Dear OTlist members,
It has been great to see the interesting comments lately on this list!
LIGUISTICS ANYONE?
I especially thought the response from Websters Dictionary on the Definitions
of OT as fascinating and plan to keep a copy of that around for a while.
Also found It extremely interesting about how Susanne in Denmark mentionsed
that in the European countries/languages there is no direct translation of the
word occupation (the one word we--in North America-- get so caught up in
debating with the assumption that it defines our profession world wide)....I
wonder how Asian or various Native cultures/languages translate the meaning or
concept of the word occupation? or do they have other words or concepts that
are similar to our concept of occupation....is there a universal human
understanding of common beliefs and values OT profession holds especially as it
relate to health and healing?
"Words are very unnecessary, they can only do harm"-Depeche Mode
WHAT's THE RATIO HORATIO?
As far as ratios of OT and PT utilization....at the SNF in which I work there
are 9 OT and 12 PT and 2 Speech...and a floating staff of PRN for each
discpline that add/subtract maybe 4 or 5 to PT and OT depending on
PRODUCTIVITY,...and PT tends to get more outpatient referrals of
people transitioning from inpatient to outpatient hence the need for increased
staffing. Of course our facility is alway hoping to hire more staff and build
the PRN list in all disciplines.
WHAT ABOUT OVERALL OVERUTILIZATION OF REHAB SERVICES IN GENERAL?
I totally agree with Joan who writes:
"I also have a theory on why PT is better known. We more often deal with
people who have multifactorial presentations and/or are marginalised for
some reason - old, poor, disabled, mentally ill, who are not as able to
problem solve through their own rehab as the active demographic in their
productive years. Most people have had some contact with a PT either
themselves or through others they know and most of these people do not
need occupational therapy to continue or resume their usual everyday
lives.
Ron's stories of the clients who have been exposed to OTs 'going
mindlessly through the motions' so some employer can collect payment in
wasted health care dollars make my heart sick."
so true Joan,
OVER-PT-IZATION
honestly I see a lot of people going to a PT for session after session
enjoying hot packs and e-stim/ultrasound, "manual work" and quickly reviewing
the home exercise program which the pt fails to do at home with no evidence of
increase functional outcomes.(mainily in outpatient clinics).
Yes, PT can often be the therapy people go to for recovery from injuries,
acute, or transient conditions where likelihood of recovery is high.... dare I
say ...even with minimal or without PT.
THE ULTRA HIGH CATEGORY: 720 minutes, 5 consecutive days, at least 2
disciplines=$$$$
I have the opinion that most of the bad experiences that families get with OT
stem from the way the reimbursement structures are set up in PPS-RUGS for
SNF....First clients are given the intervention that may or may not be needed
and then additionally, they are given more to take up time to make RUGS
categories. We try to fit the structure of our services into this model to make
it most profitable but not necessarily effective. Add to this the fact that
productivity expectations of employers leads to a compromise in the quality of
interventions because therapists are stressed with heavy demanding
caseloads.This phenomenon has been the subject of many of my past postings
DO YOU SPEEK CAJUN:
FRUSTRATION IN REHABILITATION MEANS ADMINISTRATION NEEDS EDUCATION
The PPS-RUGS model also goes a long way to promote this problems of OT= Upper
body and PT=lower body..... "Mr Johnson you will have 2 one-hour therapy
sessions today, PT will work on your legs today and come back after lunch and
OT will work your arms and fingers" It just so happens that the highest paying
RUGS categories require 2 disciplines and lots of minutes...this leads to
practice patterns that make business sense but not clinical sense! Often a
therapist just needs to advocate for the best practice and have good objective
data/documentation and reasoning to back up their clincal decisions as
presented to case and rehab managers.
ONLY IN CANADA EH!
I was born, raised, and trained in Canada, had a great education and right out
of university I moved to Florida for the weather and lifestyle. In
my client-centered training, we mainly gave patients what they needed and
stopped there. It took me a long time to get used to the American Medicare
system for SNF, I noticed from the start that OT spend an enormous amount of
time with patients especially in orthopedics practice. While it made sense to
spend up to 2 hours with stroke patients, me and my Total knee patients kind of
ran out of things to do and talk about after a couple of weeks of inpatient
rehab. And often I was encouraged to find ways to keep people on caseload and
in the facility for as long as possible. Often I had to advocate for my patient
and myself to get them home.
OT UNDERUTILIZATION
I think that It's home health where the OT profession has the most work to do
in building up the practice and market share of service and develop respect and
understanding of our services.
What can we do to make that happen?
All this akes you wonder if there really/truely is a shortage of Rehab
professionals in our healthcare system(?) or just a structural flaw
Sometimes less is more...
Ahhhh, that feels better...
--
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