I'm going to AOTA conference. I'm hawking my new book so you can find me in the exhibit hall. GR Publications. Estelle
Estelle B. Breines, PhD, OTR, FAOTA 15 Hibbler Road Lebanon, NJ 08833 908 735-8918 908 730-8919 FAX 908 797-6301 Cell -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Tuesday, March 28, 2006 7:48 PM To: Dr. Estelle Breines Subject: Re: [OTlist] Disturbing Message, Please Respond I thought about searching the archives to find maybe one post where we agreed, but I decide that it was a fruitless search <laugh>. One day, I may just give you a call! Don't forget my name!! Ron ----- Original Message ----- From: Dr. Estelle Breines <[EMAIL PROTECTED]> Sent: Tuesday, March 28, 2006 To: [email protected] <[email protected]> Subj: [OTlist] Disturbing Message, Please Respond DEB> Ron, although we never seem to be able to agree. Someday we should have DEB> a long chat. Estelle DEB> Estelle B. Breines, PhD, OTR, FAOTA DEB> 15 Hibbler Road DEB> Lebanon, NJ 08833 DEB> 908 735-8918 DEB> 908 730-8919 FAX DEB> 908 797-6301 Cell DEB> -----Original Message----- DEB> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On DEB> Behalf Of Ron Carson DEB> Sent: Monday, March 27, 2006 9:44 PM DEB> To: Dr. Estelle Breines DEB> Subject: Re: [OTlist] Disturbing Message, Please Respond DEB> Dr. Brienes, I appreciate your opinion but I see things a little bit DEB> different. >>From my experience with Medicare Part B, insurance companies are DEB> NOT DEB> looking for the language of OT. Of course, we first need to define what DEB> that language is, but I assume (risky, I know) that you are referring to DEB> the language of self-care, productivity and leisure. Insurance does not DEB> demand that clients have difficulty with cooking skills or home care or DEB> even self-care in order for them to pay for therapy. Insurance demands DEB> progress towards measurable outcomes in a timely manner for medical DEB> diagnoses. That progress can be in either ROM, improvement in balance or DEB> decreased assistance with putting on a shirt. Assuming all other DEB> criteria are the same, insurance should pay for someone who has only 1 DEB> degree of wrist flexion and the goal is to improve it to 45 degrees just DEB> the same as they will pay for someone who has 1 degree of wrist flexion DEB> and the goal is to donn their shirt. DEB> I can also tell you that my Medicare Fiscal Intermediary has point-blank DEB> told me that when the goal is to improve leisure activity, therapy is DEB> NOT medically necessary. Now, some OT's don't work in the medical model DEB> of care, but by far, the VAST majority of us do. And for us, this is the DEB> arena in which OT is faltering, at least in my experience. DEB> Another point that I see different is your statement about using cones DEB> to simulate kitchen activity. I don't necessarily disagree with your DEB> statement but from my experience, using cones is the the mainstay of DEB> most (if not all) OT's working in adult physical dysfunction. In all DEB> honesty, I have NEVER been to a rehab department where I did not see DEB> cones in use, have been told that they are used or seen them prominently DEB> displayed. And I have used a fair share of them myself. Now the reason I DEB> mention this point is not to argue about cones' therapeutic benefits, DEB> but to simply point out the gross misalignment of your point of view DEB> with what I see as mainstream physical dysfunction treatment. Again, I DEB> don't advocate the use of cones, but the contrast between your point of DEB> view and the reality that I've experienced is exactly the contrast that DEB> is occurring at the National levels. I firmly believe that OT has a DEB> white elephant syndrome and your comments sort of bring the situation to DEB> light. Any of us can say that using cones is 'wrong' but when the DEB> majority of OT's practicing physical dysfunction (at least in my DEB> experience) are practicing day in and day out using cones, then there is DEB> something missing between perception and reality. There is a white DEB> elephant in what OT says it does and what it really does!! DEB> Lastly, the clients that I work with are not concerned with things like DEB> shopping, cleaning up, planning menus, reading or measuring. By far, the DEB> majority of my adult patients whom I see either in their homes or their DEB> ALF's are concerned with one thing and one thing only. That one thing, DEB> with a few exceptions, is getting from point A to point B in the safest DEB> and least restrictive manner. And you know, when I worked at a rehab DEB> hospital 5 years ago, I noticed the same thing. Patient with whole body DEB> diseases (spinal cord injury, closed-head injury, CVA, etc) were DEB> primarily concerned with mobility not with brushing their teeth, combing DEB> their hair or putting on make-up). It seems to me that there is an DEB> almost 'primitive' drive in each of us to be mobile and when mobility is DEB> compromised, mobility becomes of central importance. >>From my experience when someone's life is globally effected the DEB> first DEB> priority is mobility. Because if mobility is improved, all the other DEB> stuff is also improved, at least in their eyes. Of course, this may not DEB> be reality and I understand that, but then we come back to insurance DEB> which really doesn't care if someone can plan a menu, read a book or DEB> clean up their house. None of these are MEDICALLY necessary. DEB> Regarding education, one's level of education in no way makes a DEB> therapist better prepared to face the myriad of challenges facing OT's. DEB> I've seen PhD, MOT, BSOT and COTA all succumb to the pressure of trying DEB> to be and OT in a non-occupational world. DEB> Ron DEB> ----- Original Message ----- DEB> From: Dr. Estelle Breines <[EMAIL PROTECTED]> DEB> Sent: Monday, March 27, 2006 DEB> To: [email protected] <[email protected]> DEB> Subj: [OTlist] Disturbing Message, Please Respond DEB>> PTs have adopted our language because that is what the insurance DEB>> companies are looking for. However, just saying it doesn't make it DEB>> so! I can't imagine any OT or OTA worth one's salt using cones to DEB>> simulate kitchen activities. Being able to reach is no measure of DEB>> cooking skills. What about reading, processing, measuring, DEB>> determining what is culturally appropriate, etc.? Who is DEB>> responsible for shopping, cleaning up, etc.? Who plans the menus? DEB>> And for whom? And who is guiding the necessary adaptations? There DEB>> is a marked difference between a profession that is holistic and DEB>> one that is Cartesian, medical model. It's parts versus wholes. Now DEB>> I recognize that there are individual therapists who don't fit into DEB>> these diametrically opposite parameters, but the professions do! We DEB>> hold with very different principles. One would hope that the DEB>> schooling this person receives will cover these issues and make DEB>> these issues clearer than a brief paragraph here. That is the DEB>> distinction between technical and professional levels of education. DEB>> If you want citations, email me at the address below. DEB>> Estelle B. Breines, PhD, OTR, FAOTA DEB>> 15 Hibbler Road DEB>> Lebanon, NJ 08833 DEB>> 908 735-8918 DEB>> 908 730-8919 FAX DEB>> 908 797-6301 Cell DEB>> [EMAIL PROTECTED] DEB>> -----Original Message----- DEB>> From: [EMAIL PROTECTED] DEB>> [mailto:[EMAIL PROTECTED] On DEB>> Behalf Of Ron Carson DEB>> Sent: Monday, March 27, 2006 7:15 PM DEB>> To: [email protected] DEB>> Subject: [OTlist] Disturbing Message, Please Respond DEB>> Hello All: DEB>> Recently, I received a 'disturbing' message from a fellow DEB> therapist. I DEB>> say 'disturbing' because I really don't know how to respond. So, I DEB> asked DEB>> the person if I could post there message and they agreed. The DEB> person is DEB>> on the OTlist but I will leave it to them to disclose who they DEB> are, if DEB>> they wish. DEB>> Please take a minute and read this therapists message and DEB> respond DEB>> accordingly. I really feel this person's pain but I don't DEB> have any DEB>> advice off the top of my head. I think the message is a good DEB> catalyst to DEB>> open a much needed discussion. DEB>> Thanks, DEB>> Ron DEB>> <<<<<<<<<<<<<<< Original Message Follows >>>>>>>>>>>>>>>>>>> DEB>> Hi Ron I am a Cota of 10 years practice in LTC. I am in the DEB> work of DEB>> starting the bridge program at [ommited]this year for OTR DEB> program. But DEB>> for the past few months I may be changing my mind. I cannot help DEB> but to DEB>> wonder what makes OT and PT different from each other. AS I do DEB> research DEB>> on scope of practice in each field I read terms of DEB> functional, ADL DEB>> retraining in self care in home, community or work integration DEB> repeated DEB>> over and over again. I find these term in PT scope of practice. DEB> Goals as DEB>> you know are the foundations of OT. ON many occasion as I work DEB> in the DEB>> rehab room I look over in shock as the PT will perform mock DEB> kitchen act DEB>> such as cones in different areas, bathroom transfers. Which make it DEB> very DEB>> hard to explain to the patient the purpose of certain act to DEB> achieve DEB>> function when PT has already address this. I am amazed of how DEB> many DEB>> doctors will order PT for shoulder injuries. So I am trying to DEB> figure DEB>> out what make OT different from PT. I wonder if years from doctors DEB> will DEB>> just order PT service since the scope of practice are pretty DEB> much the DEB>> same. DEB>> <<<<<<<<<<<<<<<< End of Message >>>>>>>>>>>>>>>> DEB>> -- DEB>> Unsubscribe? DEB>> [EMAIL PROTECTED] DEB>> Change options? DEB>> www.otnow.com/mailman/options/otlist_otnow.com DEB>> Archive? DEB>> www.mail-archive.com/[email protected] DEB>> Help? DEB>> [EMAIL PROTECTED] DEB> -- DEB> Unsubscribe? DEB> [EMAIL PROTECTED] DEB> Change options? DEB> www.otnow.com/mailman/options/otlist_otnow.com DEB> Archive? DEB> www.mail-archive.com/[email protected] DEB> Help? DEB> [EMAIL PROTECTED] -- Unsubscribe? 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