Our skilled population has gradually shifted from traditional Medicare Part A to Managed Care Part A. Therefore, our treatment focus has had to shift as well. We are no longer focusing on progressing to prior level of function, but rather progressing to next level of care.


With the goal of reducing the length of stay, we determined that we needed to aggressively treat at onset of stay. To jumpstart our therapists and create a routine for the patients, we implemented the following days:

  • Training Tuesday — We schedule patient families to come in on Tuesdays, and we provide training on transfers, functional ADLs and HEP.
  • Working Wednesdays — On this day, we focus on all of the household tasks that patients require as they return home. We have patients sweep, mop, cook and clean the kitchen, dust, do laundry and simulate vacuuming. We have them “shop” at our stocked pantry for grocery store management.
  • Functional Fridays — The focus on this day is all functional tasks, such as bathing/toileting, car transfers, tub transfers, dressing and fall recovery.


Since the implementation of our protocol, the length of stay has decreased on our managed care from 18.4 days to 15.6 days. Reviewing the length of stay of our Medicare A patients, it has dropped from 30 days to 27.9 days. During the course of review, which was a six-month period, we had 196 Managed Care patients and 58 Medicare A patients.


Our goals include the following:

  1. Manage the length of stay while obtaining better outcomes. Goal effective May 2017 is less than 14 days length of stay regardless of payer sources.
  2. Finish development of the theme for Monday and Thursday. Manic Monday will be a crossfit-based day, and Relaxation Thursday will be leisure activities to promote a more active lifestyle.
  3. With the measures in place, we will have increased customer satisfaction of both the MCO and the patient.
  4. Utilize our preferred status with the Managed Cares to convert our discharging patients to become outpatients to better serve our community.

By Andy Cisneros, PTA, Therapy Program Manager, Legend Oaks, West San Antonio, TX