Hi - I hope you are not insulted by my questions. I would like to understand
more fully your treatment concept for a patient that is not independent in
toileting. Is your setting usually in the pts home? Do you ask the pt to
take a dry run into the toilet? Do you ask the pt if they need to actually
use the bathroom? Do you simulate any activities? I do not think that you
are asking the pts to undress each time you enter their home.
In my setting, acute rehab, what type of initial suggestion would you make
to a pt a few days post CVA or Hip Fx? Lets get up and sit on the BSC? Lets
get up and get into the wheelchair so we can go to the tx gym? All my
sessions are not first thing in the AM when it really would make sense to do
concrete care such as toileting. CNA's and Rehab Techs are often the initial
contact for the day and will have already assisted the pt with their
toileting. It is not considered OT when that other staff member assists
them, and the other staff may do more for them without asking them to
participate. I often feel that I should be training the staff for more
opportunities using the skills that will be taught in tx. but that is not
billable tx time.
Asking a CNA for input in the level of assist needed for toileting would
only make sense in a perfect world. But we are asked not to overlap
PT/OT/Nursing for fear the tx will be seen as un-necessary? What the pt is
able to do for themselves certainly will change as they begin to heal from
their insult. By the time you see them in home tx they are more aware of
what their priorities are.
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