Excellent summation and response Brent. A lot of good stuff in there. Ed
On Sat, Jul 11, 2009 at 4:27 PM, Brent Cheyne <brentche...@yahoo.com> wrote: > 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... > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com > -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
