In all honesty, the problem of OT is not directly related to the work
setting. I've worked or have direct experience in acute care rehab,
academia, very briefly in-patient hospital, outpatient, private
practice, SNF and home health. ALL of these settings have a majority of
OT's focusing treatment on the UE.
As far as being in the trenches, that's a choice. I said "no" to
inpatient, got fired from a SNF, quite rehab to work and academia. There
are plenty of jobs.
But, the problem is not the location. The problem is the therapist. If
an OT focuses on occupation, they WILL NOT BE UE THERAPISTS. You can't
be both! Many people claim to do it, but I think that's a line of junk.
I fully understand that being in a SNF is VERY tough. The primary
problem in that setting is not UE ~vs~ occupation, its fraud ~vs~
medically necessary treatment. I got fired because I REFUSED to treat
patient's like cattle. Neither the 'system' nor I were willing to
change, so they let me go during my probationary period. No harm and no
foul, but there was no way I was going to cheat Medicare and rob
patients in that system.
I first started practicing occupation-based treatment while working at
an in-patient rehab hospital. It was routine to see 2 patients at a time
and 3 at a time wasn't unheard of. I couldn't spend an hour with each
patient but the time I had WAS spent on improving their desired
occupation(s). I wasn't perfect, but in my opinion, it was a heck of a
lot more therapeutic than having patients fold laundry, do dowel
exercises in a large group, wash windows, cook group, "sanding" a table
top, playing childish games, etc.
At times, I despise my profession because of the way so many adult
phys-dys OT practice. Our professional identity STINKS. In fact, I don't
even think we have an identity. And if we do, it's pretty dang crappy.
Today, I made up a flyer to distribute to my home health company's
nurses. Here it is:
=================================================================
Occupational Therapy: What Is It?
1) Education:
a) OT’s have either a bachelor, masters or doctoral degree
b) OT assistants have an associate degree
2) Definitions of occupation:
a) Any activity that occupies a person's attention
b) Activity that a person does to take care of themselves and be
productive
3) History of OT:
a) Founded in 1914
b) Originally performed by nurses
c) Use of crafts to restore meaning and value to injured and
impaired soldiers returning from war
d) Later, moved to the medical model of care
4) Current Practice:
a) Very diverse profession
b) Work across the life span because all people have
occupational needs/issues
i) OT works with neo-nates to terminally ill
c) Some OT’s focus on treating the upper extremity, i.e. hand
therapists
d) Some OT’s focus on treating occupation
5) Common Misconceptions about OT:
a) OT is above the waist and PT is below the waist
b) OT is small muscles and PT is large muscles
c) OT is about helping people find jobs
6) When to Refer to OT:
a) Patient has difficulty taking care of themselves or being
productive in their home:
i) Can’t safely dress, bathe or toilet
ii) Can’t safely access bathroom, shower or other areas
of the home
iii) Can’t safely transferring to/from bed, chair,
wheelchair, etc
iv) Can’t safely cook, clean, care for animals, laundry,
etc
7) Bottom Line:
a) When a patient has difficulty or is unable to take care of
themselves and be productive in their homes, regardless of the
cause(s), an OT evaluation is indicated.
=============================================================
Why in world is it necessary to distribute a flyer to a HOME HEALTH
company explaining OT? How can we be so far off the radar map that a
HOME HEALTH company is unsure when to refer to OT?
IT'S A SAD STATE OF AFFAIRS, THAT'S HOW!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Ron
~~~
Ron Carson MHS, OT
www.OTnow.com
----- Original Message -----
From: Diane Randall <[email protected]>
Sent: Thursday, July 23, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] Vision ~vs~ Reality
DR> I am with you about the UE problem in rehab but I really need to
DR> know how we can fix this...I have 14 patients to see within 6 hours,
DR> some are ADL's but I cannot have one on one treatments most of the
DR> time. I cannot do a shower transfer and have 6 patients waiting in
DR> the gym. I am kind of at a loss and wondering what a typical gym SNF
DR> would look like in ideal circumstances. I think a lot of blame is
DR> one therapists when we are the ones in the trenches just trying to
DR> get the minutes in and figuring out how to do it and it is the
DR> corporate structure that has forced UE rehab into the SNFs as a
DR> majority treatment by packing the gym full of patients each day.
DR> Home health is totally different. There is so much you can do one on
DR> one especially within the home. I am doing my best and frankly...I
DR> am Peds is my first love and I will be dong outpatient one on one in
DR> a a clinic full-time by sept. I will continue PRN in the SNF but it is
overwhelming at times.
--
Options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
www.mail-archive.com/[email protected]
