We rarely have an office or private room provided for us. We have to see the patients in their rooms, in the dining rooms, sitting rooms, etc. HIPAA does not apply to this situation since that involves medical records and this issue involves patient’s privacy. The clinician asks the patient where they want to be seen. If they are fine with being seen in their bed with the roommate in the room, that is their choice. If they want to be seen in the dining room or a sitting area, as long as they agree to that it is not a violation of their confidentiality.

Each clinician has a list of patients to see each day. However, there are no specific appointment times set for each patient. It is up to the clinician to find the patients when it is convenient and see them during the day. Once you learn patients’ schedules (i.e. physical therapy times, smoke breaks, meal times, etc.) it becomes much easier to coordinate the schedules of your patients and get everyone seen in a timely manner.

We have regional managers and district managers who work with nursing homes to build the referrals at the home. When a clinician is hired, we have a list of homes to go to and patients to see and we will make sure the clinician has enough patients to see. However, it is important that the clinician fosters a good relationship with the nursing home staff to ensure getting more referrals.

Depression, anxiety, and adjustment disorders are the most common. In addition, there are a lot of patients with dementia and some sort of behavioral disturbance (i.e., aggression, sexually inappropriate behavior, noncompliance with ADLs). There are also some long-term psychiatric patients with diagnoses such as schizophrenia, bipolar disorder, and personality disorders. Some nursing homes have mostly older patients but some have younger, psychiatric patients.

We see a large percentage of our patients twice a week. How many times a week we see them is based on medical necessity, clinical complexity of the case, and stage of treatment process. Usually, when patients are first referred for services, they are seen twice a week. Once they have stabilized and have been seen for a while they may be changed to once a week. However, keep in mind that many of these patients are suffering from multiple health problems, possibly dementia, as well as various psychological problems. In addition, the nursing home environment is a more structured environment for patients who cannot live on their own. Many of these patients would have to be placed into inpatient treatment if they cannot be managed in the nursing home. In inpatient treatment, patients are seen 5 days a week, multiple sessions a day. The nursing home environment is between inpatient and outpatient (where the patient is seen only once a week).