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Top 10 Things To Know About Working As A Skilled Nursing Facility SLP

by Monique Cevasco, MS, CCC-SLP


One of the great aspects of a career as a speech-language pathologist is the diverse settings in which you can work. From newborns to geriatrics, you are bound to find your niche, but if you have not experienced a certain setting it can seem intimidating to begin your career or make a career change. Below are 10 things you should know to help start your career working as a skilled nursing facility SLP.

The power of productivity

If you are just starting out as a clinical fellow (CF), or are thinking of changing to the medical side, productivity standards can be a difficult adjustment.

Productivity standards vary depending on the specific company. According to ASHA’s 2017 SLP Healthcare Survey, the average productivity requirement for skilled nursing facilities (SNFs) is 85%. Your director of rehab expects you to meet this number every day.

During your interview, one of your top questions should be: “What is the facility’s productivity standard?” It can be difficult to balance direct client therapy, paperwork, phone calls, and family or staff education to meet your standard — so flexible scheduling is key.

Scheduling and flexibility

When working in an SNF you must be able to adapt to changes quickly. A patient may leave for an appointment that may not have been reported to the rehab department or they may be extremely fatigued from their PT session. You will be assigned a caseload for the day by your director of rehab (DOR) and it is up to you to schedule your patients however you want or need. Some patients may be morning people and others may be better in the afternoon. You might also be assigned an evaluation midway through your day.

The benefit of working in an SNF is the flexibility in your hours. You do not have set work hours. You may come into work early one day to see patients with their breakfast and on another day arrive later so you can see patients at dinner. It is important to be flexible and open to co-treating with other rehab disciplines.

Interdisciplinary collaboration

The most valuable tools you will have access to while working in an SNF are the vast interdisciplinary collaboration experiences.

You will interact and work with doctors, nurses, PTs, OTs, social workers, and dietitians. As long as you are open-minded and willing to ask questions, they will provide you with invaluable knowledge.

Support system

It is important to know what your support system looks like at your facility. Will you have a team of SLPs or will you be flying solo? If you are the only SLP in the department you could be in charge of any referrals, evaluations, discharges, questions, concerns, and dietary adjustments for up to 160 beds. Nursing will play an important role in your support system. Nursing will hold meals so you can work with patients who have dysphagia and will have your patients ready for you in the morning. Another large portion of your support system will come from your DOR. They will determine your caseload size, your evaluations, and hopefully defend you from, at times, unrealistic expectations from higher management. It is important when interviewing for your CFY, to ask if your supervisor will be on-site or off-site.

Diverse caseloads

Each day will be new and different. Your caseload may even change every day. The types of patients on your caseload will be dependent on your specific facility. You may treat short-term and long-term patients who have Alzheimer's, dementia aphasia, dysphagia, feeding, and tubes. You will also work with stroke recovery, post-operative care, and assist with palliative care. Some facilities will also provide trach and vent care. Your treatment approach and materials will be unique to each patient.

Confidence, confidence, confidence!

Starting any new job can be intimidating but you must have confidence. Working in an SNF will be fast-paced and challenging. You will have a diverse caseload of patients that may each have a long list of medical issues. Do your research if you are unsure of what something is or how it may affect your patient. Ask questions to your interdisciplinary team. All of this knowledge that you gain will build your confidence. With confidence, you will be able to stand your ground when the time comes. There will be tough decisions that will need to be made and not every nurse, doctor, or DOR will like your decision. With your confidence and knowledge of solid evidence, you can defend your decision.

Census flow

Your daily caseload will ebb and flow based on the facility’s census. The average caseload can average from 7 patients up to 15 patients. You will tend to have several evaluations per week which will help maintain a steady caseload. There will also be referrals from nursing and staff if a change in status is noticed in both short-term care and long-term care patients.

Hourly versus salary

Many skilled nursing facility SLPs are paid hourly versus salary. There are pros and cons to both. If you are hourly and are cleared for overtime by your department, you may benefit when your census is high. On the other hand, if you are hourly and the census is low with no new admissions for evaluation then you may be working only half days which would affect your overall pay. With salary, you will have consistent pay when the census is low but will not have compensation when extra hours are put in when your caseload is high.

Continuing education

A lot of facilities will provide their SLPs with annual continuing education money. The amount will vary by company. To get the most out of your provided continuing education money you can put it towards certifications such as VitalStim and The Lee Silverman Voice Treatment-LOUD. These certifications are multi-day CEUs that will provide you with a bulk of your hours required and provide you with a specialty skill that can help build your resume.


You will be on your feet treating patients in the PT gym, OT gym, their bedroom, outside on the patio, or in the facilities dining room. You will find that your scrub pockets will become full of materials that you can use across multiple patients such as a deck of cards, picture cards, and tongue depressors. When interviewing, ask about what materials are available. Do they have cognitive workbooks, available technology, games? The more versatile the material item is, the less you have to carry, and the less you have to make trips to your office which will help with productivity.

Would you be a skilled nursing facility SLP?

Working in an SNF is fast-paced and ever-changing. Every day will be exciting and you will have the opportunity to work with many disciplines. What do you think about working in an SNF? Tell us in the comments below!


  1. American Speech-Language-Hearing Association. (2017). ASHA 2017 SLP Health Care Survey: Practice issues. Available from


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