Changing the Culture of Nursing Homes Through "Flipping SNFs"

Changing Nursing Home Culture: Flipping SNFs in OT

Samia Rafeedie OTD, OTR/L, BCPR, CBIS shares her passion for “Flipping SNFs” – where occupational therapy can serve as a catalyst to change the culture of a nursing home through shared governance and empowering not only our residents, but frontline workers, as well.

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10 thoughts on “Changing Nursing Home Culture: Flipping SNFs in OT”

  1. Patrick Robbins

    Gaaaaaah! Samia captures the struggle so well! I’m going to have to listen to this again.

    I chose to work in skilled nursing, 1) because I had never worked there, and 2) because everyone complained about it, but nobody was doing anything to change the problems. So, I decided that I would go learn what the real problem was, and work to change it. All this as a COTA, and hopefully soon as an OTR. Thanks so much for this topic, Mandy, as you know I’m passionate about this, as well. It is so needed for this stuff to be voiced, and CRITICAL for the profession to start changing things, with our own approaches being the front line of change.

    One of the things I found when addressing this problem in my research was that therapists tend to work in the gym more often due to the social aspects of being around coworkers, and end up not opting for occupation-based interventions because of the limiting aspects of the gym environment on occupation, including therapists who work in hybrid environments (home-like settings in the gym).

    This was so encouraging, I cannot articulate how much. I heard so many echoes of my own experiences and desires and am reminded as I transition from COTA to OT that I have to keep the hope for change going. At least I’m not the only crazy one out there that still believes in the power of REAL occupation.

    And as a current fieldwork student, I would reiterate the need for practitioners to demonstrate real occupation in practice to students, because students really need to come out of the gate strong, instead of going with the flow. So good!

    Thanks Mandy and Samia!

    1. Mandy Chamberlain MOTR/L

      Hi Patrick! I think this is definitely worth a listen – or 2 🙂 As you know, I am 100% with you on trying to be as occupation based as possible – it can be hard and honestly a culture change in some facilities (crazy?!?!?) – but YES we can do it and it is so nice to be able to have these conversations and support each other and empower each other to be the best we can be! Thanks for listening

  2. I loved this podcast, “Flipping SNF’s”!!! So much that was said in this podcast I experience daily as a COTA. I’ve worked in SNF’s for 12 years and much of what was discussed in the podcast, happens on a daily basis. I am currently experiencing burn out because of the misunderstanding of role as a COTA, productivity , frustration seeing PT’s doing OT work, being told I am just a glorified CNA(by my PD!), my company wanting us to bill more ther act than anything else!, etc. In the nursing homes companies put much pressure on Therapy to get XYZ done, when we do not have the time allotted to implement. We have productivity shoved down our throats! If we were allowed to focus on treating the patients, it would be a much better treatment for the patient! Instead we spend our treatments cleaning the patient’s up, going to the nurse to address his/her medical issues, nurse doesn’t have time because she is on hold with a doctors office, patient becomes agitated and refuses to do therapy, and the cycle just repeats itself!!

  3. I appreciate the honesty and passion in this podcast. I have been a COTA for 20 years. I feel stuck and defeated working in a SNF. The culture is the problem. The perceived hierarchy of the importance of each discipline and the lack of understanding/respect from rehab directors is challenging. I have advocated for the respect of OT with little success and tremendous push back from therapists, nurses, directors. OT’s are perceived as “whiny” when advocating for our clients and the profession. Our PT colleagues are quick to judge the value of OT. OTs are excluded from care plan meetings and discharge planning. If my patient can walk 100 feet, then they are discharged; even though they can not bathe, toilet or dress independently. I may transition into home health, but working in a SNF is my passion. Thank you for being so candid and renewing my faith that there are OTs who still believe in the importance of occupation.

    1. Mandy Chamberlain MOTR/L

      ugh Anj – I completely understand! It is one of the most frustrating aspects of working in some of these facilities.

  4. Hi Mandy!
    This episode was amazing!!! Definitely my favorite so far!! I work in a SNF as a fairly new grad and I am very passionate about occupation based interventions, but find myself just doing the “norm” or going with the flow. This episode changed my outlook on everything and I am absolutely going to be more focused on occupation based interventions in order to facilitate even the performance deficits such as balance! Thank you so much for bringing Samia on for this topic!!!!

    1. Mandy Chamberlain MOTR/L

      I know Melissa – for whatever reason, we all tend to “go with the flow” and match the culture of where we work. I am sooo excited that you are working toward being the type of OT that YOU want to be! 🙂

  5. Thank you so much for this episode. I am a new graduate COTA working in a SNF for just a few weeks and I am already tired, but I didn’t have the right words to put with my disappointment. I listened to this podcast on the way home from work one day and just cried because Dr. Rafeedie gets it. She totally gets it and can put it in words. Literally everything she described it what I am experiencing right now. I was inspired after reading this to actively seek out mentorship, join the Learning Lab, and read chapter 46 of Pedretti.

    Thank you!

    1. Mandy Chamberlain MOTR/L

      yes Laura! Dr Rafeedie DOES get it! I am so sorry you are experiencing the stress. When you do not have the support of your team, it makes it so much harder. Please reach out if I can support you in any way. YOU CAN DO IT!

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