Brent, I know what's wrong with your program... <LOL> Well, at least I
think I know what's wrong. And the reason is because I once had the
same problem.
My conclusion is that from patients' perspective, what you are
offering is all wrong. Listen to what they say: "I'm here for the
exercises", "I'm here for therapy, not cooking". Your patients are
right, they are not there for cooking!
What MUST happen, is that patients:
1. Must be educated, from day one, that they are NOT there for
exercises. They are there for rehabilitation, which by one definition
is:
"The process of helping a person achieve the highest level of
function, independence, and quality of life possible"
2. Patient MUST understand that cooking, cleaning, bathing, getting
in/out car, up/down steps, in/out of the shower, to/from the food
line, etc IS THERAPY. In fact, it's OCCUPATIONal therapy.
In my experience, until the above conditions are met, you and your
staff are barking up the wrong tree.
Also, if the OT staff is spending much of their therapy time doing
pegs, putty, hand exercises, sanding board (hate that thang), shoulder
arc (hate that thang even more)and then decide to take patients on an
outing, of course the patients are going to want to go. They are going
to feel weird, like why am I doing this cooking while everyone else is
exercising???
Also, most patients in rehab really aren't focused on shopping because
it's not a priority. However, they do want to be able to get in/out of
their homes, cars, tubs, etc. And they do want to be able to get from
point A to point B without assistance.
I bet that occupation-based assessments (COPM, or just asking), will
help identify what is important to patients and will better direct the
staff to which patients most want and outing and thus will most
benefit. It will also better direct therapists to provide optimal
treatment, assuming that the therapist listens to the patient and
actually follows up on what they say.
In rehab, what I think ALL OT's should do is HOME EVAL w/ the patient.
There is SOOOOO much information to be gleaned by taking the patient
into their home. And, the eval needs to be done way before the patient
is discharged. That way, the OT can address real-world deficits within
the confines of the rehab setting.
Ron
----- Original Message -----
From: Brent Cheyne <[EMAIL PROTECTED]>
Sent: Sunday, August 24, 2008
To: [email protected] <[email protected]>
Subj: [OTlist] Occupation Frustration
BC> Hi Ron,
BC> I'm hoping for some input and commentary on my experience in practice:
BC> The Progam
BC> I work in a SNF in Sarasota and we have ar really busy and
BC> dynamic rehab team. Last year I started a community re-entry
BC> program where the rehab patients that are preparing for discharge
BC> get an opportunity to go on an outting to practice grocery
BC> shopping, car transfers, navigating the sidewalks and crowds and
BC> planning a menu, the whole nine yards! We have a van to transport
BC> the participants, a budget of cash, the time, the staff to do it.
BC> and a ADL apartment and a rehab kitchen to prepare the meal with people.
BC> The Problem
BC> The frustration is in how many people who would benefit
BC> from participation in this program refuse to do it! A lot of the
BC> patients seem resistant to doing these real world activites even
BC> though, when they are discharged ,they will be doing it in some
BC> capacity. Some will be returning to live alone. Some seem
BC> threatened by the program, as if the therapist will take away
BC> their independence if they struggle with the task. In reality we
BC> are trying to help them maintain their independence.
BC> THe Excuses
BC> I often hear excuses like...."I'm just here for the
BC> exercises, I already know how to shop and cook." " I've shopped
BC> and cooked for years, why would I want to go and do that now."
BC> "I'm here for the therapy not for cooking... and who wants to do
BC> housework..I hate housework." " I eat all my meals at Dennys"
BC> People who need it the most ,want it the least
BC> Usually it is the client that is in most need of
BC> involvement in the community task that is the most resistant. I
BC> have many clients that take great pleasure in participating and
BC> see the value in doing it but oftern they are less in need of the
BC> service ore are already more functional. It is the individual who
BC> needs more training and needs to implement adaptive strategies and
equipment that is resistant.
BC> Promoting The Progam Outside and Inside
BC> This makes for hard work and a high tolerance for
BC> frustration from the OTs. It takes a lot of explaining, promoting,
BC> and internal marketing and generating enthusiasm to get
BC> particiapants to buy into the program. THere is a lot of education
BC> involved. And there are many PT colleagues that had to be won over
BC> because they also viewed it as a waste of time or "just fun time"
BC> but not useful therapy. We continue to work and energize and
BC> improve this program. Luckily the rehab company we work for is
BC> very supportive in terms of money and resources for the program.
BC> It is very validating that the company sees the value in the progam as a
service
BC> A Matter of Perceptions and Concepts
BC> How do we overcome this misconception in the geriatric
BC> population about Occupation Based treatment? Why do so many of our
BC> clients not take advantage of beneficial services that are
BC> functionally based? How do we educate and motivate seniors to
BC> buy-in to the value of purposeful activities that meet their
BC> demands for return to prior level of function? On my evaluations,
BC> I ask my patients what their goals are and they say "I just need
BC> to get stronger and walk." or " I want to build up my
BC> strength"..."Can you teach me some exercises that will help me get
BC> better?" These people think therapy is like personal training or something
BC> Some clients will say" I need to go home and get back to my
BC> regular routine"...I love these patients cause I know theyalrady get the
OT concept.
BC> Does America look down its nose at ADL?
BC> THe last comment I'll make is that there seems to be a
BC> overall loss in the American culture for basic everyday tasks.
BC> Most ADLs are seen as a time consuming inconvenience or an
BC> aggravating hassle....not a life affirming means to return to
BC> health. THe commercial culture in North America tells us that
BC> things should be hassle free, quick, or dealt with a new product
BC> or service "so that you don't have to deal with it".
BC> Honesly, many of my clients don't have many occupations or
BC> routines to get back to doing, they've deligated them to family
BC> caregivers or services. THey suffer from a major deficiency of
BC> meaningful activities...which may, in part, explain their
BC> dysfunction and health issues. Without a doubt, motivating the
BC> Geriatric client is often the biggest challenge of my practice.
BC> Thanks for keeping the OTList going
BC> Brent Cheyne OTR/L
BC>
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