Short Term Therapy Needs for Long Term Residents: Pain Management

Working in a Skilled Nursing Facility (SNF) with both short-term rehabilitation residents and long-term care residents, I have learned that it is especially important to not overlook the therapeutic needs that the residents living in the facility may have, which are often over-shadowed by the acute, fast-track therapy programs that provided to the short-term patients. Despite how long they have resided at the facility, there is typically always something that they could improve on or be more independent with after the time and attention of a therapist. Not to mention, from a program development and business stand point, building and maintaining a caseload with long-term residents is a productive and financial must.

First and foremost to consider is pain management. It is a physical barrier to the patient, a financial burden to the facility, and a treatment obstacle for nursing. Often, especially for geriatric patients, joint and muscle pain is usually managed with movement and medicine. Under the skilled hands of a therapist, supplemented with modalities, a patient’s chronic or acute pain can be decreased to a more manageable level.

Identifying Pain Management Needs:

Most long-term care facilities can complete pain assessments through nursing upon request, which will create a point of nursing supportive documentation for which to evaluate and screen a patient. Beyond this, a physician, staff member, or even the patients themselves can request a screen related to increased pain. The hallmark for considering therapeutic need and potential is any increases noted: increased numerical report of pain, increased frequency/dosage of pain medicines, or increased difficulty with use of affected joint/area.

Treatment Considerations for Pain Management:

Remember that the permissible point of this plan of care is that you are trying to achieve what standard nursing care cannot. The plan should be short term only, 10-30 days. Anything more without noted gains or results demonstrates a questionable therapeutic potential for improvement. Try not to get caught up with too many other deficits or needs, which long-term SNF residents often have. Simply treat the affected area and consider other times or disciplines for other needs.

• Focus on skills that are unique to therapy services: joint manipulation, deep tissue massage, stretching, and other manual techniques.
• Supplement the treatment with modalities: electrical stimulation (particularly interferential), ultrasound, infrared, etc. Don’t forget about the simple, less utilized modalities of paraffin and direct ice massage.
• Finalize on carry-over and long-term management. Hands on treatment and modalities may acutely remove the pain, but ensure that as the pain is reduced plans/services are in place to keep it low.

Goals and Outcomes with Pain Management:

Once the treatment course has reached a point that nursing or the patient themselves can manage the pain, ensure discharge. Make sure that another pain assessment or medicine review is completed upon discharge to decrease the patient’s pain medicine and treatments to only what’s necessary. If successful:

• The patient takes less medicine; decreasing drug reliance and chance for side effects/interactions.
• The facility does not need to supply addition medicine; decreasing their pharmacy expenses.
• The nurse provides less treatment; decreasing their overall work-load.
• Most importantly, the patient has less pain.

Long-term benefits from short-term therapy to long-term residents.