Hello from a long time lurker, first time poster. I am one of those OT's being 
criticized for having patients play cards, stand and fold/hang up laundry, etc 
for standing tolerance. I don't do these activities because I am lazy, but am 
actually trying the best I can to be functional in less-than-ideal environments 
and situations. First of all, I never learned real-world OT activities that are 
truly functional. In school, every case study had two things in common; the 
first is that there was some hidden passion that was just waiting to be 
discovered by the OT (she used to love water painting, or something like that) 
the second was that there seemed to be unlimited time in which to engage 
patients, and facilities with unlimited funds and space. My fieldwork 
placements were very medically oriented and did not give me much in the way of 
functional treatment ideas.  


So in my situation, I work in a SNF. Most of the patients we see are long-term 
or live in the ALF side. We have a tiny gym, no kitchen, no ADL suites, and 
limited equipment. I do a.m. ADL's as much as I can, but can only do 1-2 in the 
morning (all residents have to be in the dining room by 8). Sure, I have 
patients get things from dressers and work on transfers in the gym, but the 
reality is that I have 6-8 people in the gym at once (the PT and I do not split 
treatment but treat everyone in the same room, basically together). The things 
mentioned about take all of 15 minutes, but I have to see these patients for an 
hour. I always try to find out their interests both now and before they lived 
in the nursing home but it is often without much success. 


I am not making excuses, rather I am asking for ideas. I am always searching 
the net and journals for more functional treatment ideas, and do not find much. 
On the boards, I see a lot of "OT's shouldn't do that, we should be more 
creative" but that is easy to say without offering any solutions. I also see a 
lot of "well, go to Home Health" but obviously we can't all do that, and I 
enjoy the SNF setting. What I am asking for with this post is real-world ideas. 
I am hungry for them but see little offered. Ron, how about doing a seminar? 
Most of the seminars offered are medically oriented but offer few functional 
treatment ideas. What do others in my situation do? 


Thanks, 
Ilene from Jersey
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