Linda, Ron and all,
I work in SNF and the issue of ADL and showers comes up a lot. My thought is
that ideed there are some patients that it is too soon to work on showers....so
there should be no goal in the treatment plan for showering at that time.
Sometimes basic grooming and washing and dressing are challenging and engaging
enough to match the patients capability. Goals should be set for this type of
activity. This is a clinical judgement. It is a matter of activity analysis
and grading of activity which takes some critical thinking and logical
progression. Eventually the goal of completing a shower with assistance would
come as a progression and be an appropriate challange.
If you take a patient and hose them down and scub them up and dry them off
such that they are a passive receiver of the shower, it would be unethical to
bill for therapy for that type of treatment and we couldn't call it
occupation-based either. People don't improve function by being in the
presence of occupation but by engaging in it. There is sucha a thing as too
much too soon which is a big waste of therapy time. On the other hand just
taking patients to the gym and randomly doing puzzles and playing cards isn't
right either.
WIth all due respect, I don't think blanket rule about "OT must bathe the
patient once a week makes a lot of sense...a bit of rigid overkill" which
implicates that there is no thought, or decision-making skills required to
plan, analyze and progress the patient in logical and effective manner. In that
case the therapist is not needed . But, believe me I do understand and relate
to the frustration managers have with who don't seem to "get it" about
occupation. Staff education, inservicing, skill building, mentoring, and team
building are oftern required to keep a team fresh and dynamic and out of bad
habits. Besides...its important to look at outcomes, if patients are
progressing to the point where they can shower independently and go
home....somebody must be doing something right..who are they and what are they
doing? Eliminate those thiings that don't need doing.
"There's a time for everything under the sun" It's a gradual and
logiccal process.
SIncerely, submitted wtih respect
Brent Cheyne OTR/L
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