I am a recently recertified COTA who has just started a new position working in an SNF. My prior experience was PRIOR to PPS. Whew! What a change! I whole-heartedly agree with Brent's post. I am trying my best to provide skilled treatment, but PPS and productivity standards set by the for-profit sector make that difficult. I joined this list to get more ideas about functional/meaningful activities to do with my patients, so it has been very painful to read the extremely judgemental discussion about "bad" treatment! I already feel uncomfortable with some of the choices I have to make each day. I am hoping that as I learn to juggle better, I will be able to provide a higher percentage of meaningful tx. So I would appreciate any and all concrete suggestions from those who work in a similar environment, and less of the judgement based on uninformed assumptions. Thank you. Barb Howard Grand Rapids, MI
-------------- Original message -------------- From: [EMAIL PROTECTED] > Brent, > I believe the criticism originally came from Ron in regards to a therapist in > a > rehab hospital.? We?can all be?guilty of poor rehab at times no matter what > practice setting.? I responded to warn people of potential fraud that > therapists > might be committing and not even realizing it. > > Chris Nahrwold MS, OTR > > > -----Original Message----- > From: Brent Cheyne > To: Ron Carson > Sent: Tue, 2 Dec 2008 6:40 pm > Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! > > > > ??? Some further thoughts on OT?practice in the?SNF. However critical and > disappointed some of us who don't work in SNF feel about the pracitices of > those > who do, keep in mind that each practice setting has its own unique challenges > and limitations. > ??? The PPS system has the RUG system where the highest reinbursment is for > those patient who participate in as much as 360 minutes of OT a week.. > That's? 6 > days of 60 minute sessions, so if a person stays for a month they receive 24 > hours (?1440 minutes) of OT in a month. And this process is multiplied > got?each > OT practitioner?by a caseload (lets say for average) 7 patients per day.?Each > minute of each session is structured and guided by the therapist while > navigating a complex system of all the other therapies, nursing care, and > scheduling taking place?within the facility. > ??? This means there is a lot of therapy? being provided and?therefore a lot > of > designing and implementing and documenting interventions. Making every? > minute > of every session wonderful, meaningful, enjoyable, and occupational is quite > a > challenge. I venture to predict that rehab professional in SNF spend more > time > with their clients than any other professionals in the whole healthcare > system! > Other posts on this list have also observed that the SNF rehab client is not > always the most motivated of clients either and clients are often unable to > identify meaningful occupations on which to base treatments. > ???? Due to reasons explained previously in my other recent post, and the > factors above, some patients might have incidences of "bad OT".? Given the > shear > abount of time spent in treatment, the odds of having some non-meaningful?or > bad > experiences are? pretty high. > ???? I think any of us can identify unsatisfactory experiences with > healthcare > and other professionals on occasion. I personally have had?occasional > frustration and disappointment?at the dentist, doctor, optometrist, or even > with > the waiter at a restaurant. I think on average there are a lot of hard > working > OTs > in SNF doing a great job! Of course we always hear about the worst and best > therapy experiences that people have. > ? While all the criticism, judgement and discussion ongoing in the OT > community > may be necessary to encourage us to focus on occupation, there is no shortage > of > equal scrutiny by our administrations and regulators who have there own > definition of what expected and required of OTs. Keeping everyone satisfied > in > no easy task and I think "bad OT "is more a function of being overwhelmed > than > being lazy. Let us find a way to support and encourage eachother! > Brent C > > > > -- > 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]
