I have been thinking how to be "concrete" in treatment ideas that I would use in a SNF. This is?for the new therapists out there.? This would be for the general debility patient that we often encounter at SNFs.? I seperated?everything into?four categories for simplicity.? This is not an exhausted list whatsover and completing therapeutic activities, therapeutic exercise, and cognitive training?should only be done if there is an issue with balance/tolerance/strength/coordination/cognition that interfers with a patient's identified occupational goals (ie working on standing balance in prep for pants pull up after toileting or during dressing performance).? I have seen a particular SNF close to the hospital in which I work, whom has excellent OTs and it is not by chance that this SNF is the most popular and busiest SNF around.? They brag a 90% home rate for their skilled beds.? Is the huge success from OT?? I bet they are a huge part of that success!!!!
1.? ADL/IADL: All of the patients identified goals that "occupy their life" in which they desire to get back to in order?to make it back home safely or to improve their quality of life in the nursing home if they are a?lifetime resident. Bathing, dressing, grooming, toileting, toilet transfers, tub/shower transfers, self feeding, home management tasks (laundry, cooking, making the bed, petcare, cleaning the home), medication routine, emergency response safety, car/van/SUV transfers, getting mail, getting their newspaper, community mobility.? The list can go on for days!? It would be imposible to do many of these activities with 6-8 people in a group.? Perhaps two patient's at a time with dovetailing,?rest breaks, and with a good rehab tech. 2. Therapeutic activities.? Basic steps?toward function that helps to make improvements with #1.? Sit to stands from wheelchair, wheelchair to mat transfer, wheelchair to chair transfers, transfers in and out of a numerous sized chairs around the facility, sitting/standing balance activities that encourage the patient to reach out of their base of support in many ways, sitting/standing tolerance activities with timed performance,??gathering clothes from a closet, proper way to pick objects?up with a walker with or without a reacher?The list goes on and on depending on the patient's needs.? Perfect way to group a few patients together. 3. Therapetic exercise/neuromuscular re-education: Basic steps to improve body functions that will hence?make steps in the right direction in #1.?These exercises should not be used unless?it has been found in the evaluation that it is an impairment?a) Strength training: All muscle groups should be worked on, discuss with your rehab team how this should be delegated.? In my facility, it is by tradition that OT work on UE strength issues and PT works on LE strength issues, but you can tell from the above that the LEs are certainly worked on in OT as well, just not with PROM, AROM, and strength training programs.? I tend to spend time strengthening the triceps and scapular depressors because it assists with sit to stands and standard walker mobility big time. I then use a general exercise program to facilitate muscle balance to prevent injury.? All strength training should follow a warm up, stretching program, and end with a cool down.? b) Gross motor/fine motor control-functional reaching, grasping exercise, pinch exercises in the three functional positions.? These exercises are perfect to have a large group. 4. Cognitive training? Working on memory, problem solving, comprehension,metacognition.? I usually use functional activities for this one: Meal planning group, newspaper review group, money management (counting coins, counting paper money, check book, ATM if available, and money problem solving, time management (telling time and time management problem solving), home safety scenerios (picture identification, verbal response hypothetical type questions, action plan for their real life environment), medication routine (often with help from ST and nursing staff) my role sometimes is coming up with compensation techniques for home like a medicaiton check list or a medication alarm watch.? This list goes on and on as well. Hope this helps the newbies a bit.? OT is a great proffession if done right, don't let us pessimists get you down Chris Nahrwold MS,OTR -----Original Message----- From: Diane Randall <[EMAIL PROTECTED]> To: [email protected] Sent: Fri, 5 Dec 2008 8:57 am Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! If I agreed with everything everyone said on this forum, I would not be on it. It would be boring. I am just a student right now and I am learning a lot about the profession from reading these posts. I don't feel qualified to really contribute in the ways that some on here have done because I do not have the experience yet. I want to know what frustrations I may encounter out there in the real world. It is beginning to occur to me that we have to fight for our profession. There are many influences out there from other practice areas that may threaten OT as we know it today. Debate is a good thing. If you disagree with something, post specifically why you disasgree. Then we all learn. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Ron Carson Sent: Friday, December 05, 2008 06:44 To: Dawson Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! Dawson, thanks for your comments. The OTlist has been around for a long time. One thing is for sure, the nature of the discussions, the tone of the topics and the passion for change is not for everyone. You said you joined the list to: ...read what practicing OTs are talking about, up to, and perhaps even learn something; possibly even get some encouragement for the big step I am about to take. You ARE reading about what practicing OT's are talking about, you ARE learning something. And, while you may not be encouraged by some of the topics, these issues are real world. EVERY profession faces challenges and in my opinion OT needs to have members who voice their opinion and are willing to take a stand. In fact, your message says to me that you are one of these types of people!!! Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Dawson <[EMAIL PROTECTED]> Sent: Friday, December 05, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Arrgh! SNF OTs on the hot seat! D> Welcome Barb, D> so it has been very painful to read the extremel y judgemental discussion >> about "bad" treatment D> I have to agree with you, I find this painful on a weekly basis >> please don't let mine or anyone else's negativity adversely affect what >> you do >> D> It's very difficult sometimes not to. D> As someone who is about to start their BSC (Hons) in OT, I originally D> thought it would be a good idea to join the list and read what practicing D> OTs are talking about, up to, and perhaps even learn something; possibly D> even get some encouragement for the big step I am about to take. This is not D> the case, in fact, I couldn't feel less encouraged or more negative about D> the how occupation now if I tried. D> Dawson D> 2008/12/4 <[EMAIL PROTECTED]> >> 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] >> -- 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]
