These are a few of my favorite things….at the SNF

We all have our favorite, go-to items whether at home or at work. These things are familiar and usually are something you have used a lot. Something that is reliable and flexible. I have some therapy materials that are that way for me. Any time I show up at a facility to work PRN, these are the things I scan the closet for…
Question: What activities can I do with my adult patients that Medicare approves and are functional and “skillable” in the long term care setting or SNF setting?
For my non SLP readers, a SNF is a skilled nursing facility. The patients we treat can be short term rehab patients following a hospitalization who have plans to return home. Sometimes, these patients end up requiring more assistance than their families can provide at home. That is when they end up becoming a part of our permanent “family” at the long term care facility. Throughout their stay at our facility, they may require additional therapy when any functional decline is noted.
Our goals for speech therapy may be for swallowing to prevent aspiration but are heavily focused on cognitive aspects of language during this time such as attention, memory, problem solving, sequencing, etc.
It is very important to work on functional tasks, hands on, interactive tasks in a crowded therapy room. I’m not saying that I never use worksheets or do in room therapy, but I am saying, it doesn’t happen often. This setting as well as most home settings require a combination of cognitive and motor tasks. Ever heard the saying “Walk and chew gum at the same time”? That is what we have to prepare our patients for. They have to be able to do more than one thing at a time in order to think about and act on their own safety to prevent getting them back in the situation they are in when we are seeing them!

The following items are found in all of the therapy rooms that I work in, partly because I have purchased them and left them for my fellow therapists to use when I’m not there!
(Affiliate links abound today!)

1. I use this Melissa and Doug parquetry board activity EVERY WEEKEND that I work at the skilled nursing facility. First I have them complete the board by placing the pieces on top of each printed piece until the puzzle is complete. If they do that with minimal cueing, I have them copy the puzzle beside the board on a blank surface. I get all kinds of comments during this task about torture and trickery but we continue on and cue as necessary!
I own at least three of these:
2. Flow Free App- I once again LOVE this for cognitive therapy at the SNFs where I PRN. It targets sequencing, problem solving, memory and I’m sure tons of other goals for fine motor, and strengthening (we put cuff weights on their wrists while playing/more “torture”). In this app, patients have to connect the dots of same colors to make a complete line without crossing another line or it breaks. It’s fun to watch as well as for the patient playing. Of course as with any activity, you can cue as necessary to promote independence with the task.

Best part of all…It’s FREE!

3. The Lauri Pegboard- I have used both the 100 peg and the smaller version depending on the attention span demonstrated by the patient. Again, I like to co-treat with the OT staff because they have patients peg along all day in there!
This board can be used for the lower level activities (just putting all of the reds on the board) to high level memory and attention activities (look at this pattern for one minute, remember it, now recreate it). You can quickly see if they are exhibiting any “left neglect”, just have them fill the board and you will see where their visual deficits lie. All around, it’s the best tool in the therapy room and they ALL have one.
What do I like to do next? As soon as they think they have figured me out, change it up on them! Have them follow sequential directions: “After you make a red triangle, put a yellow square around it”!

Download my FREE peg board patterns HERE

4. The Melissa and Doug Bead Sequencing Set- Another great activity that can be leveled depending on cognitive ability. I first have my patients sort the beads by color onto the sticks. If they are able to do that, I ask them to alternate two colors and advance up as tolerated.
The activity intends for patients to use a picture that is placed behind a pole to match the beads by sliding them onto the pole (another OT co-treat for reach and ROM). If they have good attention, sequencing and problem solving skills, they will be able to do more than one at a time. I think it holds five cards and poles at a time.

5. When you get to a new therapy room always check the storage room for a “pipe tree”. Along with it there will be a book of patterns. If you are lucky, someone might have labeled the PVC pieces to help the patients as they arrange them on the stand. It is great for your men patients who may not like the ‘silly games’ like jigsaw puzzles or the peg patterns. With the pipe tree you can work on problem solving, memory (just show them the picture and remove it to see if they can reproduce it), attention and divided attention.

6. This program changed my way of doing therapy. Peggy Watson has developed a program for families, therapists, nursing staff to follow on how to react/respond to patients with Alzheimer’s Dementia.
This book explains the types of dementia, the stages of dementia, has tips for families to use in the home as well as important tips for facility caregivers to consider and implement into their programs. The spiral bound program booklet gives functional GOALS for all three disciplines to work on (PT, OT, SLP) based on the behaviors the patient is experiencing. There are several pages of reminisce type questions that they recommend leading any interaction with to get the patient in a less defensive or fearful mood.
We used this in my OWN FAMILY so that should speak volumes for how much I love this program. They have a website that is updated frequently with TONS of resources and latest research. If you are a therapist who works with patients with dementia or a family member of a loved one with dementia,  I would recommend getting your hands on ANY publication by these ladies.

7. Last but NOT Least! The Breather by PN Medical.
This is the main thing I use when working with patients with decreased breath support. Read about how I assess and treat them HERE. 
You can NOT go wrong with this device to accompany your therapy sessions for dyspnea, speech production, dysphagia and cognition which are affected by poor breath support such as in patients with COPD, Parkinson’s, Asthma, Chronic Bronchitis, Pneumonia etc.
My patients will carry these in their shirt pocket or on a string around their neck while doing more physical activities or ADLs. It’s a great product that I can’t live without.


  1. I have never seen the breather before and am excited about the idea in using it in therapy, working in an SNF of course I have a multitude of patients who would benefit from that. I saw on the website that they are $39 a piece but reimbursable by medicare. Do you know anything about getting them for your patients?

    Your blog is awesome

  2. My facility has always purchased them through our main vendor. They are available from AliMed as well. We keep about 5 on hand all the time. The patient keeps them when discharged for maintenance.

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