Exactly, Neal! I always ask patients what their goals are, but the majority of the time, I cannot write them down. The insurance companies don't care if a patient can go fishing or play with their kids, and they would never pay for treatment with those goals.
Ron, when reading your posts, I wondered every time if you ever have insurance companies questioning the value of the goals you write, or even refusing to pay? About the only thing they care about with the pain management program is can they go back to work? If they don't at least have the potential to go back to work, or don't want to go back to work, the coverage is denied. Pat -----Original Message----- >From: Neal Luther <[EMAIL PROTECTED]> >Sent: Oct 22, 2008 7:34 AM >To: [email protected] >Subject: Re: [OTlist] Clearly DelineatingOT and PT? > >I think your research is incredibly valuable both to us as a profession >and ultimately to the communities we serve. Here's why. >I'll use one of the areas your research is focused--interpersonal >expressions of caring. Often the aged/elderly population have lost so >many meaningful expressions of "life and love" that bathing themselves >is completely irrelevant. But holding that grand baby in their arms and >rocking them to sleep... now, suddenly that same person is alive with >meaningful occupation. The problem is (as always) third party payers >could care less. And I believe they could not care less because we >(OT's) have not demonstrated to them the value of this occupation and >how it impacts this persons ability to stay engaged...maybe even stay >home longer...maybe even have carry effect to other areas of personal >self care. >Keep it up! > > >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 Sue Doyle >Sent: Tuesday, October 21, 2008 11:02 PM >To: [email protected] >Subject: Re: [OTlist] Clearly DelineatingOT and PT? > > >Just another idea from my OT researcher mind. I have been observing >stroke patients for many years. Many patients can function well to >complete their basic self care tasks one handed. The meaning of having >both arms able to function well goes beyond the basic self care tasks we >tend to focus on. The concepts of communication (how many of us talk >with our hands), self esteem and sense of social acceptance (not being >seen as disfigured or disabled), and interpersonal expressions of caring >(eg hugs etc) are ones that I am currently observing as strong >dissatisfiers for clients post stroke who have otherwise mastered basic >self care but are still unhappy with their current performance levels or >the upper extremity function. > >I am currently designing a research study to further investigate these >concepts. But where does that take us as OTs with treatment? > >Just to spin the record at a slightly different speed. > >Sue> Date: Tue, 21 Oct 2008 22:26:59 -0400> From: [EMAIL PROTECTED]> >To: [email protected]> Subject: Re: [OTlist] Clearly DelineatingOT and >PT?> > If I evaluated a CVA patient (new or old) and they were unable >to> identify occupation goals, they I would d/c them. Recommending PT> >might or might not be indicated.> > No, I do not think we should use >"common sense" to coerce goals.> Occupational goals are not about your >or me, they are about a> patient's perceived needs and values. Just >because we think something> is important, that is no indication that a >patient will agree.> Especially were patients face catastrophic loss of >occupation. What we> value may be meaningless to our patients. Thus, >using a "common sense"> approach can create more harm than good and >leave patient's feeling> utterly frustrated.> > On the other hand, a >skilled OT may need to enlighten a patient as to> the realities of life >with a CVA. Often this is done during the eval,> either through >questioning or actual performance. After a> comprehensive >occupation-based evaluation, it's is my opinion and> experience that an >OT has a very good understanding of a patient's> concerns and thus their >motives.> > I think a LOT of OT success lies in the timing of our >services. If> patients are not willing or able to focus on occupation >then our> success in improving occupation may be greatly diminished. >However,> when patients are focused on lost occupation, and in the hands >of a> skilled occupation-based OT, improvement in occupation performance >is> almost guaranteed.> > Ron> --> Ron Carson MHS, OT> > ----- Original >Message -----> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]>> Sent: >Tuesday, October 21, 2008> To: [email protected] <[email protected]>> >Subj: [OTlist] Clearly DelineatingOT and PT?> > cac> What should an OT >do if the patient identifies that they want to> cac> be able to look to >the left (attention?=body?function)?because of> cac> a right CVA?to >their parietal lobe (body structure)?? They> cac> unfortunately do no >personally state any occupations that they> cac> want to address in >particular.? Should we pass the patient to> cac> physical therapy or >should we "coerce" a few occupational goals?through common sense?> > >cac> Chris Nahrwold MS, OTR> > > cac> -----Original Message-----> cac> >From: Ron Carson <[EMAIL PROTECTED]>> cac> To: [EMAIL PROTECTED] ><[email protected]>> cac> Sent: Tue, 21 Oct 2008 7:59 pm> cac> Subject: >Re: [OTlist] Clearly DelineatingOT and PT?> > > > cac> I've been >spinning this "record" for 10+ years and I'm not about to> cac> stop >now! <smile>> > cac> I also want to add that I have absolutely NO >PROBLEM with OT's> cac> addressing physical limitation. Like you said, >we are shooting> cac> ourselves in the proverbial foot if we stop >treating physical> cac> limitations. However, I have two "buts" to add >this statement:> > cac> But 1: OT must NOT address ONLY upper extremity >physical function. As> cac> occupational experts, we MUST learn to >address the musculoskeltal> cac> function of all extremities. I'm not >sure about the spine, but> cac> definately we must address the LE.> > >cac> But 2: OT must NOT address physical function for the sake of >physical> cac> function. That is what PT does. OT's must address >physical function> cac> from an "empowering occupation" perspective. In >other words, OT's ONLY> cac> address physical function when improving >occupation is the WRITTEN> cac> GOAL of treatment and a specific >physical function is a CLEARLY> cac> identified barrier to a SPECIFIC >occupation.> > cac> For example, if my UE eval had stated something >like: "You know, I> cac> spill food with my left hand and I can't get my >right elbow to bend> cac> far enough to get food in my mouth and I so >want to eat with my right> cac> hand!" Then, Bam! we have a SPECIFIC >occupation that is clearly> cac> limited by physical function.> > cac> >However, OT's must not "coerce" or draw parallels between ABSTRACT> cac> >occupational goals and physical barriers. Goals must be identified by> >cac> the patient, often with the help of the OT. After all, goals >should> cac> state what's important to the PATIENT, not what's important >to the> cac> therapist, or the referring MD. If it's not important to >the patient,> cac> then I don't think OT should be addressing it in >therapy. Again, that> cac> should be a hallmark difference between OT >and other professions.> > cac> Ron> cac> --> cac> Ron Carson MHS, OT> > >cac> ----- Original Message -----> cac> From: [EMAIL PROTECTED] ><[EMAIL PROTECTED]>> cac> Sent: Tuesday, October 21, 2008> cac> To: >[email protected] <[email protected]>> cac> Subj: [OTlist] Clearly >DelineatingOT and PT?> > > cac>> I agree with the delineation provided >by Ron.? As OTs though, we> cac>> need not be afraid to address the >physical limitation that is a> cac>> barrier to the person's >occupational profile.? Funny how we spend> cac>> 100s of dollars a year >on continuuing education that mainly focus> cac>> on the impairment >level, also I might add that these courses are> cac>> usually endorsed >by AOTA.?Funny how AOTA has this article called> cac>> the practice >framwork in which the restoration of?client factors> cac>> a) body >functions b) body structures is clearly outlined.> > cac>> I think the >UE/LE divide has evolved out of professional> cac>> courtesy over the >years mainly in the relm of outpatient> cac>> clinics.? I would have no >objections for a PT to treat a UE/hand> cac>> if they are skilled to do >so.? I would have no objections for an> cac>> OT to treat the LE if they >are skilled to do so (I have?seldom> cac>> heard of this happening >though).? I think the complexeties of the> cac>> of body functions and >structures are large enough that both> cac>> disciplines should share in >the workload of research and> cac>> treatment.? Again, I strongly >believe that to stop treating the> cac>> UE would be professional >suicide for Occupational Therapy, as Ron> cac>> is unfortunately >experiencing firsthand in his quest to become an> cac>> "occupation as >an only?means" therapist.> > cac>> Is this record player broken?? I keep >hearing the same song over and over > cac> again.? Smile!> > cac>> Chris >Nahrwold MS, OTR> > > cac>> -----Original Message-----> cac>> From: Ron >Carson <[EMAIL PROTECTED]>> cac>> To: [email protected]> cac>> Sent: >Tue, 21 Oct 2008 4:47 pm> cac>> Subject: [OTlist] Clearly DelineatingOT >and PT?> > > > cac>> Our most recent discussion leads me to ask this >question:> > cac>> Can you CLEARLY delineate the role between PT and >OT?> > > cac>> My Answer:> > cac>> PT is most indicated when the FOCUS >of concern (by referral> cac>> source and/or patient) is on body parts >or body processes. OT> cac>> is most indicated when the FOCUS of concern >is on human> cac>> oc> cac> cupation.> > cac>> Ron> > > > cac> --> cac> >Options?> cac> www.otnow.com/mailman/options/otlist_otnow.com> > cac> >Archive?> cac> www.mail-archive.com/[email protected]> > cac> --> cac> >Options?> cac> www.otnow.com/mailman/options/otlist_otnow.com> > cac> >Archive?> cac> www.mail-archive.com/[email protected]> > > > --> >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] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
