Responses to “Under Pressure” As a second-year SLP in a [skilled nursing facility] setting, a lot of the sentiments described in the “Under Pressure” article mirrored experiences that I have had in my short professional career. The article made me feel relieved that I am not the only SLP experiencing the strains on ... Inbox
Inbox  |   August 01, 2014
Responses to “Under Pressure”
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Special Populations / Older Adults & Aging / Healthcare Settings / Practice Management / Professional Issues & Training / Telepractice & Computer-Based Approaches / Inbox
Inbox   |   August 01, 2014
Responses to “Under Pressure”
The ASHA Leader, August 2014, Vol. 19, 4-5. doi:10.1044/leader.IN1.19082014.4
The ASHA Leader, August 2014, Vol. 19, 4-5. doi:10.1044/leader.IN1.19082014.4
More Empowered
As a second-year SLP in a [skilled nursing facility] setting, a lot of the sentiments described in the “Under Pressure” article mirrored experiences that I have had in my short professional career. The article made me feel relieved that I am not the only SLP experiencing the strains on time and professional expertise in this setting. I am hopeful that some changes will be made and now feel more comfortable voicing some of my concerns with productivity and the quality of patient care in my building.
Thank you again for the great article!
Diana Wilson, Beech Grove, Ind.
Productivity’s Effect on Families
Having read the cover story in the June issue (“Under Pressure”), it is painfully clear that SLPs in many medical facilities are subject to unreasonable productivity standards that put both patient and clinician at risk.
The outrageous practices maintained by providers to maximize reimbursement, and the unmerciful spiral of profits versus therapeutic integrity—combined with a general disregard for therapists and a ready supply of “disposable” patients—is enough to disgust even the most jaded tabloid reader.
I feel it is grounds to justify a massive class-action suit defending SLPs from a systemic hostile work environment, but I understand this practice has generally become routine, especially in right-to-work states.
My personal interest in this subject concerns the negative impact on the family life of health care workers, who concede many unpaid hours of what should be rejuvenating personal time spent with family or in outside interests.
The productivity metrics my wife is required to meet allow no time in a routine, fully booked day to adequately fulfill all aspects of patient care, documentation and follow-up. So, after a nine-plus hour workday, she arrives home with enough time to eat and spend 45 minutes with the children (including bath, stories and bedtime) before working until past midnight completing the day’s required paperwork.
Space prevents me from detailing additional duties required by her company. When I hear politicians bemoan, “out-of-control health care spending,” I wonder: How much blood can you get from a stone?
Name withheld by request
Watching in Horror
In 38 years of practice, with 25 years having my own contract business, I must respond to the article “Under Pressure.” I have watched with horror the changes in SNF and home health services over the years and am shocked by the fraud taking place in patient care, most specifically the pressure put on all therapists to see patients when we feel it is not necessary. I have worked in these facilities as a contract SLP and witnessed this many times.
I strongly advise our profession to stand up to this either by saying something or just not working at the facility—and spreading the word to colleagues about these places. If no one puts up with this, maybe facilities will not be able to find SLPs and will figure out something is very wrong.
There are good facilities that do not expect us to go against our professional opinions but they are few and far between. It is deplorable that Medicare will not address our complaints, so go to the state licensing bureau responsible for the facility and report these incidences. I strongly suggest that ASHA should take a much more active role in assisting us in reporting and work harder with Medicare/insurance/Medicaid to stop this and accept our complaints as valid and serious. Home health is now also starting to show the signs of wanting just the money instead of good and responsible patient care. I, personally, cannot wait to retire and get away from all of this.
Lisa Bright, Clearwater, Fla.

The Leader received many responses to “Under Pressure”—the June 2014 article on productivity requirements for SLPs and other therapists working in skilled nursing facilities—in letters, blog posts and social media. Here is a sampling.

1 Comment
August 7, 2014
Haley Huckabee
totally disagree
I just got my ASHA Leader and I'm once again disappointed at the completely one-sided view you have painted of SNF therapists. Some of us work for fantastic companies that support us in working with integrity, doing things ethically, and allowing us to take care of our patients! I shouldn't feel like I have to defend myself against my own professional organization. This is ridiculous and The American Speech-Language-Hearing Association should have published responses to "Under Pressure" in the letters to the editor besides the negatives ones. You've set a precedent that it's "therapists vs. therapy companies" when the real problem is CMS and their continued efforts to restrict our patients' access to their benefits through caps, MMR processes, and PPS systems that are clearly NOT designed to be patient-centered. If a therapy company wants you to do something unethical, you report them and you walk away. That's your individual responsibility. If all of these people that wrote in were not still working for these unethical companies, they wouldn't be in business. Come work for me! I am happy to go to work every day and I sleep soundly every night knowing I do what is right and I have provided good care for my patients. I love the company I work for and love that one of our core values is integrity and that we stand by it. So thanks ASHA for making me feel like I should be ashamed or defensive about the setting I work in. For all the improvements I have seen in the Leader in the last few years, this has been a huge disappointment and the bias you've shown in publication is blatant and hurtful. Sincerely, Haley Huckabee M.A. CCC/SLP
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August 2014
Volume 19, Issue 8