Reducing Physical Therapist Burnout with Supportive Strategies in Healthcare

Hi, Laszlo Bayer here, Senior Vice President and Head of Sales and Marketing at Therapeutic Industries. I had the pleasure of interviewing Clemente Aquino, the Vice President of Rehab Practice Standards at Life Care Centers of America. With over 25 years of experience in occupational therapy and rehabilitation management, Clemente has a wealth of insights on the evolving landscape of healthcare.

During our discussion, Clemente reflected on how drastically the industry has changed since he began his role in 2010. He recounted the “heyday” of rehab under PPS reimbursement, where capturing therapy minutes across all disciplines was central to operations. However, shifts in CMS policies, the introduction of PDPM, and the unprecedented impact of COVID-19 have reshaped the field. As facilities navigate this new environment, rehab’s role in reimbursement has diminished, moving from a central focus to one component among many.

Clemente shared a remarkable story from the early days of COVID-19, when he was asked to assist at Life Care of Kirkland, the first U.S. facility hit by the virus. His time there, serving as a CNA on night shifts, highlighted the extreme challenges healthcare workers faced on the front lines. The toll of the pandemic on staff, coupled with the demands of PDPM, led to significant burnout and attrition across the industry.

We also explored how Life Care is addressing these staffing challenges. Clemente emphasized the importance of recruiting new graduates while supporting seasoned therapists to combat burnout. He highlighted Life Care’s mentorship programs and supportive work environment as crucial for employee retention, aiming to sustain engagement and alleviate the physical and emotional strain therapists often face. Additionally, he noted how the Barihab Treatment Platform, with its innovative design to reduce physical exertion, is helping to prevent injuries and ease the demands on clinicians.

Our conversation underscored the urgent need for continued support and adaptability in healthcare. Clemente’s insights emphasized that addressing burnout and supporting therapists is not only essential for staff well-being but also vital for sustaining quality patient care in a changing industry.

 

Transcript:

Laszlo:

You know, I was thinking about this the other day, Clemente, was that, how long have we known each other?

Clemente:

Oh my gosh.

Laszlo:

God, I thought about that a little bit. And it’s been, I think 14 years.

Clemente:

That’s correct. 2010

Laszlo:

2010 to now. So I wanted to ask you, the other thing that came to my mind was how much this industry has changed? It’s completely kinda gone upside down. Can you talk about that from your perspective?

Clemente:

Oh my gosh, I don’t know where to start, Laszlo. In 2010 we’re right in the midst of a booming time, and I think therapy was booming in the therapy world. We were under PPS reimbursement, and so it was really easy for us to be able to capture all the minutes for all the therapy that we’re delivering, all across all three disciplines, OTPT and speech. And for us, it was what I call the heyday. And then as time went on, I think there was a lot of reimbursement changes that CMS proposed. And obviously moving through that time period changes occurred in 2018, 2019, And then obviously we got hit with Covid. So you talk about an evolution in a short period of time. We’ve changed quite a bit from being the main driver of their reimbursement to now being just a part of that or a slice of pie of reimbursement. So it’s really made a difference in terms of how rehab has been looked at.

Laszlo:

Right. Are you still doing the same function for Life Care Centers? Are you still the Vice President of everything? Or has that changed?

Clemente:

Well, I’ve been the VP for Rehab for life Care for the last 15 years. And so it’s been rewarding to say the least, and I’ve been blessed with the role that I have. And so it’s morphed though. I think over time that things have changed, practices have changed. We are not the driver anymore. We’re on the seat, but we’re not in the driver’s seat. And I think that’s a big change for us. It’s hard to be in the passenger seat when you’ve been in the driver’s seat for a while. So we’re getting used to that seat. It’s a different viewpoint for sure.

Laszlo:

Right, right. Now, when you were at the epicenter of when Covid hit the industry, you were at the place ground zero.

Clemente:

That’s right.

Laszlo:

How did you deal with all that when it first happened?

Clemente:

Well, my boss said, Hey, I think you still have a license in the state of Washington. And I said, yeah, I keep that up. And he goes, well, I think they need a little bit of help up in the northwest. And I said, sure. I’d be more than happy to help. And not realizing what I was walking into. I flew on a plane from Tennessee to Seattle, and when I got off the plane, my boss said, I want you to sit for a little while because I want to give you some background before you walk into this building. And so I sat in the car for a while and he said, yeah, I want to let you know that there gonna be several new stations parked in front of this building, and I want you to be aware of this because they’re gonna be probably scrutinizing what’s happening at this building. And I said, oh, no problem. So I drive up to the building Life Care of Kirkland, and sure enough, there were probably eight different new stations there parked in front of our building. And so I walked in and of course our President and our Division Vice President were there, and they said, Hey, we need you on the floor. And I said, sure. I go, well, we need you on night shift.

Laszlo:

Oh my

Clemente:

Working as a CNA. And I said, not a problem. So I put on my scrubs and that evening, so I got off at three o’clock. By nine o’clock I was on the floor. And sure enough, the state and every surveillance team that I think from an infection control perspective was at Kirkland. And so they started orienting us to this thing called covid, and we had to wear to be fully gowned masks, wear some goggles, and they said, this is what you need to do, walk into patient’s room. And I’m like, oh my gosh, this is going to be a little different. And so for the next four weeks I was there spending time helping out with the care that was needed at Life Care Kirkland.

Laszlo:

Wow. It just amazes me that you know the things that the industry went through during that time, and one of those things I think long-term care is still trying to recover from to a degree would be just the black eye. It was like all of this terrible tragedy was happening in long-term care buildings. And it just was like, oh man, I don’t want to go there, right? And for me, because we were selling product, the 

to long-term care industries, we weren’t allowed to go in. We have no budget for your equipment because we’re spending it all on PPE equipment and disinfecting and all of that. So that was a tough time for I think everybody, but again, we came out on the other end. And it’s interesting that PDPM kind of all happened at the same time in a way, didn’t it?

Clemente:

That’s right. Yeah. It was right before covid hit, and I don’t think really anyone had a good grasp of what PDPM is as it was back in 2019. And so today it’s much different. I think many companies and probably all of them that are doing well, understand the dynamics of how to capture accurately what we do every day. And I think it’s really important to be able to kinda capture everything because such a highly regulated industry. So being able to stay on top of all the different metrics and all the different diagnoses and just what you do day in and day out on that MDS, that minimum data sheet is all encompassing. Right,

Laszlo:

Right. Now, how did these events, PDPM, along with covid, how did that impact the employee base in long-term care from rehab to CNAs, nurses, the whole thing. Did a lot leave the industry because of these events that occurred?

Clemente:

You hit it right on. I think burnout is probably the name of the game. Therapists and healthcare workers in general, they have their heart in the right place, and so they always try to do the right thing. But over a period of time when you’re under high scrutiny, working long, long hours, I think burnout kind of set in for many, in some cases, scared some folks just with the fact of possibly catching covid. And then the effects of what could happen if you did get covid. And so I think a number of healthcare workers, including therapists, decided to leave the industry and either move into different sectors. And so as a result, we do have a shortage of nurses and therapists out in the industry right now.

Laszlo:

So what kind of recruiting efforts do you guys do to bring on the new graduate class of 2024 that is just entering into the therapy world?

Clemente:

That’s a great question. I was just on a call earlier today and we talked about our therapy strategies and how to recruit, and it comes down to just the heart of therapist and showing them that a company like Life Care can really embrace a new graduate with education and mentorship and support from not only seasoned therapists that have weathered the storm, but also therapists that are willing to work in this environment. And so it takes quite a bit, but we have an arm in student connections with looking at new grads, even starting with first year students, second year students, and really educating them in the industry that we’re in right now. And so that’s one aspect. Another aspect is just making sure that our current therapists that we have in our facilities are retained because again, we don’t want them to burn out and leave.

Laszlo:

Right.

Clemente:

So we’ve got to keep the folks that we currently have in our facilities happy. And I think it comes down to just that recognition and acknowledgement and really the success that we do with the patients that we work with every day.

Laszlo:

How much do you think technology plays in employee retention? I mean, just providing the latest technologies, the latest modalities, helping the therapist to move and transfer and do all that with patients, Is that a factor?

Clemente:

Oh, that’s a huge factor. Laslo. I think having technology that assists therapists in getting the best outcomes that we can achieve, having the right equipment and the latest technology that can assist therapists makes a huge added value in terms of recruitment.

Laszlo:

Well, that’s one of our important points that we always try and make is that I think a lot of people aren’t aware of what a typical day is like for a therapist, lifting, transferring eight hours a day can cause a lot of stress. And the other factor I think is injuries. If we can help them to avoid injuries, that was our goal in the very beginning was here we have this product and we know what its value is and how do we get it out there? And so we were able to capture visionaries like yourself and Mr. Mike Reams to be real champions for us in the beginning. Without you guys, I don’t know where we would’ve been because any new product faces that whole new product resistance issue. And when it’s accepted by a person like yourself and Mike and you guys legitimize what we’re trying to do, it really kind of legitimizes the reason why we’re doing things, the reason why we’re approaching companies. So I want to thank you and Mike for believing in our company and our product over the past 14 years. Now, here’s a completely different question. How does the rehab hospital industry, how has that affected long-term care.

Clemente:

I think the hospital setting is all about trying to get those patients back home. And I think patients want to be back home. And the reality is, if I was a patient in the hospital, I’d want to go home too. So the first and foremost thing that they’re going to look at is can they get from the hospital back home safe? And if the team at the hospital feels that way, they’re gonna advocate for that patient to go home. But I think in many cases, the opposite is true. That is they probably need additional help and they probably need to stay at a skilled nursing facility based on their core morbidities and the diagnosis that they’re having. So it’s educating folks and payer sources. Different managed care companies are going to advocate for a shorter length stay, get them straight home. And there’s a benefit to coming to skilled nursing, not for everyone, but I think there’s a piece of the puzzle where patients should consider that if they don’t have the right resources and support to safely be at home.

Laszlo:

Do you see census getting back up to the levels that they were pre covid?

Clemente:

I think before covid hit, we’re still probably in that tsunami wave, right? As the population grows older, I mean the weight just like hurricane clean that just hit us last week. It’s a wave that’s still there. And it may not hit all at once, but over time, I think the census is going to grow, and I think there’s going to be a case where skilled nursing is a valuable part of that continued care.

Laszlo:

Right. So what do you see in the next three to five years for the long-term care industry?

Clemente:

I think we have to be smart. One, the skilled nursing industry has to pivot a little faster, and they have to be adapt at looking at getting patients to that next level. In the past, I think rehab’s always thought before you go home, you have to be independent. Well, that’s not the case anymore. And I think oftentimes it’s looking at the support systems that are there, that are available to patients who do go home or to a lesser level of care. So I think the next three to five years, technology is going to be a part of that equation. It’s gonna be assisting where patients go, and so the smarter companies are gonna be able to grab and have the best outcomes at whatever level they are at and discharge ’em to the safest possible position.

Laszlo:

I’ve read recently a lot of acquisitions are taking place, big guys are eating up little guys, and little guys are trying to grow and acquire more. Do you see that the industry is starting to kind of get to a point where there’s 2, 3, 4 major national providers that will dominate the landscape?

Clemente:

Yeah, it goes in waves. I think like the pendulum, it swings one way and then it will swing the other way. And over time you’ll see a few companies that will gobble up the smaller companies that aren’t sustainable. And I think in a short term, that’s what’s gonna take place. You’ll see some of these companies that come out fairly well that’ll grow, and then over time, that contraction will take place again. So it’s gonna be an ebb and flow, and I think the companies that are smart and think three to five years down the road in terms of how to survive this wave going to be there down the road.

Laszlo:

Well, I know that Lifecare has been in the top five in the country for a long, long time, and we’re just happy to be a part of that association with life care, and we look forward to working with you guys for the next three to five or until I retire, and then what’s going to happen.

Clemente:

That sounds good Lazlo.

Laszlo:

Yeah. Yeah, hopefully. Well, you know what? It’s always great catching up with you.

Clemente:

Likewise

Laszlo:

Again, You haven’t aged today, so don’t work too hard. I’m glad you’re back to work, and I’m glad you’re home safe.

Clemente:

Thank you.

Laszlo:

So let’s keep in touch.

Clemente:

Okay? Definitely, definitely.

Laszlo:

Tell Mike Reams I said hello.

Clemente:

Will do. Hey, it was great catching up with you.

Laszlo:

Yeah, good talking to you too. Thanks for your insight. Really appreciate it.

Clemente:

Yep. Thanks again.

Laszlo:

Okay, bye.