The Speech-Language Pathologist's Role in Improving Long Term Care

When I was asked to guest edit an issue of Seminars in Speech and Language focusing on the skilled nursing facility (SNF) setting, I was pretty excited. I have worked in the SNF setting since I graduated with my master's in communication disorders in 2011. Something unexpected happened; I fell in love with my patients and was intrigued by the challenge of serving those with dementia, but I also began to see opportunities for major improvement.

In the fall of 2013, I led a grassroots effort to begin a conversation at the national level about speech language pathologists' (SLPs') concerns regarding ethical care, clinical autonomy, and Medicare fraud in the SNF setting. I am a loyal rule abider and team player, so finding my advocacy voice felt awkward at first. Then I realized that my first priority as a clinician should not be to my company. My first priority should be my patients' care (and good care benefits the company). I am a team player; I play on my patients' team.

As I began to investigate the ethical dilemmas in the SNF setting, I realized that if we were to remove the struggles with unrealistic productivity, lack of clinical autonomy, and Medicare fraud, we would be left with another ethical dilemma. For far too long therapists have been pressured into focusing too much energy into meeting unrealistic expectations that we have just been surviving. It is time to thrive! It is time to reexamine how we provide services and investigate how person-centered and habilitation-focused care can improve our patient's quality of life.

The articles in this issue of Seminars in Speech and Language investigate ways we, as therapists, can improve care in the SNF setting, including:

• Recognize and support workplace cultures and organizational climates that support change and improvements in delivery of care and acknowledge how culture and climates impact how SLPs implement best practices.

• Appropriately incorporate evidence-based practice and practice-based evidence into SLPs' work, which is especially helpful in the SNF setting, where we are often working with patients with multiple comorbidities that may not represent patients seen in published research.

• Design personally relevant goals for people with mild dementia that are focused on their strengths, weaknesses, and interests and participation in life and leisure and create personalized resources to help them engage with their environment with greater independence.

• Explore environmental (and the people in the environment) changes to improve the quality of life for people with moderate to severe dementia in a way that provides better assistance (rather than more assistance) to improve the patients' ability to make choices and engage in their environment.

• Bring the energy of the Montessori approach to care in long-term care communities to focus on engaging residents in daily activities to maintain their highest level of function while supporting increased quality of life.

It is my hope that these articles will leave you inspired to provide better care in the SNF setting. Not only is providing better care good for our patients, but in my experience, focusing on person-centered and habilitation-focused care is more enjoyable for the therapist due to the abundant opportunities for creativity. It is time to seize those opportunities for creativity and thrive as clinicians.

Yours in person-centered advocacy,