hi, i am a new OT and spent the summer working in a snf. i loved the patients and the staff i worked with were all caring and creative. While I agree that OT is not just upper extremity work I think it's a shame to spend so much time defending or trying to make people understand a philosophy and take that time and put it toward real issues. I always tried to make treatment sessions relevant, and what is important to one patient isn't to another. for example, I would gladly spend time problem solving with a patient on being independent in don/doff shoes and socks if that was important but some people say right now that isn't a priority to me or someone will help me with that when I'm home. but I'd really like to be able to make a cup of tea. all right then, we'll focus on that. OT involves dynamic interaction with the environment, which includes UE and LE. a patient said, well someone will give me a shower, and my sister will cook for me, so I said, well are you going to sit up in bed and get out of the bed. she laughed, but I explained that OT would help her learn and practice these skills so she'd feel comfortable doing these things at home. all this said, I see staff burn out when meeting minutes just keep piling on and on - 600 minutes in a day - 120% productivity - !! - meet that and more is added - working with 4 patients in one session, not in a group session. caseloads are switched to meet more minutes so that it doesn't matter what relationship you've developed over the course of a few weeks, you may come in one day and find that patient off your caseload now. staff and patient morale suffer. the mindset of the dor is getting the money - this makes for terrible OT. I joinged this list hoping to learn from experienced therapists and hear about a wide range of experiences and opportunities. Linda
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