Am anything but insulted. I appreciate that you are seeking information.
I will ask that other list members also add their 2 cents to this
discussion. Now, to answer your question.
Yes, I do work in home health. I previously worked in acute care rehab
and loved the patient population but hated the productivity
requirements.
I was a new therapist then and my approach to treatment is a lot
different today. I think if I was working in rehab my approach would be
as follows:
Help the patient identify their occupational goals, identify
what's impairing those goals, treat those areas that are
treatable and that I'm trained to treat.
In some ways, working with a patient 2 days post stroke can be very
similar to working with a patient 2 months post stroke. Sure, some
things will be different and you may have a very low level patient who
is unable to verbalize goals. Of course, I also have patients who are
that way.
More than anything else, almost every patient you have is going to want
to stand and/or walk. They will want to stand to get and put on their
clothes. They want to stand to go to the bathroom and shower. So, work
on these goals by starting with the lowest common denominator.
Ron
--
Ron Carson MHS, OT
www.OTnow.com
----- Original Message -----
From: Barbara H. Hale <[email protected]>
Sent: Tuesday, February 10, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] Back to basics?
BHH> Hi - I hope you are not insulted by my questions. I would like to
understand
BHH> more fully your treatment concept for a patient that is not independent in
BHH> toileting. Is your setting usually in the pts home? Do you ask the pt to
BHH> take a dry run into the toilet? Do you ask the pt if they need to actually
BHH> use the bathroom? Do you simulate any activities? I do not think that you
BHH> are asking the pts to undress each time you enter their home.
BHH> In my setting, acute rehab, what type of initial suggestion would you make
BHH> to a pt a few days post CVA or Hip Fx? Lets get up and sit on the BSC? Lets
BHH> get up and get into the wheelchair so we can go to the tx gym? All my
BHH> sessions are not first thing in the AM when it really would make sense to
do
BHH> concrete care such as toileting. CNA's and Rehab Techs are often the
initial
BHH> contact for the day and will have already assisted the pt with their
BHH> toileting. It is not considered OT when that other staff member assists
BHH> them, and the other staff may do more for them without asking them to
BHH> participate. I often feel that I should be training the staff for more
BHH> opportunities using the skills that will be taught in tx. but that is not
BHH> billable tx time.
BHH> Asking a CNA for input in the level of assist needed for toileting would
BHH> only make sense in a perfect world. But we are asked not to overlap
BHH> PT/OT/Nursing for fear the tx will be seen as un-necessary? What the pt is
BHH> able to do for themselves certainly will change as they begin to heal from
BHH> their insult. By the time you see them in home tx they are more aware of
BHH> what their priorities are.
BHH> --
BHH> Options?
BHH> www.otnow.com/mailman/options/otlist_otnow.com
BHH> Archive?
BHH> www.mail-archive.com/[email protected]
--
Options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
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