Unfortunately, the current health care reimbursement system is not really set up for therapists working with seniors; even though that's what Medicare is supposedly for. Once an individual has retired, there is much more to a quality life than ADL/IADLs and maintenance can be paramount to continued participation in desired occupations. However, leisure is often frowned upon as pivotal reasoning for therapy; but that is what is important to these clients and makes their lives worthwhile. Leisure skills are often much more motivating than ADL/IADL and can certainly be utilized therapeutically for goal attainment; but what of those individuals whose quality of life has declined significantly because of loss of participation in leisure occupations? The current health insurance system does not view this as 'necessary' in terms of therapy. I find this frustrating in my practice as I work solely with seniors and leisure occupations are often addressed in the rehab package; but not spelled out as such in their POC. It would be interesting to see reactions if this were simply a documentation note and not a d/c.
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Saturday, December 06, 2008 11:58 AM To: [email protected] Subject: OTlist Digest, Vol 49, Issue 3 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: A "Whopper" of a D/C Note! (Diane Randall) 2. Re: Arrgh! SNF OTs on the hot seat! ([EMAIL PROTECTED]) 3. Re: Arrgh! SNF OTs on the hot seat! ([EMAIL PROTECTED]) 4. Re: Arrgh! SNF OTs on the hot seat! (Karen) 5. Re: OTlist Digest, Vol 49, Issue 2 ([EMAIL PROTECTED]) 6. Re: A "Whopper" of a D/C Note! (Ron Carson) 7. Re: A "Whopper" of a D/C Note! (Diane Randall) ---------------------------------------------------------------------- Message: 1 Date: Fri, 5 Dec 2008 10:26:24 -0500 From: "Diane Randall" <[EMAIL PROTECTED]> Subject: Re: [OTlist] A "Whopper" of a D/C Note! To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" OK Ron, I am confused. can you really write notes like that? I was told to never put the actual intervention into a note.....especially "crochet". This sounds like a note from a mental health clinic. It is not Phys Dis, is it? Did she have some sort of fine motor issue? The note would certainly not indicate this...I mean... how could this possibly be billable..at all...even if you reworded it? Is renewing an interest in "occupation" billable? Was there more to the note? Confused -as-usual-student-in-training Diane -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Ron Carson Sent: Thursday, December 04, 2008 19:00 To: [email protected] Subject: [OTlist] A "Whopper" of a D/C Note! Check out this D/C note. Can you imagine what a doctor will say *IF* they ever read this note.... "At evaluation, the patient was devoid of any meaningful or productive occupation (activity). As such, the primary role of OT was facilitating the patient to re-initiate her interest in the occupation of crocheting. At d/c, the patient showed interest and spontaneously participated in her previous occupation. Her husband was educated on the benefit of keeping the patient appropriately engaged in this occupation." You know, being an OT is at time wonderful. In one day, I was seeing a patient to facilitate her engagement in crocheting and facilitating another patient to stand from her wheelchair. The diversity of our profession never ceases to amaze me!!! OT - The (O)ther (T)herapy <smile> Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ------------------------------ Message: 2 Date: Fri, 05 Dec 2008 16:29:15 +0000 From: [EMAIL PROTECTED] Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! To: [email protected] Message-ID: <[EMAIL PROTECTED] .net> Content-Type: text/plain Hi Ron, Thanks for your reply. We ALL take things personally at times - it's the curse of human nature! I work with that struggle every day. But a reminder is always good. Though it is difficult to read emotion in emails, I sense that you also, took my post a bit personally! I respect everyone's need to vent. But my suggestion is that perhaps it is useful/more skillful to attempt to vent as constructively as possible. Enough said. As for my post, what I was attempting to point out is that it is easy to criticize what a therapist might do as not meaningful when viewed out of context. Yes, I ask people to stand and do activities that don't directly relate to their personal life/interests/point of view, but in the context of trying to be "productive" (!!!) to satisfy the corporate bean counters while still doing tx that is of some concrete benefit in terms of the patient's long term goals for d/c, I often feel that I am making the best possible choice, relative to the given circumstances. Is it the best possible choice in the broader scope of the goals of the profession???...probably not. And I do care about that - hence my interest in getting ideas from the list to have more options in my bag of tricks when choosing activities for patients IN THE CONTEXT of having to meet so many and often contradicting requirements of SNF rehab in a for-profit world. After my first day back on the job, my venting to a friend (non-OT practitioner) was basically.."Oh, my God! What have I done! This is impossible! I can't do this job, blah, blah, blah...." Once I let go of the negative Greek chorus in my head, I began brainstorming about how I can continue to do this job in a both skillful and productive way. This lead me directly to your list. So please, bring on the constructive ideas, criticism, creative perspectives!! I am here and ready to try just about anything. Thanks, Barb Howard -------------- Original message -------------- From: Ron Carson <[EMAIL PROTECTED]> > Hello Barb: > > I know it's hard to NOT thing's personally, but please keep in mind > that comments are NOT generally directed to any one person. Instead, > we tend to talk in generalities that may or may not apply to a > particular person. > > On this list, I think it's important that two things happen: > > 1. Everyone is honest > > 2. Everyone is open to new ideas > > Having said this, I understand how and why you might be offended but > please don't let mine or anyone else's negativity adversely affect > what you do. Take what I and other's say with "the grain of salt". > > I strongly believe that the PROFESSION of OT needs to wake up and get > its head out of the sand. I am constantly being negative, because I > think that's about the only way to raise awareness. And without > awareness, there will never be any change! > > Thanks for sharing your honest opinion!!!!!!! > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: [EMAIL PROTECTED] > Sent: Thursday, December 04, 2008 > To: [email protected] > Subj: [OTlist] Arrgh! SNF OTs on the hot seat! > > bcn> I am a recently recertified COTA who has just started a new > bcn> position working in an SNF. My prior experience was PRIOR to > bcn> PPS. Whew! What a change! I whole-heartedly agree with Brent's > bcn> post. I am trying my best to provide skilled treatment, but PPS > bcn> and productivity standards set by the for-profit sector make that > bcn> difficult. I joined this list to get more ideas about > bcn> functional/meaningful activities to do with my patients, so it > bcn> has been very painful to read the extremely judgemental > bcn> discussion about "bad" treatment! I already feel uncomfortable > bcn> with some of the choices I have to make each day. I am hoping > bcn> that as I learn to juggle better, I will be able to provide a > bcn> higher percentage of meaningful tx. So I would appreciate any > bcn> and all concrete suggestions from those who work in a similar > bcn> environment, and less of the judgement based on uninformed assumptions. > bcn> Thank you. > bcn> Barb Howard > bcn> Grand Rapids, MI > > bcn> -------------- Original message -------------- > bcn> 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] > bcn> -- > bcn> Options? > bcn> www.otnow.com/mailman/options/otlist_otnow.com > > bcn> Archive? > bcn> www.mail-archive.com/[email protected] > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] ------------------------------ Message: 3 Date: Fri, 05 Dec 2008 19:34:42 -0500 From: [EMAIL PROTECTED] Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! To: [email protected] Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" 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] ------------------------------ Message: 4 Date: Fri, 5 Dec 2008 19:10:13 -0600 From: Karen <[EMAIL PROTECTED]> Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! To: [email protected] Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=US-ASCII; format=flowed 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 >>>> >>>> >>>> >>>> -- >>>> 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] > ------------------------------ Message: 5 Date: Sat, 6 Dec 2008 04:03:37 +0000 (UTC) From: [EMAIL PROTECTED] Subject: Re: [OTlist] OTlist Digest, Vol 49, Issue 2 To: [email protected] Message-ID: <[EMAIL PROTECTED] cast.net> Content-Type: text/plain; charset=utf-8 Okay, how? What ideas do you have for OT's working in SNF's to make the treatment more functional? I originally wrote asking for ideas to make my treatment more functional, so how about we try to stick to that instead of the easier but much less helpful criticisms, however right or wrong they may be. ~Ilene Rosenthal, OTR/L "I ?strongly believe that the PROFESSION of OT needs to wake up and get its ?head ?out ?of the sand. I am constantly being negative, because I think ?that's ?about ?the ?only ?way ?to ?raise awareness. And without awareness, there will never be any change!" ------------------------------ Message: 6 Date: Sat, 6 Dec 2008 03:45:49 -0500 From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] A "Whopper" of a D/C Note! To: Diane Randall <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=windows-1252 This patient is on home health and her primary OT diagnosis is dementia. She had NO fine motor issues, in fact her skill with a crotchet needle was quite amazing. What I posted is the entire D/C note. The question of reimbursement is interesting. I'm unsure what Medicare might say if they audited my record. Your questions prompted me to look at this patient's goals and I clearly see there is inconsistency between the goal and the d/c note. That itself, is enough for Medicare to deny payment. I'm disappointed with myself because I did not document a good case for my intervention. This is one of those cases where I feel that OT services were of great benefit to this patient's health, but that insurance could care less. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Diane Randall <[EMAIL PROTECTED]> Sent: Friday, December 05, 2008 To: [email protected] <[email protected]> Subj: [OTlist] A "Whopper" of a D/C Note! DR> OK Ron, I am confused. can you really write notes like that? I was told to DR> never put the actual intervention into a note.....especially "crochet". This DR> sounds like a note from a mental health clinic. It is not Phys Dis, is it? DR> Did she have some sort of fine motor issue? The note would certainly not DR> indicate this...I mean... how could this possibly be billable..at all...even DR> if you reworded it? Is renewing an interest in "occupation" billable? Was DR> there more to the note? Confused -as-usual-student-in-training Diane DR> -----Original Message----- DR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] DR> Behalf Of Ron Carson DR> Sent: Thursday, December 04, 2008 19:00 DR> To: [email protected] DR> Subject: [OTlist] A "Whopper" of a D/C Note! DR> Check out this D/C note. Can you imagine what a doctor will say *IF* DR> they ever read this note.... DR> "At evaluation, the patient was devoid of any meaningful or productive DR> occupation (activity). As such, the primary role of OT was DR> facilitating the patient to re-initiate her interest in the occupation DR> of crocheting. At d/c, the patient showed interest and spontaneously DR> participated in her previous occupation. Her husband was educated on DR> the benefit of keeping the patient appropriately engaged in this DR> occupation." DR> You know, being an OT is at time wonderful. In one day, I was seeing a DR> patient to facilitate her engagement in crocheting and facilitating DR> another patient to stand from her wheelchair. The diversity of our DR> profession never ceases to amaze me!!! DR> OT - The (O)ther (T)herapy <smile> DR> Ron DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/[email protected] DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/[email protected] ------------------------------ Message: 7 Date: Sat, 6 Dec 2008 09:04:00 -0500 From: "Diane Randall" <[EMAIL PROTECTED]> Subject: Re: [OTlist] A "Whopper" of a D/C Note! To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" This is all very interesting to me. I was warned that Medicare (prob most insurance) needs to see medical terminology and goals in notes or they will just deny because most outside our profession do not understand the therapeutic benefit of everyday interventions beyond the typical obvious ADL's of dressing, toileting, bathing etc. For instance 1. "folding towels" would be "activity designed to increase bilateral coordination, sequencing and problem solving skills" 2. "pennies in theraputty" would be "activity designed to increase fine motor strength, pip/dip flexion/extension etc etc" 3. "crossword puzzles" would be "cognitive training activities" The wonderful thing in OT is that we can really do almost anything we want and make it therapeutic. What you did Ron was obviously therapeutic but under appreciated in the medical community. I would think that if I ever ran into that situation, I would just either not put it in the note at all (because I am assuming that she had other goals that you worked on) and do exactly what you did or reword it so that there would be no question that services were necessary. Hmmm.... Such as "Pt participated in familiar fine motor activities to increase cognitive processing skills, facilitate long-term memory, and increase social occupation skills." "Family was educated on the important of maintaining brain function by encouraging the pt to participate in cognitive activities after discharge. As a result of this intervention, the pt has shown significant improvement in.........." I was also warned not to put the word "maintained" in an initial note( I am guessing a D/C note is oK). Medicare in particular wants to see progress. Dementia patients are hard. Medicare is looking for that plateau moment when there isn't anymore significant progress and OT can no longer be justified. Not sure I am on the right track. I just think there is nothing worse for those of us in OT than to know that someone was denied payment because of wording issues. Ron, you clearly see your patients as real people with emotional/social needs and not just a "case". -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Ron Carson Sent: Saturday, December 06, 2008 03:46 To: Diane Randall Subject: Re: [OTlist] A "Whopper" of a D/C Note! This patient is on home health and her primary OT diagnosis is dementia. She had NO fine motor issues, in fact her skill with a crotchet needle was quite amazing. What I posted is the entire D/C note. The question of reimbursement is interesting. I'm unsure what Medicare might say if they audited my record. Your questions prompted me to look at this patient's goals and I clearly see there is inconsistency between the goal and the d/c note. That itself, is enough for Medicare to deny payment. I'm disappointed with myself because I did not document a good case for my intervention. This is one of those cases where I feel that OT services were of great benefit to this patient's health, but that insurance could care less. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Diane Randall <[EMAIL PROTECTED]> Sent: Friday, December 05, 2008 To: [email protected] <[email protected]> Subj: [OTlist] A "Whopper" of a D/C Note! DR> OK Ron, I am confused. can you really write notes like that? I was told to DR> never put the actual intervention into a note.....especially "crochet". This DR> sounds like a note from a mental health clinic. It is not Phys Dis, is it? DR> Did she have some sort of fine motor issue? The note would certainly not DR> indicate this...I mean... how could this possibly be billable..at all...even DR> if you reworded it? Is renewing an interest in "occupation" billable? Was DR> there more to the note? Confused -as-usual-student-in-training Diane DR> -----Original Message----- DR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] DR> Behalf Of Ron Carson DR> Sent: Thursday, December 04, 2008 19:00 DR> To: [email protected] DR> Subject: [OTlist] A "Whopper" of a D/C Note! DR> Check out this D/C note. Can you imagine what a doctor will say *IF* DR> they ever read this note.... DR> "At evaluation, the patient was devoid of any meaningful or productive DR> occupation (activity). As such, the primary role of OT was DR> facilitating the patient to re-initiate her interest in the occupation DR> of crocheting. At d/c, the patient showed interest and spontaneously DR> participated in her previous occupation. Her husband was educated on DR> the benefit of keeping the patient appropriately engaged in this DR> occupation." DR> You know, being an OT is at time wonderful. In one day, I was seeing a DR> patient to facilitate her engagement in crocheting and facilitating DR> another patient to stand from her wheelchair. The diversity of our DR> profession never ceases to amaze me!!! DR> OT - The (O)ther (T)herapy <smile> DR> Ron DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/[email protected] DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ------------------------------ -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED] End of OTlist Digest, Vol 49, Issue 3 ************************************* -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
