I am a COTA who works in a subacute rehab/SNF/Long term care facility and because of PPS the pressure is on! I treat most patients one-on-one, in their rooms working on ADL and patient-specific goals, but my productivity suffers as a result. I don't feel my Program Manager (a Speech Pathologist) recognizes the difference between the way I treat patients and my counterpart (another COTA) who almost exclusively treats in the rehab clinic using UE therex, pegboards and the ROM arc. It seems unfair, but when you are told to treat 12 patients daily and if you can double them up in the gym, then you have time to complete documentation and you look good in the eyes of management because you are productive.
>From: [EMAIL PROTECTED]
>Reply-To: [EMAIL PROTECTED]
>To: [EMAIL PROTECTED]
>Subject: Re: [OTlist] Advance Article on OT Curriculum
>Date: Sat, 6 Sep 2003 12:52:57 EDT
>
>In a message dated 09/06/03 9:29:30 AM Central Standard Time,
>[EMAIL PROTECTED] writes:
>
>
> > Most OT clinicians use approaches that OT educators
> > consider more like [PT]... to treat the deficit rather than the whole
> > person. In the clinic, that is perfectly acceptable and understood by
> > other disciplines.
>
>I find this to be often true in nursing homes. I supervise two COTAs at two
>nursing homes, and have for many years. I write both kinds of goals - my
>700s/701s usually have 8 to 10 short term and 8 to 10 long term goals, including
>ADLs and UE function, and activity tolerance and patient education. I admit I k
>ind of ignore the fact that my COTAs usually address mostly the UE goals and
>activity tolerance in treatments, and consider home health, where I actually
>treat patients rather than supervising, to be the better setting for OT. But
>recently, I changed nursing homes where I supervise and changed COTAs and I
>found that my new COTA actually does address many of the ADL goals that I
>write, and suggests extra ADL goals, which include ambulating, like ambulate
>safely from bed to toilet, perform toileting and clothing management, and return
>safely to bed with whatever assistance and than as LTG, independently. ( I
>know Ron has called ADLs the A word, but I find them to be important occupations
>for the frail elderly population, and anyway that is another conversation.)
>My new COTA spends most of her treatment time in the patients room and bathroom
>or in the dining room. She hardly ever uses the "Therapy room" which is
>equipped with mat table, parallel bars, and reductionist OT equipment like range
>bow and pegs. She does use the counter and sink in the therapy room and has
>done some cooking activities with a crock post especially for going home
>patients. I am impressed. For years, I have just not worried if the COTAs act like
>UE PTs, but it is refreshing to work with this COTA. I only wish I could
>switch them now since my reductionist COTA works at a nursing home that is
>equipped with a nice ADL apartment in the therapy room and my Occupation COTA works
>at a home with a crummy therapy room converted from a whirlpool room ( the
>whirlpool is still there in the way. But even if everone agreed to that it
>wouldn't work. The Occupation COTA already drives about 45 minutes to work and it
>would be 75 to the nursing home with the ADL apartment, although it would
>decrease the reductionist COTA's commute from 30 to 15 minutes if they switched.
>Plus the Occupation COTA and herf husband are building a log house after
>living in a trailer for 15 years so I don't think she would want to move. Blah
>blah I have gotten off topic, but anyway, theres my thoughts. -- Jody
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