I understand your comments but I guess I have to clarify.....I would never ask an OT to do the job of a tech or a nursing assistant and simply give a patient a bath who can not participate at all. I do agree that it would not be right to charge for that service. However, I DO think that it is partially OT's role to work with nursing, especially when these patients first come to the unit, to make sure that the nurses are setting up the bathing situation so that the patient CAN participate, so that it does become as functional as possible. After all, this is the concept of providing 24 hour REHAB care on a CARF accredited unit (they don't really expect therapy to be there 24 hours, they expect nurses and therapists to work together and the nurses to carryover plans/goals). Our nurses and OT's work together well most of the time, but the nurses sometimes place the patient in a more dependent position for some of these types of ADL's than they need to be...usually due to lack of knowledge....not a lack of desire. We are, after all, the experts on adaptation and function. For example, maybe they need the OT to suggest using a bench that will allow the patient to weight shift and clean their own bottom rather than a chair that holds them in and does not let them do for themselves. Maybe they need to be educated to let the patient with a left hemi use the right arm to wash the left arm so they develop more awareness, etc. However, if the OT says "that patient is to low level to really do the shower" then they are not intervening at all until the patient is stronger, better, and can do more for themselves. And the focus of the 'strengthening' becomes gym tasks rather than functional tasks...
I guess I also have to stress that we are an acute rehab unit. Our average length of stay is about 14 to 17 days....so for most of our patients, this would still only be one or two baths in a stay. I am just looking for a way to get the OT's to get involved in these kinds of things earlier. If they help nursing and the patient is in the best position, and doing the most for themselves, than they can quickly reassess that a week later and see if there is any need for further adaptations or any other opportunity for more functional participation by the patient. The way this has been discussed is that they would work WITH the nurse or nurse assistant for bathing initially. I guess this is what I am looking for and am getting some resistance. Now I also fully agree that if bathing is not a goal of the patient or family that it does not need to be done by the OT. I also fully agree that if the patient has been doing 'sponge baths' for years, that the OT should work on that skill and not the act of taking an actual shower. However, sometimes I really feel that this is just an issue that the therapists don't like to do baths, they don't like to be out of the gym and away from the others, and so they resist and say "the patient is not high level enough"....and do one bath the day before discharge and then say they have 'addressed' bathing needs....and maybe they have from an adaptive equipment standpoint. Those are my comments based on the last couple of emails.... I am still interested in others thoughts... Thank you for your input.... Linda Linda Stovall, OTR/L [EMAIL PROTECTED] Program Manager Memorial Hospital at Gulfport Comprehensive Medical Rehabilitation Program 228-867-4179 228-867-5357 (fax) 228-883-8443 (beeper) A CARF (Three-Year) Accreditation was awarded to MHG for the following programs: Inpatient Rehab - Adults, Adolescents, and Children Inpatient Rehab- Stroke Specialty >>> "Neal Luther" <[EMAIL PROTECTED]> 9/9/2008 3:02 PM >>> You're right Brent. It's analogous to OT orders for splinting...its reductionist thinking. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of [EMAIL PROTECTED] If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Tuesday, September 09, 2008 3:47 PM To: [email protected] Subject: Re: [OTlist] OT role in ADL 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
