When I tell other therapists that I work in aged care, they're OK with that. If I mention that a portion of my work is in pain management, the reaction is almost always negative. Why? Because the sad reality is that the pain management component of aged care often has a bad reputation.
But, guess what? I LOVE working in “pain management”. I was working in aged care before ACFI came along, with very few opportunities to see clients regularly, as homes had to pay for physiotherapy out of their own budgets. I jumped at the chance to see residents four times a week. That level of treatment provide the opportunity to make huge change in resident’s lives. I saw countless success stories. One of my first ACFI clients, a 90-year-old man, was able to regain the ability to use his arm through a series of treaments. Before that, his family had been pleading for over a year for him to have more therapy.
However, then I started seeing the “dark side” of pain management. How exercise and mental health were not included in pain management. At my private practice down the road I would never have considered treating someone in pain without including exercise and mental health. I only had the choice to see someone either once a week, four times a week or 0 times a week and that was influenced by funding.
I started lobbying for change when I realised all of this and more, however I still believed, as I do now, that it’s better to have allied health on the floor, in a system that needs improving, than not being there at all. I tried finding ways to incorporate mental health and exercise (after I’d met the ACFI requirements) as an extension of the treatment. I always tried to find ways to focus on benefiting function, not just “doing a massage” or putting a TENS on which I knew from all the research base is not supported in making a long-term difference.
I was determined to work within the system to make change, rather than railing from the outside.
I learnt a lot though from talking to other therapists in the industry. For every company that made their therapists see upwards of 60 clients a day, there were caring genuine therapists who really wanted to help older clients as I did.
I started getting more discerning when choosing where I and my team would work. I shied away from places where we would be “just massage robots” or economics ruled over care (don’t get me wrong - economics are very important and lead to more allied health and shifts for nurses and better resident care. However, no-one will ever convince me that someone with contractures is not worth seeing by a physio when it costs and a high is already claimed in complex).
My company is smaller and we are lucky we get to choose where we work. However, I find from talking to a lot of therapists (particularly new grad and overseas trained therapists) that they don’t know the right questions to ask when they apply to work for a job in pain management. Similarly, nursing homes don’t know the right questions to ask of their allied health providers coming in, who may promise the world but what they deliver is far different. We’ve even lost therapists who went to work in “higher paying jobs” in pain management but then found the list sizes and hours they worked were far more than with us.
My intention in writing this list (which I’m sure will get the blood pressure up of some of my competitors) is not to help my business. I can’t work everywhere and employ everyone, and I wouldn’t want to. What I would like is for some of these “dark side” of our industry to have some light shone on it so that therapists and management can go in with eyes wide open into the world of aged care and pain management and not be fooled by those working in aged care for the wrong reasons.
So, here are my Top 10 questions to ask a pain management provider.
What is the average list size a therapist will see in a day? Don’t get confused if the company person starts talking about grandfather clauses for 4Bs from last year. A list size is still a list size and can be compared. Call a few pain management companies and see what they say. Have a look on LinkedIn for therapists who’ve worked for these companies and contact them and ask them what they found. If a company is defensive and won't share that information - that says it all. Also, work it out on a calculator yourself. If a requirement is 80 minutes per a week (and it is for everyone after 1st Jan 2017, so eventually all residents will be) then you can’t see more than 24 clients in a day unless something dodgy is happening! A follow-up question – what evidence do you provide facilities to show that you are not seeing excessive numbers of clients in a day?
What is your policy if a resident refuses treatment and how long can a resident refuse before we stop trying to treat them? Every resident has the right to say no. So again, this information should be straightforward.
What policies and procedures do you have to make sure your staff don’t develop overuse doing manual therapy and treatments during a work day? This is a fair enough question to ask from a WH&S point of view. All the pain management providers offer manual therapy training, so it's important to determine what they give their own staff.
How many minutes on average an hour will your staff be doing massage? How many hours of massage training will your staff get if they haven’t done massage before i.e. OT new grads. Get specific. "Yes, I know I can put Tens machines on, but do you track how many minutes on average are spent massaging across your team?"
What other type of work and for how many hours will your staff be doing other than massage and TENS? If they say assessments, that’s great, but find out what type of assessments - are they pain management or related more to other areas i.e. seating reviews etc.
What do you do to prevent your staff becoming deskilled and disheartened when focusing exclusively on pain management treatments? New graduate programs and extensive PD can sound appealing (esp. when lots of money is thrown at you) however what does the PD do to help your future career rather than just its monetary value. There is no point having a well-trained therapist who has gone to lots of great PD, but gets burnt out and leaves the industry. It would be worth checking what diversity there is in terms of work and whether they spread the work across community and residential aged care.
When you say pay for staff will be X dollar an hour, how many hours exactly do I work each week? For managers, the follow-up question is not just what the hourly rate is but what is the TOTAL cost per a year - paperwork, travel, accommodation, holiday rates etc. If staff don’t get the work done, can they still go home on time each day? I’ve heard numerous examples of therapists being given too big a list size i.e. 60 clients and they’ve had to work 6 days to get them all done but are only paid 38 hours. A salary of $90,000 a year or $45.54 seems very appealing if it’s a 38-hour week however if you work 60 hours a week your rate is actually $28 an hour.
How many other therapists look after this facility and how do you ensure the same therapist sees the same clients and they aren’t chopped and changed all the time? What plans are in place if staff are sick, on holidays, study leave or if they just need a break? Remember the requirement for a 4B is four days per a week week in week out, holidays included.
How long on average do your therapists on the floor stay in your organisation? Again, check out people on LinkedIn and see what they have to say. I’ve heard 3 months average at some places, and rarely more then 6-12 months for the majority of others.
If there’s a resident that is in pain, but there is no funding available for that resident because they have the maximum funding already, can they still be treated? How? How much will it cost the facility? Will the facility pay this? If you’re a therapist or a manager new to the area - read the ACFI user guide before you call up, especially question 12 where the pain management section is, so you don’t get confused about what a 4A and a 4B is and you know the requirements. Be informed so someone more knowledgeable can’t confuse you with terms you aren’t familiar with. And, this isn’t just for therapists. I’m finding more and more discerning family members asking questions like this at facilities that do pain management to decide if their Mum or Dad are going to stay there. A lot of therapists who’ve worked in the industry tell our family and friends so the knowledge is out there now. Smart organisations and nursing homes know it’s better to be upfront and clear, as that’s more sustainable in the long run.
I really believe it’s possible to feel completely fulfilled and happy working in aged care and pain management. You just need to ask the right questions and have the courage to find out more information. ACFI will inevitably change, but finding out what organisations are doing right now in the rules that are currently in place will tell you a lot.
And, I believe the reputation of our industry can change, so that next time someone asks “do you work in pain management” you can proudly say YES and be respected and admired. It takes someone special to work in aged care.