American Speech-Language-Hearing Association

Skilled Nursing Facility Considerations

SLPs are presented with a varied caseload that has become more acutely ill than in the past. They also face numerous staffing and reimbursement challenges that are unique to this setting.

Note: The questions below have not been repeated in more recent surveys.  This is the most current survey data regarding employment challenges and changes.

The 2007 Health Care Survey asked the following question: "What are the greatest challenges you face in health care?" In rank order, respondents from SNFs reported the following challenges:

  1. High productivity requirements (65.4%)
  2. Paperwork (clinical and reimbursement) (58.1%)
  3. Insufficient reimbursement (for clinical services) (38.2%)
  4. Keeping current with advances in clinical information (31.8%)
  5. Managing caseloads at multiple sites (29%)
  6. Not being valued by other disciplines/administration (24.7%)
  7. Unsatisfactory salary/benefits (18.3%)
  8. Resources to respond to diversity within caseload (10.3)

In 2009, respondents were asked about undesired changes they had experienced in their work environment over the previous year. This question was asked, in part, because of the challenging economic times. In rank order, respondents from skilled nursing facilities reported the following:

  • None of the above (36%)
  • Increase in caseload/workload/productivity (32%)
  • Increase in the number of sites served (18%)
  • Reduction in work hours (13%)
  • Reduction in caseload/workload/productivity (12%)
  • Reduction in salary or benefits (without changes in hours) (9%)
  • Increase in work hours (9%)
  • Conversion from salaries to hourly or PRN pay (6%)
  • Job loss/layoff (4%)
  • Replacement by support personnel (1%)

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