-term care industry is undergoing extensive auditing for compliance at the state and federal level, and that they must be responsive to concerns.
NASL leaders and ASHA staff identified the need for evidence-based treatment benchmarks for patients with different profiles of swallowing, communication, and cognitive impairments, and other co-morbidities. Fear of denials or lack of experience in treating patients with dementia may make some clinicians uncertain about how to identify appropriate patients and develop treatment plans to improve function.
The representatives from the two organizations agreed that collaboration may help to raise awareness about ethical challenges in skilled nursing facilities and to provide education about clinical practice, documentation, and advocacy.
Are You Facing Employer Pressure? Check Out These Resources

SLPs facing employer pressure can seek guidance from several ASHA resources:

SLPs in skilled nursing facilities can learn more about best practices in their setting through the publications and e-mail lists for ASHA special interest groups (to join, go to ASHA’s SIG webpage):

  • SIG 2, Neurophysiology and Neurogenic Speech and Language

  • SIG 13, Swallowing and Swallowing Disorders

  • SIG 15, Gerontology

In addition, ASHA’s National Outcomes Measurement System (NOMS) gathers information about patient diagnoses and areas of intervention from SLP at participating facilities. These data are aggregated for the facility and can be compared to national benchmarks for that setting. For information about participating in NOMS, contact Tobi Frymark at tfrymark@asha.org

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April 2010
Volume 15, Issue 4