"My other curiosity is why, if people are having such 
negative OT experiences in rehab, they bother to come for
 more OT once discharged?"
Jeanne, you pose an interesting question, and one that is pretty easily 
answered.  For the population covered by Medicare A , which is the main payer  
for physical rehabilitation for the largest portion of the population receiving 
OT services, it is ignorance plain and simple. Most of these clients have no 
idea what the MD's order; many a time I go to do a home care OT eval and my 
clients will balk that they didn't know the doctor ordered home care let alone 
OT.  So in a sense they are somehat a captive audience. And since under the 
part A benefit they cannot be balanced billed, the see no direct out of pocket 
cost associated with OT.    So, although they may hate or love their OT, until 
our clients have more connection to the investment versus outcome assoicated 
with OT, we will continue to offer in some circumstances a mediocre product 
with not much accountability, because the market will bear it.  I am surprised 
quiet frankly that Medicare hasn't demanded more from the
 profession.  

When I teach OT students, my mantra is always "would YOU pay out of pocket for 
your service? Would others see the value in what you are doing with their loved 
one? Would there be enough face validity to your interventions that you could 
feel good about what you are doing and what you charge for the skilled service? 
"  If you can't answer yes to these questions, then in all likelihood you are 
not offering a skilled intervention and will burn out in this field"

After 15 years in this profession, I have really come to the conclusion that 
many OT's in adult and geriatric rehab are not that invested in truly operating 
as professionals. They want the paycheck and some sort of prestige, but they 
don't hold up their end of the equation by continuing their educations, using 
the best  evidence and offering their clients a truly unique and skilled 
service.  And they can get away with it because the patients/clients don't know 
any better and don't have to yet.     If there were even a $5co -pay under part 
A for every therapy visit/session, this situation would change in a heartbeat, 
because the clients would demand better from us, and we would have to deliver 
to remain viable as a profession.

The real question is: do we continue to "feast" on a sinking ship or do we 
abandon sloppy practice and hold ourselves accountable before we are forced to 
do so? In my mind that is what makes a real professional. 


Terrianne

JM <[EMAIL PROTECTED]> wrote: <
they were supposed to do, they would make a big difference in patient's 
lives".>>

I would also be interested in knowing what the sister believes O T's are 
supposed to be doing.... a lot of people don't even know what OT is.  My 
other curiosity is why, if people are having such negative OT 
experiences in rehab, they bother to come for more OT once discharged? 

I would be very uncomfortable working in a SNF where I was not allowed 
to address mobility in regards to ADLs....I have been fortunate to never 
have been pigeon-holed in that manner.  Currently in my inpatient acute 
setting, I am constantly working on educating other staff that I am not 
a "PT" because I happen to get people out of bed-----Unfortunetly, I 
follow several OT's that never got people out of bed--fairly useless in 
my opinion

On another topic, I am arranging activities at my facility for OT 
month--I had to cringe when the COTA was wanting to bring the cones and 
the arc to the demonstration table as OT modalities.  I don't use these 
things as a general rule except with very low level neuro for 
tracking/color recognition and some basic grasp etc.  I gently declined 
in favor of providing information on how not to pack a backpack and fall 
prevention in the community.....Just having items on a table doesn't 
show purpose even when there is one...

anyway, always  intersting to open my OTLIST digests :>

Jeanne Marie

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