Hi
I was really glad to read your email. You are right there are a lot of Dor's 
that really force productivity on therapist. But we have to remember that at 
the end of the day it is our clinical judgement to do what is appropriate or 
not. Productivity should be considered but shouldn't  be the only 
consideration. We have be able to judge wether its appropriate to do group or 
concurrent treatments with certain patients or not. Most of the Dor's that I 
work with know that I work this way so they never give me a case load that is 
more than what is necessary. Thank you. 

Jerome

On Aug 17, 2007, at 9:55 AM, [EMAIL PROTECTED] wrote:

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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