You have hit the proverbial nail on the head there Ron ... "EVERY
profession faces challenges"
Where ever you go, there are people who love their jobs - and have that
"passion" for the profession. Then there are those that come in, get
through the day to pick up the check at the end of the week. Sadly
enough, there seem to be too many of those!
I have worked in/out of a SNF for the past 10 years and intervention
is usually dependent on the "level" of the patient. Productivity can
be tough at times, but when I can, I try to get a couple of high
level folks that can maybe mix a batch of cookies or an easy recipe -
even just a box of instant pudding that can be done "the old fashioned
way" with a hand mixer that has the turning handle on the side (can be
found at most Target stores) or a whisk. This can be done in standing
to address endurance, balance, strength and coordination. Sometimes
you can try to "piggyback" 2 pts for the time - then get your next 2
to complete the project, or decorate the cookies. I love the holidays -
we just finished a gingerbread house that took all week to complete
that had at least 4 of my ladies working on it (sorting candies,
cutting sugar drops...) while others may be making simple beaded candy
canes that are easily strung onto pipe cleaners then hung on the
tree(dynamic standing balance! ).
Paper cut out snowflakes also a great one that many enjoy (remember
those?) Also has that dynamic standing to tape onto a window! . Once
you get the productivity started, you can get some time that you need
for the more challenging or one- on-one patients.
I also do 1 or 2 showers a week with each of my patients and to work in
the rooms, grading the ADL anywhere from max or I with set- up.
Hopefully, by the time they are DC'd, they are making the bed and
cleaning the trash out of the can in their rooms.
And for the students that are out there, try to gleam as much as
possible from the therapists that you see out there that are making the
differences in their patients lives -
On Dec 5, 2008, at 5:43 AM, Ron Carson wrote:
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 extremely 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
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