A Day in the Life of a SNF Occupational Therapist
When I entered the profession, most of the occupational therapy jobs in my city were for nursing homes or skilled nursing facilities (SNFs). It was common to start your career at places like these to get experience, and then move on to another practice area. For some, however, it was always in their heart to work with older adults and this was their dream job.
SNFs can offer both short term rehab (also called subacute rehab) and long term care. You will be treating people who are either temporarily or permanently unable to return home. Cases include joint replacements, cardiac surgery, generalized weakness, and CVAs.
I spent two fieldworks in this setting, and later worked as a PRN OT in three SNFs. I worked full time in another SNF for almost three years. Here is my experience working as a SNF occupational therapist. A quick note, that since SNF is pronounced “sniff,” we will be referring to it as “a SNF” versus “an SNF.”
The Basics of a Day in the Life of a SNF OT
When working in a SNF, you are mostly working with older adults, with the occasional younger adult with a severe diagnosis or unique case. In subacute rehab, therapy is usually the main focus and star of the show. Your treatments will revolve around ADLs and community re-entry.
On the long term units, treatments are more about improving quality of life, basic mobility, and ADLs. Therapy may no longer be the star of the show, as these patients may require more extensive medical care.
I worked with a PT partner and a team of wonderful COTAs and PTAs. Not all facilities are arranged this way, but this was beyond beneficial for entry level training and mentoring. Ask about therapy teams while you are job hunting!
When you speak to seasoned SNF therapists, you will see they are somewhat of a mediator. They find solutions that work for both the patient and the nursing staff. They are always trying to find an easier way to function. They offer creative options while also taking the client’s interests into account. This is what I admire about OT in this world.
The Start of Shift
OTs usually start early and end early. This is great if you have kids or a second job. I began around 7am and ended around 3pm (not including documentation). This is to ensure you have enough morning time to spend doing ADLs or assisting with breakfast.
This also means that once the PTs come in after 8:30am, you may have already completed a Max Assist shower session, started an evaluation, and may or may not be covered in spilled milk. You may have practiced hemi-dressing techniques, transfers with a non-weight bearing leg, or diaphragmatic breathing.
Since you are usually the first one waking your patients, you will have to seek out nursing for medications and miscellaneous complaints. Patients are in recovery in a strange place, so I always set gentle expectations at this hour. Many clammed up at the notion of exercise first thing in the morning. Your sessions can focus on self care or education, instead.
They may need to practice donning compression stockings or using an arm sling in order to go home independently. Walking to the bathroom? OT session. Opening up the blinds? OT session. Helping them dial the phone better or use the new remote? OT session.
We had a timed schedule of patients, but I have also worked where there was no schedule. With both, you will still run into barriers and have to be extremely flexible. Patients will have outside appointments or be unavailable for therapy due to medical treatments or wound care.
I would prepare a list of treatment ideas for each patient ahead of time. This reduced the mental pressure needed to come up with ideas on the spot when patients are coming and going out of scheduled order.
You will begin to understand your patients’ needs and habits. If you know your patient always needs a bathroom break around noon, factor this into your total session so nobody is late to lunch.
The unit CNAs will be your go-to. They know the residents well, and can also be a good source to reinforce any methods that you taught in therapy. Your training might make their job easier, too. For example: “When Mary brushes her teeth, she does much better when resting an elbow on the sink to reduce tremors.”
Our rehab evals were scheduled for 60 minutes. Sometimes functional information is missing from hospital records, and you might have to call caregivers to collect more. You are looking for a prior level of function, what their home environment is like, and what precautions they are still on from the acute stage.
Function levels varied greatly with this population. Sometimes you spent the whole evaluation easing their anxiety, helping them get into bed, and just collecting data. Other times you could be climbing stairs, walking outside, and simulating grocery shopping. This range helps you to be adaptable as a clinician. You learn how to set realistic goals and to modify activity challenges.
My rehab let us choose the length of sessions depending on medical need and the patient’s tolerance. We usually wanted to give them the most therapy possible so they could go home quicker, 90 minutes or 1 hour per day of OT. A lower tolerance could result in 15 or 30 minute sessions daily.
For OT evaluations and treatments I was primarily stationed on one wing of the rehab, but would also float to other long term care units. Documentation is heavy in this setting. You are expected to track patients’ progress and report everything back to their insurance company.
Before lunch rolls around, I may have completed 1-3 evaluations. On lighter days, or if no one is being discharged from the rehab, you may have no evals. You are expected to complete point of service documentation, but it was hard for me to focus on the EMR software and clicking the right boxes.
I typed most of my information into a plain document first. I then copied and pasted things over later. Writing initial info by hand works, but keep in mind you will then have to type everything from scratch.
You will likely be typing or calling family members during your lunch. Sometimes you may be asked to conduct assessments in the resident dining room. This is to ensure staff knows the posture, seating, and adaptive equipment needs of each resident.
This is another way to catch problems before they become safety issues. You may find residents to add to your caseload that will benefit from program. These types of screenings are usually done on the long term care units.
Although it may sound like extra work, this is where I learned the most about what OT can offer nursing home residents. Wheelchair positioning is one major element of SNF life. If a resident has poor positioning, this impacts their meals, communication, and safety.
OTs can trial a program to improve body alignment and find the right devices. An OT plan of care doesn’t always have to include strengthening and IADLs. You can create small goals that will be meaningful to the resident and reduce caregiver burden on the staff.
Demands of the SNF Setting
You will be performing a lot of self care duties and breaking a sweat with transfers. This may make other people confuse you for an aide. Your goal is to frame every interaction as functional and focused on independence. You are not just helping people to get dressed, you are assessing their balance and endurance as they do it.
You will be doing a lot of bathroom/toileting sessions and tidying up their room. If you can have patients actively participate in small ways, then it becomes client-centered instead of just task-centered.
A SNF OT position will make you stretch your comfort zone to achieve the best outcomes for your patient. In a facility specifically made to provide care, sometimes the element of independence can be lost. This is where occupational therapy’s special skill comes in. You will be doing family education, caregiver training, and presenting to the nursing staff.
You may call an orthotic office to order a brace. You will speak to doctors to clarify orders and to advocate for your patients. You will collaborate with the social worker to arrange the best discharge. You will be dealing with the now (medical instability, pain, ROM) while also thinking about the future (community resources, car transfers, living alone again).
The End of Day
The afternoon sessions are usually more relaxed. All of the business has settled and outside appointments are done. You may run into more napping patients at this time and have to work on your coaxing skills to motivate them to do therapy. This is when I am finalizing all of my notes and attending to matters with nursing.
If a new patient is admitted, you can greet yourself and give a brief overview of what to expect. Some facilities might want you to complete the evaluation that same day. This can be difficult for a number of reasons, but it does give you a head start on their program. If any major information from their file is missing, play it safe and avoid heavy activity the first day. You can always edit their goals on the next progress note.
You might attend meetings or conferences, which is nerve-racking at first. Since patients are here for medical reasons, you may be surrounded by medical thoughts and jargon. Embrace the fact that you get to share your unique perspective. You will often witness things within your patient that nursing does not, and are now able to bring attention to them.
I used to worry about what to share and how much to share. If it is a discharge planning meeting, all the team really wants to know from you is what does the client require to go home safely. They do not need to know a whole occupational profile with likes and dislikes, but they do need to know what occupations you are working on.
Our therapy teams would keep a spreadsheet of people’s progress and anticipated discharge dates. I struggled with predicting or estimating a timeframe, but having a general sense of dates does keep the rest of the multidisciplinary team on track.
Final Thoughts About Working as a SNF OT
Providing occupational therapy in a fast-paced SNF can be challenging in the moment, but the skills you take away from it make it worthwhile. You will learn how to turn anything into a therapy session, establish a rapport with a wide variety of people, and learn how to work with other disciplines. Most times it does seem like “you learn as you go,” which is hard to accept at first.
SNFs do have a bad reputation for productivity (back-to-back treatments with high goals), but every setting you work in will have these same standards, just with different terms. If you like the topics of energy conservation, healthy aging, adaptive equipment, or stroke rehabilitation, then SNFs may be a good fit for you.
If you’re interested in working as a SNF occupational therapist, be sure to also check out our article 9 Things to Consider Before Working in a Skilled Nursing Facility.