Who Am I?
I am early in my career as an SLP. I graduated in 2011, but SLP is not my first career. My first career was working in a university admissions office. It was very inspiring as I was given a great deal of responsibility and autonomy. Through enrollment counseling, I built my counseling skills and began to enjoy that part of my job. I worked with an incredible team and together we accomplished some amazing things. I love the problem-solving aspect associated with a therapy career.
I initially did not think I would be interested in working with an adult rehabilitation, but while in school, I challenged myself to complete observation hours across the scope of practice. I fell in love with adult rehab, which was in the inpatient rehabilitation hospital and outpatient settings. I started working in the SNF setting after graduation and enjoyed working with geriatric patients as well. This caught me by surprise, since that was the one area I had not observed.
The lack of autonomy caught me by surprise too. I hopped around in multiple jobs in three large rehab companies in two different states during the first two years of my career as an SLP. I went from feeling like I was the problem; why could I not achieve the high productivity expectation and why was this person with poor rehab potential not getting better? I began to understand that the problem was much bigger than me. I discovered what I now call the prevailing model of the therapy delivery. The prevailing model is profit-centered, rather than person-centered. The prevailing model thrives on micromanagement rather than clinical autonomy.
I began talking to other therapists via social media about ethics in the SNF setting in the summer of 2013. In the beginning, the commiseration felt really good. After a while, I was ready to see action as a bigger group. I organized a letter-writing campaign to ASHA. Previously, I felt like my individual conversations with my state and national associations were not successful. They did not seem to understand how large this problem was. I hoped that a group of therapists acting together would achieve my goal of ASHA validating the concerns therapists have about care in the SNF setting. I believe the letter-writing campaign was successful because ASHA began to have a dialogue. Since the campaign, ASHA has addressed SNF ethics via the ASHA Leader, the National Convention, through several web chats, collaboration with AOTA and APTA, which resulted in a consensus statement, and clinical judgment in healthcare settings and numerous other activities. As I have been following AOTA and APTA, I have seen that as they have been involved in these conversations, and they have also started talking about the issue via their publications. I am so glad that all of the associations are involved because it is not a problem with just one discipline. That is just one piece of the puzzle. Even with our associations’ involvement, I continue to be an advocate.
Why Am I An Advocate?
I found a job where I have clinical autonomy. The problem has been solved for me and my patients. Throughout my life as a healthcare consumer, I have experienced great care and poor care. Great care made all the difference for me as a patient. I believe we all deserve great care, even if Medicare is paying for it.
I had grandparents pass away while living in a long-term care facility a decade ago, and recently had a grandparent die from Parkinson’s disease. I remember discussing with family members the type of care my grandfather was getting in the last few years of his life. I understood the system, but I still found it challenging to be an advocate from across the country. I believe our elders deserve great care inside and outside our profession. People will remark, "They are 90 years old. What is the point?" They are not dead yet. You are very much living until the moment you are not. People deserve to have the best quality of life no matter if they have 40 years left or 40 days left. Despite age or third party payers, our elders deserve great care.
