Interviewing Rehab Companies: How to Find an Ethical Job

jobinterview
The most frequent questions I see on forums about finding a job or interviewing are:

  • What do you know about X company?
  • What is a good hourly rate for SLP in X location?
  • What kind of questions will they ask during an interview?

These are good questions, but, given the concerns many of us have about ethical practices in skilled nursing facilities, I believe we could focus on better questions. Why? Well let’s take a look at the common questions:

What do you know about X company?
In my experience talking to therapists about ethical dilemmas, I have not come across one company that is through and through unethical. There are some really great directors of rehab who will buffer corporate productivity pressures and advocate for clinical autonomy. They are dedicated to patient-centered care. Make sure you are able to interview the person that would be your immediate supervisor.

That being said, there are some companies that foster patient-centered care from the top. I am interviewing them and featuring them on my blog Gray Matter Therapy as I am connected with them. (If you have suggestions, contact me.)

What is a good hourly rate for SLPs in X location?
I believe SLPs provide an outstanding value to their rehab teams and should be compensated appropriately, but as an advocate for patient-centered care rather than profit-centered care I think about my wage in a different manner. In talking with therapists who work for ethical companies, I find we have something in common. We get paid a little less, but we never feel pressured to work off the clock and we are allotted time to complete important non-billable tasks.

Use ASHA’s salary data as a starting point, but consider the entire compensation and benefits package. I consider my quality of life and work-life balance to be a benefit. And I feel better about myself when I can focus my energy on patient care rather than number games.

What kind of questions will they ask during an interview?
This varies drastically. Most companies asked me logistical questions such as: When can you start? Can you work weekends if required? Can you be X% productive? I have been to a few interviews where I was asked how I would handle a particular client situation. I like those questions. It is evidence to me that my interviewer cares about the quality of the therapy patients receive, rather than just the quantity.

Turn the tables: You ask the questions
Take another look at the title of this post, “Interviewing Rehab Companies.” That’s not a typo. It’s not supposed to say “Interviewing With Rehab Companies” or “How to Answer Interview Questions Perfectly.” In my previous career, I interviewed job candidates. The candidates who brought thought-out questions (writing them down is OK) were my favorite. They did a little research beforehand and thought about what they could give to the team. They were thinking about continual growth. They made great employees.

Another reason to ask questions is to learn the answer to the question I get most often: “Is this an ethical company?” The only way to find out is to ask. Ask the interviewers questions, such as:

  • How would you handle a situation when a patient is on a particular “resource utilization group” (RUG) level; however, at the end of their assessment period they have a stomach bug and don’t want to participate in therapy?
  • How are discharge dates (from each discipline and the facility) determined?
  • Will you provide an example of how activities and restorative nursing coordinate with therapy in order to best serve patients?

Your interviewer might be a little surprised if you ask tough questions. Don’t worry about this. One of three things will happen:

  • It will be a good surprise. Your interviewer will see your concern, care and critical thinking and know you’ll be a good team member.
  • They won’t like it. You might be considered someone who questions authority. You won’t get hired. That’s OK. One of the big complaints I hear from therapists is the lack of clinical autonomy they have in jobs. You’ve just screened a potential employer and avoided that situation.
  • They won’t like it, but they are desperate to fill the position. They offer you the job. That’s OK. Now you get to practice saying “no.” If the job doesn’t meet your expectations, don’t take it.

By agreeing to work only in ethical workplaces, you are advancing the bottom-up approach to affecting change. Thank you, from all of us!

If you are looking more suggestions on finding an ethical job, read the “Interviewing Tips for Finding Ethical SNFs” post at Gray Matter Therapy.

Please join us at the ASHA Convention in November for the session, “Productivity Pressures in SNFs: Bottom Up and Top Down Advocacy.” Check the program planner for details.

 

Rachel Wynn, MS, CCC-SLP,  specializes in eldercare, and, as the owner of Gray Matter Therapy, provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an affiliate of ASHA Special Interest Group 15 (Gerontology) and an advocate for ethical elder care and improving workplace environments, including clinical autonomy, for clinicians.

Comments

  1. I would also ask them how much stress they put on point-of-service documentation. If the company places a high level of stress on this you can be sure they are expecting high productivity, often at the cost of effective therapy. My personal opinion is that this is a ridiculous idea. While it might work for PT and OT, SLPs wear a different hat when they deal with their patients. Constant monitoring of patient responses is vital. When you work with divided attention, therapy outcome will suffer. Patients are often given an iPad app to play with while the clinician works on the notes. I do not believe this can be called therapy. To me, therapy is active interaction with the patient where you monitor all responses and redirect them as appropriate. An app can only go so far in providing required user interaction. The human element of knowing when the patient is hesitating or having difficulty seeing items on the screen, etc, can never be discounted. When it comes to dysphagia, much of it is hands-on. You cannot be fiddling around with your iPod or laptop while the patient needs to be provided dysphagia therapy.

    Another aspect is emphasis on group therapy and collaborative work with PT and OT. While these may be useful in some instances, not all patients may be stimulable in a multidisciplinary environment.

    The third aspect that might clue you into the quality of patients in the facility is to ask about the ratio of dementia to dysphagia clients in the facility. Also ask them how many on caseload are medicare part B. This might help you understand whether the facility really circulates a lot of new patients from the community or whether they are constrained, and might expect you to pick up long term care patients, many of whom may not be stimulable.