Wow Joan, well put. Wish I could shadow you for a month or two. I
also have a heart for people and their families who suffer from
dementia, but sometimes I am at a loss for what to do.
-----Original Message-----
From: Joan Riches <[email protected]>
To: [email protected]
Sent: Thu, Jul 23, 2009 10:07 pm
Subject: Re: [OTlist] Vision ~vs~ Reality
Rest assured Diane your patients benefit from your caring. For many of
those in an SNF the activity is the occupation. Many have no sense of
future but a powerful urge to use their hands. In the sterile
environment of an SNF there are few opportunities to do that and it
seems your gym is one place where it is possible. Goals are very
different in a situation where maintenance of abilities is difficult and
improvement unlikely. Handling things, especially familiar things,
grounds them with a sense of self. From what you say you are attempting
to match your folks with activities that will invoke procedural memory
based on what you know about what that memory may contain.
Ron and I disagree strongly about whether it is possible to do real
occupational therapy with people who cannot intellectually conceptualise
a goal. I advocate for them and I believe it definitely takes a skilled
therapist to provide the support that maintains a person's best
abilities to remain occupied until the end of life and to teach others
how to support them.
You are going to have a great time in paeds. Many of them don't
conceptualise goals either but they are on their way and they leave you
in no doubt if your goals are not in line with theirs.
Blessings, Joan
403 652 7928
-----Original Message-----
From: [email protected] [mailto:[email protected]] On
Behalf Of Diane Randall
Sent: July 23, 2009 8:35 PM
To: [email protected]
Subject: Re: [OTlist] Vision ~vs~ Reality
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.
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