Advice to the Newly Appointed Rehab Director

After working as a rehab director in a SNF and LTC facility for a few years, my opinion of how things should be have changed tremendously. Even though I now work full time in the public school setting, my experiences and former position has continued to affect the way I view not only this profession but business in general.

I still work PRN in the SNF setting and always find it interesting the comments I hear and conversations I participate in about productivity, ethics, privacy, professionalism, etc. Does anyone really see and understand the perspective of the Department Head? Do they really understand how much pressure they are under?

I recently asked a question on a Geriatric FB page for therapists that I belong to… “If you could give any new Director of Therapy one piece of advice, what would it be?

Mine would be: Educate your therapists on your expenses and earnings. Make sure they understand that the company they work for has to be able to make a profit in order to employ them and provide benefits.

If you have worked for me, you have heard this question more than once: “Can you go home at the end of the day and rest knowing that you have provided this company and these residents with the quality and level of therapy we have reimbursed you for?” So many therapists move around, company to company raising their salary request to make another dollar. This in turn has made companies fiercely more competitive to meet their therapists expectations financially—affecting the amount of minutes you have to bill in order for them to meet their bottom line. Did you ever think of it that way?

Who is this field ultimately about? Why did you become a therapist? For the patients. Not for your own personal and financial gain. If you have changed your purpose or passion, stop and reconsider what you are doing.

Below are some of the responses I received from other therapists:

When you come in to a new situation, take time to observe your therapists treatment styles, personalities and leadership qualities.

Support your therapists when communicating or decision making with other departments, they know their patients’ needs emotionally and physically.

Never forget what it is like to be a staff therapist, treat as often as you can and follow a patient through the long haul of their stay.

Always ask for and consider staff feedback and opinions.

Have a high standard for quality therapy. It is about meeting patient goals and expectations, not minutes. Your team should have a good reputation of professionalism and ethics.

Do what is clinically appropriate for each individual patient. No one besides the treating therapists should decide what RUG a patient should be.

When you make a mistake, own it, because it will happen. Take responsibility and put systems in place to avoid making the same mistake in the future. When your therapists make a mistake, correct them kindly not accusingly. No one wants to be on the defensive.

Build a team that supports each other by setting the example. You aren’t above the lowest task you would ask someone else to do.

Maintain professionalism not favoritism. Be fair, honest and consistent.

Be a therapy advocate. Know about all disciplines and educate the family members, facility staff and physicians on each person’s role in the patient’s recovery process.

Never burn bridges with staff. You will need them to build a good PRN pool to use holidays and sick days. Never delete a contact in your phone!

Be present and available. Always take time to completely listen when a therapist needs to talk to you.

I hope this list has been helpful and taken to heart as you begin your new position. Always feel free to contact me with any questions or advice to add. You are going to do great as long as you stay grounded and keep priorities in line. Every job will not be easy, as a matter of fact, this position was the hardest I have ever had, but in the end, looking back on what our team built from the ground up…the most rewarding!


  1. Great advice in some of these suggestions! I definitely appreciate that any company has to be fiscally responsible. I wonder, though, about characterizing some therapists in this field as changing jobs just to make another dollar. I can understand how management might interpret it that way: from the employee's perspective, not wanting to burn bridges, it's much easier to attribute a job change to earnings rather than to limited clinical autonomy, stress resulting from never knowing how many hours a week you'll get, and other commonly cited employment problems in this field. I would much rather have preferred a lower fixed salary (meaning salaried compensation, instead of hourly, as befits a professional job) instead of an admittedly high hourly rate but having to constantly focus on meeting high productivity and never knowing how many hours per week I would get (incredibly stressful!!). I have no doubt that some number of therapists does what you describe, but I doubt that it's more than a handful. Most of us went into this field because we're helpers and carers by nature.

  2. Lots of great ideas here. I have looked at the stock market though and when companies make millions in profit, that is after they have paid all the staff and expenses so pressuring us to up the RUGS and promising the DORs bonuses for making sure of high RUGs and productivity ( I have sat in on phone conference where this is discussed)continues to be wrong. Of course we should provide the patients what they need, and of course it is a business, and most of the businesses are making money so I am not going to worry about them.

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