Hi Brent! Glad to hear about your community re-entry program and to maybe get a chance to contribute. I'm not totally clear whether: 1: this is an "all or nothing" program - say, if someone truly isn't into any cooking, can they skip it? 2: how much of the program is done in a group and how much is individual sessions?
IMO, needs would differ a lot, according to both previous lifestyle and what problems they now have. Examples: IMO certain group outings during rehab are especially important if the patient has acquired a visible disability. Like, maybe needing a wheelchair, maybe needing help eating or special eating utensils. Going out eating in a restaurant first time, chances are you're going to be extremely self conscious - sure people are looking!! Plus there are new difficulties to work around - access, room to maneuver, table heights, toilet visits etc. Chances are, if you don't go on a group outing (or hear about others doing it), you'll never get around to doing it yourself. Sure you as their OT will have a clue about who "needs" the group outing, and who'll get there eventually by themselves - perhaps dragged by relatives:-) (In the latter case, I'd offer to provide them with the resources to research access etc). Same about the shopping and cooking - I'd look at how I see their needs, and, at least at first, go easier on those that may look to manage in another way. Maybe just offer a session on making coffee and heating a meal - if there are security issues, explain that this is part of what you want to check out. Also - a starter for you making those judgements might be an AMPS test - now, if you find a lot of difference between what they say they can do and what the test says..: They may then need a lot more than an outing! (And their opting out of the program thus a meaningful sign to you). You asked: > Why do so > many of our clients not take advantage of beneficial > services that are functionally based? Yeah - maybe we are sending them mixed signals (as you also mentioned). I wonder, since you wrote that his program is offered to patients that are preparing for discharge - that is, I take it, late in the rehab stay - if it'd be more useful for bits and pieces of this to show up much earlier. Like, if there are any concerns on anyones part about how the patient will manage in the kitchen, why not go there sooner? An approach I remember from working in a hospital setting is this: First time I met with a patient out of bed (might have met before while he/she was bedridden), I'd arrange for us to meet in the OT department's kitchen. And I'd tell my patient that my plan was for us to make a cup of coffee together - "also so that I can see how you manage with this" (pointing to whatever walking aid/cast etc he/she might be using) - "then let's sit down and talk about how we proceed from here". And by the time we started the interview and the planning, I'd already have lots of kitchen observations to refer to.... Any of this useful? - I'd be glad to read your feedback and ponder it! Warmly susanne, OT in denmark ---- Original Message ---- From: "Brent Cheyne" <[EMAIL PROTECTED]> To: <[email protected]> Sent: Sunday, August 24, 2008 11:04 PM Subject: [OTlist] Occupation Frustration > 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
