Honestly Ron, you speak of ideal situations...but many of my patients do not have occupations that they want to work on specfically and I don't even think some are appropriate for therapy...but as a new COTA, I don't think my opinion counts for much. I don't do evals, or set goals or even treatments plan...I just do treatment and bill. I know what functional treatment looks like. My FW rotation represented that but I only had at most two patients at a time that I did not have to share with other professionals. I do what I can to make sure that whatever treatment I am doing is meaningful to the patient in some way. When doing ADL's , I talk with them to find out thier occupational goals. I don't have men who don't cook...cook etc. It seems to be mostly focused on ADL's...which is occupation...I am just not permitted to do that all day long. i guess i am learning as I go.
-----Original Message----- From: [email protected] [mailto:[email protected]]on Behalf Of Ron Carson Sent: Thursday, July 23, 2009 20:32 To: Diane Randall Subject: Re: [OTlist] Vision ~vs~ Reality 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] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
