Hi all,

Forgive the throwaway account here, but I‘m going to say things I can’t admit to my employer, and SLP is a surprisingly small community. Though I’m trying my best, I’m also feeling unethical working with many of the patients I’m treating, but feeling like I have no choice.

I’ve been working at a ~150 bed SNF/ALF going on three years. When I started, we had an outpatient clinic and homecare wing. It gave some variety to the day, and brought in some interesting patients with real speech/language/swallowing/cognition issues. It was a decent gig, a friendly place, and they even made some investments in equipment and materials for speech therapy.

Then Covid hit.

Since COVID19, our outpatient clinic has shut down, I haven’t been taking homecare for the same reason, and our census is at about 60%. Morale has been super low, many of our therapists have been furlowed or have quit due to lack of hours. Since I’m the only SLP, I’ve managed to hang on, but I have a much smaller population to work with.

On top of that, we are admitting mostly patients who are inappropriate for speech/swallowing therapy (either straight-up ortho cases or GDS Stage 7 dementia). I assume the typical speech-heavy neuro patients are opting for homecare and skipping SNFs altogether. Our LTC wing is a locked dementia unit, and from time-to-time I pick up a few people from there, but again these are people who are generally aphonic, incontinent, dependent for everything, and have been that way for years.

But I need to make a living, and I would lose my healthcare coverage if I stopped working full-time hours. To make matters worse, I’m in the US on a visa which is tied to my employer, meaning that I would need to either leave the country or scramble to find a new job if I quit. So I’m digging really deep to find goals for the small patient population I have to work with, and hold together a caseload.

Yesterday, I was sitting outside a patient room waiting for him to be toileted, with a resident sitting next to me (not my patient), and one of the unit nurses came up to me and said “I thought you were actually working with someone instead of just sitting there”. Usually nurses barely acknowledge my presence, and gloss over my recommendations; this really stung, since I was already feeling useless and backed into a corner. The worst part? It was probably a fair observation.

TLDR: Covid blew up my nice, ethical, interesting SNF/homecare/outpatient. I now feel pressured to keep up a F/T caseload with much smaller patient population by picking up borderline appropriate patients (and some that are straight-up inappropriate ); if not, I would loose my medical insurance, probably my job, and would have to leave the country. Ethical nightmare.