Hi Ron,
I'm hoping for some input and commentary on my experience in practice:
The Progam
I work in a SNF in Sarasota and we have ar really busy and dynamic rehab
team. Last year I started a community re-entry program where the rehab patients
that are preparing for discharge get an opportunity to go on an outting to
practice grocery shopping, car transfers, navigating the sidewalks and crowds
and planning a menu, the whole nine yards! We have a van to transport the
participants, a budget of cash, the time, the staff to do it. and a ADL
apartment and a rehab kitchen to prepare the meal with people.
The Problem
The frustration is in how many people who would benefit from
participation in this program refuse to do it! A lot of the patients seem
resistant to doing these real world activites even though, when they are
discharged ,they will be doing it in some capacity. Some will be returning to
live alone. Some seem threatened by the program, as if the therapist will take
away their independence if they struggle with the task. In reality we are
trying to help them maintain their independence.
THe Excuses
I often hear excuses like...."I'm just here for the exercises, I already
know how to shop and cook." " I've shopped and cooked for years, why would I
want to go and do that now." "I'm here for the therapy not for cooking... and
who wants to do housework..I hate housework." " I eat all my meals at Dennys"
People who need it the most ,want it the least
Usually it is the client that is in most need of involvement in the
community task that is the most resistant. I have many clients that take great
pleasure in participating and see the value in doing it but oftern they are
less in need of the service ore are already more functional. It is the
individual who needs more training and needs to implement adaptive strategies
and equipment that is resistant.
Promoting The Progam Outside and Inside
This makes for hard work and a high tolerance for frustration from the
OTs. It takes a lot of explaining, promoting, and internal marketing and
generating enthusiasm to get particiapants to buy into the program. THere is a
lot of education involved. And there are many PT colleagues that had to be won
over because they also viewed it as a waste of time or "just fun time" but not
useful therapy. We continue to work and energize and improve this program.
Luckily the rehab company we work for is very supportive in terms of money and
resources for the program. It is very validating that the company sees the
value in the progam as a service
A Matter of Perceptions and Concepts
How do we overcome this misconception in the geriatric population about
Occupation Based treatment? Why do so many of our clients not take advantage of
beneficial services that are functionally based? How do we educate and motivate
seniors to buy-in to the value of purposeful activities that meet their demands
for return to prior level of function? On my evaluations, I ask my patients
what their goals are and they say "I just need to get stronger and walk." or "
I want to build up my strength"..."Can you teach me some exercises that will
help me get better?" These people think therapy is like personal training or
something
Some clients will say" I need to go home and get back to my regular
routine"...I love these patients cause I know theyalrady get the OT concept.
Does America look down its nose at ADL?
THe last comment I'll make is that there seems to be a overall loss in
the American culture for basic everyday tasks. Most ADLs are seen as a time
consuming inconvenience or an aggravating hassle....not a life affirming means
to return to health. THe commercial culture in North America tells us that
things should be hassle free, quick, or dealt with a new product or service "so
that you don't have to deal with it".
Honesly, many of my clients don't have many occupations or routines to get
back to doing, they've deligated them to family caregivers or services. THey
suffer from a major deficiency of meaningful activities...which may, in part,
explain their dysfunction and health issues. Without a doubt, motivating the
Geriatric client is often the biggest challenge of my practice.
Thanks for keeping the OTList going
Brent Cheyne OTR/L
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