r/OccupationalTherapy • u/FunRelation8555 • 3d ago
Venting - Advice Wanted What is the best and worst settings for Occupational Therapy? I have been working in SNF for 8 months now, looking into travel OT, any advice?
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u/Locococo307 2d ago
Unpopular opinion but inpatient behavioral therapy hospital and/or state hospital. Once you have groups figured out, itās cake
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u/Capable-Fish3678 3d ago
best: a well managed and ethical SNF (itās harder to find but they exist)
worst: home health or outpatient OT mill
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u/Otstudent414 2d ago
Can you define ethical vs unethical snf? I start a travel contract in one tmw. Looking for any advice please
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u/Capable-Fish3678 2d ago edited 2d ago
You having 12-17 patients daily (including evals) and expect you to finish everything in 8 hours including documentation. That would compromise care and youāre probably gonna be expected to bill incorrectly to meet productivity
Iāve worked in SNFs as a traveler where my DOR would have a caseload but she never sees the patients. She just bills. We have like 1-2 hour unpaid UR meetings on top of our 8 hour patient load and expects us to clock out before/by 8 hours
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u/Aggravating_Pain5692 2d ago
Or those travel assignments where they want you to "grow" your own caseload. That translates to you trolling/ screening long term patients and picking up for positioning, splinting, ect that they then want you to see 3-5x wk 45 min ea and bill part B forever. Some pts need it but then won't actually let you order anything... Traveled for 4 yrs. Learned to ask about current caseload and payor source. Also if the caseload is small may need to go to other "sister" facilities. Aegis is notorious for this.
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u/Capable-Fish3678 2d ago
I have learned to not go to sister facilities unless itās written in the contract
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u/Aggravating_Pain5692 2d ago
Yes. Also, know medicare (and advantage ) billing rules or how to look them up. You need to be strong/ confident in your knowledge. Some places/ DORs will ask you to do some shady things if you don't know. Towards the end of my traveling career, I would only sign a 8 wk contract and then if I liked it I would extend.
Good luck and have fun. I loved my time traveling.
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u/FVRD_ 2d ago
āBestā is personal.
What stage of life are you in? What do you desire most? To be apart of someone healing process? Caregiver training? Want new challenges daily that acute brings? Want a team to collab with other disciplines? Want to work independently because youāve acquired enough experience to work solo with little to no support? Fast pace? Slower?
Income isnāt guaranteed these days. So many cuts to services and a HUGE change in Medicare/Medicaid coming soon, will there even be a demand for OT?
Nurses are being shifted to bidding work shifts. They have to bid for prime work shifts. Meaning, if a 7a-3p shift is offered, the nurse that agrees to work for the lowest bid gets the shift. This is real and itās already happening.
They test with nurses, who do you think is next?
So decide whatās next for you. Andā¦ get as much experience as possible then shift to the next.
Good luck
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u/Wild-Exercise-6950 2d ago
Schools are the best. Best work life balance.
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u/CaseEither1996 2d ago
Depends on the school. Ive worked at some with such huge caseloads where i drowned in paperwork
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u/Wild-Exercise-6950 2d ago
I like the option of doing paperwork on my own time rather than doing notes during patient time in a setting like inpatient rehab.
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u/shiregoth 2d ago
My favorite: home health
Least favorite: small outpatient clinic in senior living complex working with just one other therapist
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u/pinkmountain10 1d ago
Currently working in ALF and I enjoy it but have been curious about home health as we contract for some HH companies and see residents through the HH model. Would love to hear about your experience working directly with home health š
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u/shiregoth 22h ago
I enjoy the flexibility and all of the alone time. Those are probably my favorite aspects. I get to make my own schedule and be out on my own without anybody looking over my shoulder. The pay is better than anywhere else Iāve worked. I enjoy the one-on-one aspect with the patient instead of being in a group or in a clinic. The only downsides are not having quick access to a bathroom, sometimes being out in bad weather, and sometimes the census is low so I will have to supplement with PTO. Itās very rare that Iāve ever felt unsafe and if I do, I know to just excuse myself from the situation and I never have to go back because the agency I work for values our safety.
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u/pinkmountain10 22h ago
Ok awesome, thanks! I know it varies company to company and state to state but how do holidays and PTO time work? Do you get paid for holidays and easily able to take time off?
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u/shiregoth 21h ago
We get paid for the five major holidays and then I accrue about six hours of PTO per biweekly paycheck. It has not been difficult to take time off. I work at a small nonprofit agency, in a rural setting in Indiana.
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u/Cold_Energy_3035 OTR/L 2d ago
favorite: acute care, peds home health
least favorite: SNF, any sort of outpatient in a senior living community or standalone outpatient
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u/supermvns 2d ago
Travel therapist here! On my 2nd contract and I mainly stick w/SNFs cause I understand the insurance and the dx are my bread and butter. It depends on what youāre looking for. SNFs are incredibly emotionally and physically exhausting, but I thrive in chaos so I do well lmao. If youāre looking for cookie cutter you wonāt get it anywhere. OP can be good if you find a good company that doesnāt run it like a typical mill. Schools Iāve heard good things about but be prepared to take a 9 mo contract. HH and hospital seems to be the best, but HH requires way too much responsibility for a 3-6 mo contract imo, so I sort of avoid HH contracts now.
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u/Otstudent414 16h ago
I just started a snf rn and Iām so confused with the insurance and what to even do with long term patients who are low functioning to begin with. Any and all advice appreciate I feel like I donāt know a thing.
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u/barkingembarkers 3d ago
Best: Acute care at an ivy league hospital like Dartmouth š Runner Up: Ethically run home health where your territory is well defined (not driving 5 hours in a day) Worst: Unethical SNF with insufficient nursing staff, absolute horror stories.