Sometimes it pays to be old enough to be able to remember/understand something that the youngsters can't know. The reason we have fewer privileges with regard to Medicare is because our profession was located in NY, not in Washington when the rules were being made. Any other excuse is an attempt to rationalize our current position. We started out behind the eight ball, and although we have gained privileges, we have never caught up. Now we are much more sophisticated with regard to politics and law, but when you start behind the 8-ball, .... I have read recently on this list serve that some folks are leaving the political arena to others while they concentrate on practice. That will never work. If you do not take an active political position advocating for our profession, you are missing the boat. We are fewer in numbers, and therefore have to make up for our short fall with activism.
Dr. Estelle Breines Seton Hall University -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Joe Sent: Sunday, February 15, 2004 3:24 PM To: [EMAIL PROTECTED] Subject: Re: Re[4]: [OTnow] Response when you explain OT Occupational Therapy= "to occupy" in "goal directed tasks". It does not mean the 'goal' in itself needs to be the 'occupation' but it may involve tasks directed to achieve the goal. Obviously all insurances companies recognize and hence, practitioners must recognize the 'goal', which we all fashionably may call 'outcome' as well. Example: Goal is to dress independently. My task is not just going to be to daily try and put a shirt on without addressing the steps that require to do so. If this means to address thumb adduction/ flexion, finger opposition, lateral prehension or lumbricals strength to do so, I will. As I know, that this needs to be developed for buttoning/ unbuttoning and if that is not possible well I will try a button-hook next or go to velcros. But I disgaree on using 'life tasks' as the sole 'occupation', I believe any task that occupy the client physically or mentally (the performance components) to facilitate occupational independence viz. ability to dress (perform basic ADL), ability to stand on the stage and have the courage to address a crowd without stress (if he is a public speaker), ability to bathe her infant child, if she is a mother, ability to function as a soldier in the front lines with optimal physical and mental fitness; all falls in my role as an occupational therapist. Whether I am competent to address all the many different avenues within Occupational therapy is a different question. That's why you have specialization, you should be able to find an OT specializing in any of those fields. My job as an OT is to ensure my client is 'occupationally' fit as much as possible ( a more holistic approach than just physically fit or mentally fit and not always congruent to medically fit either). I don't feel as a profession we need to be hung around what modalities we use. What's important is that we identify ourselves as professionals that address people's needs by helping prevent impairments and overcoming disabilities to lead a life with 'normal/ healthy' life roles. Don't fight over your tools or give away your tools, you already work with less...and people will take them away and are already doing so. The reason why we are behind PT on the curve: As a profession, we tend to follow what PTs do. We do not take the lead. Ofcourse, they want to be the gatekeepers for rehab and if we cannot match our educational demands (doctoral entry)/ transitional programs (for already employed profesionals), prove our holism (ability to address issues of 'functioning'), we have no right to complain. Ofcourse, the public would seek out a doctoral trained professional that now addresses 'mentation' and 'occupational issues/ ADLs" as well as other physical issues that they already have a brand recognition for. Would you see Psych.D. or an LISW for your psychotherapy at least for that 'gate' visit? We can delude ourselves that our expertise in addressing 'occupational' issues will keep us viable without matching our other requirements with our sister professions. See how many independent OT private clinics are around you compared to PTs. Our approach should be to declare our 'holistic' approach in all arena of health, upgrade our professional image (not as the rather 'para-professional' image we currently have), go for direct-access as we should be able to 'diagnose' and treat occupational dysfunctions no matter the genesis of the issue being an underlying medical condition, mental/ emotional disturbance or movement dysfunction. Or else, let's just shut up and let others make the referrals to us as they deem fit based upon what they think we can do or not do and, just be limited to working kitchens, patient rooms and bathrooms in the facilities we work in..........Ofcourse, in home health the reason we are not allowed to open a case yet is because according to a US HHS report I read, nurses and PTs had a wide ranging expertise to 'assess' a client's needs and ST had a very specific role, hence, they became the qualifying professions....Ofcourse, the OT's job or the need for OT could be recognized by the qualifying professions , so where is the need!!!! Don't look at what we shouldn't do, see as a profession what all we should be doing.......the public will follow and so will insurance companies. Just my two cents (always a long one). Joe ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]> Sent: Sunday, February 15, 2004 4:43 AM Subject: Re[4]: [OTnow] Response when you explain OT > Hello Ann; > > Maybe you and your associates do practice occupation based therapy. But, in > my experience, you are exceptions to the general rule. I wish that I had > more observations and experiences with therapists such as yourself!! > > I am not degrading any specific therapist. I am degrading our profession in > general. My gosh, our profession is nearly 100 years old (older than PT) and > we still can't open a home health case. It seems that somewhere along the > line something has happened to make OT lose creditability with other health > care providers and payers. This loss is caused by any one therapist but it > was and still is being cause by a general lack of practice and apathy by > OT's towards occupation. While it's very nice that the AOTA has generated a > framework based on occupation, it's too bad that it took them this long to > do it. > > In December, I visited the old rehab hospital where I used to work. I > haven't been there in about 3 years. You know what, nothing has changed. The > OT's were still stuck in the corner having clients standing at the table > doing the restorator (i.e. Upper extremity bike). I bet if you ask the > department head and maybe even the leading OT, they both would say that OT > addresses ADL's, life roles, etc. And yes, they even do home evaluations!! > Howerver, I know from experience that that is just a bunch of lip service. > Because what they really do is UE strengthening, cognitive re-training, > endurance training, fine motor control, balance training, etc. Sure they > probably do ADL's in the AM, the occasional cooking group and even community > outings. But my experience with this rehab facility and ALL other rehabs > that I have been to is that on a day to day basis, occupation is NOT what > they do! > > What do I hope to accomplish?? Good question. I hope that one day, OT will > do what OT says it does. Granted there will always been room for individual > practitioners to see things differently than the mainstream but I hope that > by bringing my experience and opinion to the forefront that one day there > will be continuity among our profession. Additionally, I want to better > understand my profession's practices, not practices like NDT, but like how > does our profession work as a whole. Finally, I hope that by stimulating > conversation, some of which can be negative, that readers will at least > consider their day to day practice of OT. > > To me, what is happening in our profession is like a dirty secret or the > elephant in the room. It is my feeling that most people know that in > general, many OT's don't practice the way we advertise. But they either > don't want to or don't know how to say anything about it. Over the years, I > have gotten into many tirades over the way we practice. During each one, I > receive both negative and positive responses. If nothing else there has been > conversation about what I perceive to be a problem. > > I started OT school in 1994. Over the past ten years, I have had numerous > roles relating to OT. I have been everything from an OT student to an OT > educator and have had two private practices. I have worked in rehab, long > term care and hospice. With very few exceptions, I have never ran into a > situations where people around me understood the role of OT. In my opinion, > there are reasons why people don't understand OT. As far as I can tell, the > primary reasons are because OT's don't understand it and don't practice it > and yet they call themselves occupational therapists. Something somewhere > has got to give. With the PT profession coming on strong, NOW is the time > for OT's to identify a common treatment outcome that is unique and > sophisticated enough to be reimbursed by insurance. I've said it before so > this isn't news, but OCCUPATION is that treatment outcome. > > Thanks for writing and sharing your opinion. I am enjoy being challenged and > hope that YOU will not find anything I have written to be directed > personally towards yourself. > > Ron > > > ======================================================= > On Saturday, February 14, 2004, @ 9:31 PM, you wrote: > > Dac> In a message dated 2/14/2004 8:19:29 PM Eastern Standard Time, > Dac> [EMAIL PROTECTED] writes: > > > >> I really don't think that there are a lot of practitioners who > >> practice > >> occupational therapy in a way our profession advertises itself. One of > >> AOTA's greatest slogans is that OT "Teaches skills for the job of living". > >> Personally, I have met very few OT's who address the job of living. By far, > >> most are addressing skills needed to move arms and then leaving it up to > >> clients to figure out how to put their lives back together. > >> > >> You know, I think that as a profession we need to get our ducks lined up. I > >> have been an OT since 1997 and I have never once felt that our professional > >> organization, academicians and clinicians were ever on the same page or > >> even > >> in the same book. > >> > >> I don't think my displeasure with OT is about being a good or bad > >> therapist. I have met OT's who were good at what they did but what they were > >> doing was NOT OT. A person can be good at something but it doesn't > >> necessarily mean that it is something that they should be good at. > >> > >> Ron > >> > > Dac> How many clinics, OT depts. in hospitals, etc. have you visited, Ron? You > Dac> are *once again* making sweeping generalizations about the entire profession. > Dac> While I'm sure there are OTs only working on upper extremities in any vicinity, > Dac> I doubt the majority of OTs make it their sole mission. I manage a > Dac> department, and every OT that works for me, as well as every OT I've ever interviewed > Dac> for a job(over the last 17 years) has been able to articulate and/or > Dac> demonstrate an approach that addresses the patient's needs and interests in ADL's, > Dac> IADL's, and life roles. We have an apartment in our department that includes a > Dac> kitchen, bath, bed and living room, and the folks in my department spend many > Dac> hours with the patients working on activities that have nothing to do with upper > Dac> extremity exercise. This is not to say they never address UE strengthening, > Dac> just that it is secondary to the primary goals they have established with their > Dac> patients. We have a community re-entry program, working with the patient on > Dac> buying groceries, going out to lunch, etc. We have a driver assessment > Dac> program, to address an occupation that is very relevant to any person with limited > Dac> access to public transportation. We occasionally do home visits, to assess and > Dac> assure that the patient will be able to function in their home environment > Dac> safely and as independently as possible. We are not alone in these programs - > Dac> there are other rehab. hospitals in the region who address the same issues we > Dac> do, as do the therapists working in the local home care agencies. > Dac> I'm not sure what you are hoping to accomplish by continually denigrating the > Dac> rest of the people who happen to have chosen the same profession you have, > Dac> but I can't envision anything constructive emerging from it. I'd much rather > Dac> see OT's work together to build on our unique, holistic approach to our > Dac> patients, and figure out how to make the reimbursement entities better recognize our > Dac> vital role in the rehabilitation process. > Dac> Ann > Dac> _______________________________________________ > Dac> To unsubscribe, visit: > Dac> http://otnow.com/mailman/listinfo/otlist_otnow.com > > Dac> The OTnow Mail Archive: > Dac> www.mail-archive.com/[EMAIL PROTECTED] > Dac> =============================================== > > > _______________________________________________ > To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com > > The OTnow Mail Archive: > www.mail-archive.com/[EMAIL PROTECTED] > =============================================== > _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] =============================================== _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
