Hello Estelle: Finally, someone explains WHY OT can't open home-health cases. To date, I have never heard and explanation!!
Great going, ROn ======================================================= On Monday, February 16, 2004, @ 5:12 PM, you wrote: DEB> Sometimes it pays to be old enough to be able to remember/understand DEB> something that the youngsters can't know. The reason we have fewer DEB> privileges with regard to Medicare is because our profession was located DEB> in NY, not in Washington when the rules were being made. Any other DEB> excuse is an attempt to rationalize our current position. We started DEB> out behind the eight ball, and although we have gained privileges, we DEB> have never caught up. Now we are much more sophisticated with regard to DEB> politics and law, but when you start behind the 8-ball, .... I have DEB> read recently on this list serve that some folks are leaving the DEB> political arena to others while they concentrate on practice. That will DEB> never work. If you do not take an active political position advocating DEB> for our profession, you are missing the boat. We are fewer in numbers, DEB> and therefore have to make up for our short fall with activism. DEB> Dr. Estelle Breines DEB> Seton Hall University DEB> -----Original Message----- DEB> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On DEB> Behalf Of Joe DEB> Sent: Sunday, February 15, 2004 3:24 PM DEB> To: [EMAIL PROTECTED] DEB> Subject: Re: Re[4]: [OTnow] Response when you explain OT DEB> Occupational Therapy= "to occupy" in "goal directed tasks". It does not DEB> mean the 'goal' in itself needs to be the 'occupation' but it may DEB> involve DEB> tasks directed to achieve the goal. Obviously all insurances companies DEB> recognize and hence, practitioners must recognize the 'goal', which we DEB> all DEB> fashionably may call 'outcome' as well. Example: Goal is to dress DEB> independently. My task is not just going to be to daily try and put a DEB> shirt DEB> on without addressing the steps that require to do so. If this means to DEB> address thumb adduction/ flexion, finger opposition, lateral prehension DEB> or DEB> lumbricals strength to do so, I will. As I know, that this needs to be DEB> developed for buttoning/ unbuttoning and if that is not possible well I DEB> will DEB> try a button-hook next or go to velcros. But I disgaree on using 'life DEB> tasks' as the sole 'occupation', I believe any task that occupy the DEB> client DEB> physically or mentally (the performance components) to facilitate DEB> occupational independence viz. ability to dress (perform basic ADL), DEB> ability DEB> to stand on the stage and have the courage to address a crowd without DEB> stress DEB> (if he is a public speaker), ability to bathe her infant child, if she DEB> is a DEB> mother, ability to function as a soldier in the front lines with optimal DEB> physical and mental fitness; all falls in my role as an occupational DEB> therapist. Whether I am competent to address all the many different DEB> avenues DEB> within Occupational therapy is a different question. That's why you have DEB> specialization, you should be able to find an OT specializing in any of DEB> those fields. My job as an OT is to ensure my client is 'occupationally' DEB> fit DEB> as much as possible ( a more holistic approach than just physically fit DEB> or DEB> mentally fit and not always congruent to medically fit either). I don't DEB> feel DEB> as a profession we need to be hung around what modalities we use. DEB> What's DEB> important is that we identify ourselves as professionals that address DEB> people's needs by helping prevent impairments and overcoming DEB> disabilities to DEB> lead a life with 'normal/ healthy' life roles. Don't fight over your DEB> tools DEB> or give away your tools, you already work with less...and people will DEB> take DEB> them away and are already doing so. DEB> The reason why we are behind PT on the curve: As a profession, we tend DEB> to DEB> follow what PTs do. We do not take the lead. Ofcourse, they want to be DEB> the DEB> gatekeepers for rehab and if we cannot match our educational demands DEB> (doctoral entry)/ transitional programs (for already employed DEB> profesionals), DEB> prove our holism (ability to address issues of 'functioning'), we have DEB> no DEB> right to complain. Ofcourse, the public would seek out a doctoral DEB> trained DEB> professional that now addresses 'mentation' and 'occupational issues/ DEB> ADLs" DEB> as well as other physical issues that they already have a brand DEB> recognition DEB> for. Would you see Psych.D. or an LISW for your psychotherapy at least DEB> for DEB> that 'gate' visit? We can delude ourselves that our expertise in DEB> addressing DEB> 'occupational' issues will keep us viable without matching our other DEB> requirements with our sister professions. See how many independent OT DEB> private clinics are around you compared to PTs. Our approach should be DEB> to DEB> declare our 'holistic' approach in all arena of health, upgrade our DEB> professional image (not as the rather 'para-professional' image we DEB> currently DEB> have), go for direct-access as we should be able to 'diagnose' and treat DEB> occupational dysfunctions no matter the genesis of the issue being an DEB> underlying medical condition, mental/ emotional disturbance or movement DEB> dysfunction. Or else, let's just shut up and let others make the DEB> referrals DEB> to us as they deem fit based upon what they think we can do or not do DEB> and, DEB> just be limited to working kitchens, patient rooms and bathrooms in the DEB> facilities we work in..........Ofcourse, in home health the reason we DEB> are DEB> not allowed to open a case yet is because according to a US HHS report I DEB> read, nurses and PTs had a wide ranging expertise to 'assess' a client's DEB> needs and ST had a very specific role, hence, they became the qualifying DEB> professions....Ofcourse, the OT's job or the need for OT could be DEB> recognized DEB> by the qualifying professions , so where is the need!!!! DEB> Don't look at what we shouldn't do, see as a profession what all we DEB> should DEB> be doing.......the public will follow and so will insurance companies. DEB> Just my two cents (always a long one). DEB> Joe DEB> ----- Original Message ----- DEB> From: "Ron Carson" <[EMAIL PROTECTED]> DEB> To: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]> DEB> Sent: Sunday, February 15, 2004 4:43 AM DEB> Subject: Re[4]: [OTnow] Response when you explain OT >> Hello Ann; >> >> Maybe you and your associates do practice occupation based therapy. DEB> But, DEB> in >> my experience, you are exceptions to the general rule. I wish that DEB> I DEB> had >> more observations and experiences with therapists such as yourself!! >> >> I am not degrading any specific therapist. I am degrading our DEB> profession DEB> in >> general. My gosh, our profession is nearly 100 years old (older than DEB> PT) DEB> and >> we still can't open a home health case. It seems that somewhere DEB> along DEB> the >> line something has happened to make OT lose creditability with other DEB> health >> care providers and payers. This loss is caused by any one therapist DEB> but DEB> it >> was and still is being cause by a general lack of practice and DEB> apathy DEB> by >> OT's towards occupation. While it's very nice that the AOTA has DEB> generated DEB> a >> framework based on occupation, it's too bad that it took them this DEB> long DEB> to >> do it. >> >> In December, I visited the old rehab hospital where I used to DEB> work. DEB> I >> haven't been there in about 3 years. You know what, nothing has DEB> changed. DEB> The >> OT's were still stuck in the corner having clients standing at the DEB> table >> doing the restorator (i.e. Upper extremity bike). I bet if you DEB> ask DEB> the >> department head and maybe even the leading OT, they both would say DEB> that DEB> OT >> addresses ADL's, life roles, etc. And yes, they even do home DEB> evaluations!! >> Howerver, I know from experience that that is just a bunch of lip DEB> service. >> Because what they really do is UE strengthening, cognitive DEB> re-training, >> endurance training, fine motor control, balance training, etc. DEB> Sure DEB> they >> probably do ADL's in the AM, the occasional cooking group and even DEB> community >> outings. But my experience with this rehab facility and ALL other DEB> rehabs >> that I have been to is that on a day to day basis, occupation is DEB> NOT DEB> what >> they do! >> >> What do I hope to accomplish?? Good question. I hope that one day, DEB> OT DEB> will >> do what OT says it does. Granted there will always been room for DEB> individual >> practitioners to see things differently than the mainstream but I DEB> hope DEB> that >> by bringing my experience and opinion to the forefront that one day DEB> there >> will be continuity among our profession. Additionally, I want to DEB> better >> understand my profession's practices, not practices like NDT, but DEB> like DEB> how >> does our profession work as a whole. Finally, I hope that by DEB> stimulating >> conversation, some of which can be negative, that readers will at DEB> least >> consider their day to day practice of OT. >> >> To me, what is happening in our profession is like a dirty secret DEB> or DEB> the >> elephant in the room. It is my feeling that most people know DEB> that DEB> in >> general, many OT's don't practice the way we advertise. But they DEB> either >> don't want to or don't know how to say anything about it. Over the DEB> years, DEB> I >> have gotten into many tirades over the way we practice. During each DEB> one, DEB> I >> receive both negative and positive responses. If nothing else there DEB> has DEB> been >> conversation about what I perceive to be a problem. >> >> I started OT school in 1994. Over the past ten years, I have had DEB> numerous >> roles relating to OT. I have been everything from an OT student to DEB> an DEB> OT >> educator and have had two private practices. I have worked in DEB> rehab, DEB> long >> term care and hospice. With very few exceptions, I have never ran DEB> into DEB> a >> situations where people around me understood the role of OT. In my DEB> opinion, >> there are reasons why people don't understand OT. As far as I can DEB> tell, DEB> the >> primary reasons are because OT's don't understand it and don't DEB> practice DEB> it >> and yet they call themselves occupational therapists. Something DEB> somewhere >> has got to give. With the PT profession coming on strong, NOW is DEB> the DEB> time >> for OT's to identify a common treatment outcome that is DEB> unique DEB> and >> sophisticated enough to be reimbursed by insurance. I've said it DEB> before DEB> so >> this isn't news, but OCCUPATION is that treatment outcome. >> >> Thanks for writing and sharing your opinion. I am enjoy being DEB> challenged DEB> and >> hope that YOU will not find anything I have written to be DEB> 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 DEB> itself. DEB> One of >> >> AOTA's greatest slogans is that OT "Teaches skills for the job of DEB> living". >> >> Personally, I have met very few OT's who address the job of DEB> living. By DEB> far, >> >> most are addressing skills needed to move arms and then leaving DEB> it DEB> 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 DEB> lined DEB> up. I >> >> have been an OT since 1997 and I have never once felt that our DEB> professional >> >> organization, academicians and clinicians were ever on the same DEB> page DEB> or >> >> even >> >> in the same book. >> >> >> >> I don't think my displeasure with OT is about being a good DEB> or DEB> bad >> >> therapist. I have met OT's who were good at what they did but what DEB> they DEB> were >> >> doing was NOT OT. A person can be good at something but DEB> it DEB> 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, DEB> Ron? DEB> You >> Dac> are *once again* making sweeping generalizations about the entire DEB> profession. >> Dac> While I'm sure there are OTs only working on upper extremities in DEB> any DEB> vicinity, >> Dac> I doubt the majority of OTs make it their sole mission. I manage DEB> a >> Dac> department, and every OT that works for me, as well as every OT DEB> I've DEB> ever interviewed >> Dac> for a job(over the last 17 years) has been able to articulate DEB> and/or >> Dac> demonstrate an approach that addresses the patient's needs and DEB> interests in ADL's, >> Dac> IADL's, and life roles. We have an apartment in our department DEB> that DEB> includes a >> Dac> kitchen, bath, bed and living room, and the folks in my DEB> department DEB> spend many >> Dac> hours with the patients working on activities that have nothing DEB> to do DEB> with upper >> Dac> extremity exercise. This is not to say they never address UE DEB> strengthening, >> Dac> just that it is secondary to the primary goals they have DEB> established DEB> with their >> Dac> patients. We have a community re-entry program, working with the DEB> patient on >> Dac> buying groceries, going out to lunch, etc. We have a driver DEB> assessment >> Dac> program, to address an occupation that is very relevant to any DEB> person DEB> with limited >> Dac> access to public transportation. We occasionally do home visits, DEB> to DEB> assess and >> Dac> assure that the patient will be able to function in their home DEB> environment >> Dac> safely and as independently as possible. We are not alone in DEB> these DEB> programs - >> Dac> there are other rehab. hospitals in the region who address the DEB> same DEB> 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 DEB> denigrating the >> Dac> rest of the people who happen to have chosen the same profession DEB> you DEB> have, >> Dac> but I can't envision anything constructive emerging from it. I'd DEB> much rather >> Dac> see OT's work together to build on our unique, holistic approach DEB> to DEB> our >> Dac> patients, and figure out how to make the reimbursement entities DEB> 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: DEB> http://otnow.com/mailman/listinfo/otlist_otnow.com >> >> The OTnow Mail Archive: >> www.mail-archive.com/[EMAIL PROTECTED] >> =============================================== >> DEB> _______________________________________________ DEB> To unsubscribe, visit: DEB> http://otnow.com/mailman/listinfo/otlist_otnow.com DEB> The OTnow Mail Archive: DEB> www.mail-archive.com/[EMAIL PROTECTED] DEB> =============================================== DEB> _______________________________________________ DEB> To unsubscribe, visit: DEB> http://otnow.com/mailman/listinfo/otlist_otnow.com DEB> The OTnow Mail Archive: DEB> www.mail-archive.com/[EMAIL PROTECTED] DEB> =============================================== _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
