Hello Carmen: There are two areas in which I think OT best fits:
1. Pediatrics 2. Mental health In my experience and opinion, OT is not a good fit for adult physical dysfunction. Not that it can't be, it just isn't at the moment. I agree that people do seek OT services but in my experience, this is primarily because they have an UE problem, cognitive dysfunction or a SI problem. Insurance does reimburse for OT services but as we all know, OT lags behind PT in many areas. We are very fortunate that Medicare recognizes our profession, but it would only take one swipe of a pen to eliminate our role. Let us not forget APTA's ongoing drive for Medicare direct access. Should that happen and OT get left off, we will really be behind the power curve. And given that OT can still NOT open a home health case, I will be greatly surprised if OT is included when PT gets direct access. OT is HERE today but we have not really arrived. Carmen, I appreciate your enthusiasm, but I can hardly even remember one person who has recognized OT as being specialists in occupation. The word occupation is NEVER mentioned in any Medicare document except for as it relates to occupational health. And keep in mind, OT is NOT a required service for Certified outpatient Rehab Facilities. Here's a couple excerpts from Medicare's Benefit and Policy Manual - Chapter 12: PT> A qualified physical therapist has the knowledge, training, and PT> experience required to evaluate and reevaluate a patient's level of PT> function, determine whether a physical therapy program could PT> reasonably be expected to improve, restore, or compensate for lost PT> function, and recommend to the physician a plan of treatment. OT> Occupational therapy is a medically prescribed treatment to improve OT> or restore functions that have been impaired by illness or injury OT> or, when function has been permanently lost or reduced by illness or OT> injury, to improve the individual's ability to perform those tasks OT> required for independent functioning. Call me crazy, but I don't see how OT's speciality is recognized. In fact, OT sounds almost identical to PT, doesn't it? There certainly is enough of a difference that the average person could discern any difference. There is a reason why OT is often seen as PT for the UE; that's because many, many OT's practice that way. But, we didn't just wake up one day and find ourselves pigeonholed into this situation. It has taken at least one, maybe two generations of previous OT's to practice as upper extremity PT's before it became the norm. Carmen, in my opinion, WE are NOT AOTA. In fact, part of AOTA's role is to do things that we as individuals can not do. I am ONE of AOTA's members, but I am not AOTA. Individual practitioner are not enough to make the needed changes, because much of the change is at the national and state policy levels. This level of change requires AOTA, at least for the most part. I don't deny that an individual practitioner can effect a policy change, but doing so is not the norm. We pay our dues to AOTA because they are a member organization and that has clout! Ron ----- Original Message ----- From: Carmen Aguirre <[EMAIL PROTECTED]> Sent: Friday, April 28, 2006 To: [email protected] <[email protected]> Subj: [OTlist] Occupation CA> Strongly disagree. CA> Our specialty IS recognized by patients who seek and agree on CA> the benefits of our intervention,; referral sources which consider CA> us important enough to do just that: refer clients to us; Ins Co's CA> which pay ( if they did not recognize OT, $$ would NOT be sent our CA> way!) and physicians, nurses, other professionals . CA> I get the impression this discussion is "stuck" in the CA> bio-mechanical FOR. Are we stuck in the things OT can not do? CA> What about the world of difference OT makes in Mental Health CA> practice, Pediatrics, Geriatrics, and others, where MOHO, CA> Occupational Science; etc, are heavily applied . CA> If Occupational Therapy were not recognized here and now, we CA> would not be here today! The various changes/opportunities MCR and CA> other Ins. Co's have implemented to their policies, precisely CA> because of OT contributions, would not be available to us... CA> Are we making a positive difference in the lives of the clients CA> we treat on not? If not, why are we still practicing... CA> I am thinking of prior discussions about AOTA and cost of CA> membership: How would those " doing something " efforts be paid for? CA> Some practitioners don't even want to be members because of the CA> dues... CA> I believe that WE are AOTA and it is in our hands to create the CA> changes..."do something", one doctor in the elevator at a time, one CA> passer-by in the street at at time. The alternative is from this day CA> forward, to mis-educate consumers that OT is like PT but for the CA> upper extremity! CA> Carmen CA> ----- Original Message ----- CA> From: Ron Carson<mailto:[EMAIL PROTECTED]> CA> To: Joan Riches<mailto:[email protected]> CA> Sent: Friday, April 28, 2006 4:59 AM CA> Subject: Re: [OTlist] Occupation CA> Hello Joan: CA> I think I understand what you are saying about OT's being specialists in CA> occupation, but the system in which we work (system includes: patients, CA> referral sources, payers, other providers) does NOT recognize this CA> speciality. Having a speciality that is not recognized by others is of CA> little value. In our beginning, OT's speciality in occupation was CA> recognized and highly valued, but over the years, this speciality and CA> valuation has been lost. Again, I think this is our problem and is CA> exactly why SOMETHING must be done by AOTA. CA> You said: CA> quote > Part of our problem is that occupation is present in EVERYTHING CA> quote > that anyone does. Our special expertise is that we see that. CA> then went on to say: CA> quote > Many people can do their own OT interventions. CA> On one hand, it seems that occupation is OUR speciality and the other CA> hand, it seems that almost anyone can do it - these statements appear CA> conflicting. CA> Joan, I understand your dentist example, but I don't think that is how CA> most people think. Most people, including me, think; my tooth hurts, who CA> can help me? I wish things were the way you described but my reality is CA> that they are not. CA> One of OT's claim to fame is the use of therapeutic occupation (i.e. CA> using teeth brushing as the agent to improve dynamic standing) Your CA> comments seem to point against the use of occupation as a therapeutic CA> agent, at least in the below example. CA> Great dialogue, CA> Ron CA> ----- Original Message ----- CA> From: Joan Riches CA> <[EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]>> CA> Sent: Thursday, April 27, 2006 CA> To: [email protected]<mailto:[email protected]> CA> <[email protected]<mailto:[email protected]>> CA> Subj: [OTlist] Occupation CA> JR> Right Ron CA> JR> The dentist is a person with a profession who has a specialised expertise CA> JR> just like us. The dentist looks at a toothache with dentist eyes. The CA> JR> occupational deficit is implicit in the dental problem but it is not her CA> JR> expertise to address it - just as (unlike the OT/PT confusion) it is not CA> JR> part of our expertise to address the toothache per se. CA> JR> Part of our problem is that occupation is present in EVERYTHING that anyone CA> JR> does. Our special expertise is that we see that. I am remembering my own CA> JR> frustration when in Home Care I kept walking into situations where VERY CA> JR> OBVIOUS simple things were working against the client or compromising CA> JR> safety. Finally I realised that those things were not obvious to either the CA> JR> nurse or the client. It took OT eyes to see them and make them explicit and CA> JR> that is why I was there. Value your OT eyes. They are special. They are what CA> JR> make us specialists in occupation. They have become so much a part of us CA> JR> that we take them for granted. CA> JR> There is a problem our profession has that many others do not have. Many CA> JR> people can do their own OT interventions. You have described a lot of them. CA> JR> We do go to the dentist so we can eat corn on the cob. We've unconsciously CA> JR> done the assessment and identified the component that needs to be addressed. CA> JR> Then we name the component as the problem in order to access the specialty CA> JR> that can address it. CA> JR> The difference between us and the dentist is that dentistry is not embedded CA> JR> in all of life. The people who need us are those whose unconscious CA> JR> assessments are incomplete; for whom return to 'normal' is compromised by CA> JR> factors they do not have the expertise to consider; or whose present CA> JR> distress can be alleviated by practical means while natural or medical CA> JR> healing takes place. CA> JR> Quote from Michael "When given the choice of brushing their teeth standing CA> JR> at the sink (or) performing resistive standing exercises in parallel bars in CA> JR> most cases pt choose the exercises." I would too. I want to get my mouth CA> JR> feeling fresh and it's easier and more satisfying to do with the CA> JR> environmental modifications of sitting down with a glass and kidney basin. CA> JR> Struggling to do it standing at the sink compromises my occupational goal of CA> JR> a clean mouth and makes me feel inadequate. I'd sooner work on the standing CA> JR> separately in a social atmosphere where it is the prime concern. Someone CA> JR> (like us) needs to notice when I can stand well enough to use standing to CA> JR> support teeth brushing and encourage it. At that point standing ceases to be CA> JR> an occupation that requires my full attention and becomes a component to CA> JR> support dental hygiene. As I recover, dental hygiene will cease to be an CA> JR> occupation and become a component as well. This is called client centred CA> JR> practice. It's about not confusing our goals with the client's and then CA> JR> getting frustrated because we think our goals are more important. Lots of CA> JR> people will progress to standing at the sink on their own. We can help them CA> JR> by noticing and making the progress explicit since most of them will be CA> JR> focusing on the things they still cannot do 'nornally'. CA> JR> Wow has this discussion ever taken off. It's hard to keep up. Such a joy to CA> JR> have a place to struggle with these questions and others to 'listen ' with CA> JR> OT ears. Sorry if I'm pontificating. It's exciting to be so stimulated. CA> JR> Joan Riches CA> -- CA> Unsubscribe? CA> CA> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> CA> Change options? CA> CA> www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> CA> Archive? CA> CA> www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]> CA> Help? CA> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> -- Unsubscribe? 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