"Enabling Occupation: An Occupational Therapy Perspective" ----- Original Message ----- From: bbh1...@comcast.net <bbh1...@comcast.net> Sent: Saturday, February 14, 2009 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] The Saddest OT Statement I've Ever Heard
bcn> What was the book??? bcn> I DO try to focus my tx around the patient's needs/desires. bcn> Remediating underlying issues often DOES involve balance and bcn> strengthening, especially when you are working with the elderly bcn> whose main concern when coming into tx is debilitation and bcn> weakness. Anxiety is also often a barrier as well as motivation - bcn> do they really want to do for themselves or have they succombed to bcn> the cultural prejudice of "you're old and so you just can't do as bcn> much anymore." The goals I work on with people are often pretty bcn> basic - can you dress, wash and toilet on your own, and is it safe to do so. bcn> Productivity is a HUGE issue. If I have to see 12 patients in a bcn> day, most of whom have an average of 50 minutes (their RUG level bcn> according to the Medicare system), I don't have much time to plan bcn> individual tx's. Regardless, I really try to do this, contrived bcn> activities and all. Filling up 50 minutes of tx time when you have bcn> to work multiple patients and save time for documentation is a bcn> challenge, even when I use the contrived activities. I do my best bcn> to choose on the basis of the specific goals of the patient, and bcn> attempt most days to schedule tx times so that I can work with bcn> people who have similar/same issues so that I'm not just providing bcn> busy work for one while I work with the other. Many people have bcn> combined balance and UE limitations which make it extremely bcn> difficult to find any activity to do with them, functional or not. bcn> One thing I do accomplish with most patients is meaningful bcn> interaction. This is an effective way to find out what their bcn> needs/desires are. I say this because it is difficult to do when bcn> you feel "rushed" to see many people at one time and to keep up bcn> with what you are doing with each. Other therapists do not take bcn> the "time" to do this, and sometimes come to me for help in bcn> motivating a "difficult" patient. I don't say this as a criticism. bcn> I understand exactly the pressure they work under. bcn> Hence my obsession with concrete suggestions. And I mean concrete bcn> as in... what did you do with patient x to address issues x, y and bcn> z. I understand the overarching philosophical importance of bcn> functional tx, but it is difficult to be a purist when the work bcn> environment makes so many other demands of you, demands that must bcn> be met to appease Medicare and your supervisors. Unfortunately, I bcn> need a job. And I do like working in rehab. I just need to find a bcn> way to juggle all these variables in a way that serves the patient bcn> best. I am looking for a different position, but in Michigan, that takes time. bcn> Thanks for listening, bcn> Barb Howard bcn> ----- Original Message ----- bcn> From: "Ron Carson" <rdcar...@otnow.com> bcn> To: "bbh1...@comcast.net" <OTlist@OTnow.com> bcn> Sent: Friday, February 13, 2009 3:24:42 PM GMT -05:00 US/Canada Eastern bcn> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard bcn> Barb, I want to offer a suggestion. In my early days as an OT, I worked bcn> in adult rehab. It was VERY faced paced and therapists generally had 2 - bcn> 3 patient's hour. In the beginning, I was stuck in the peg, cone, etc bcn> routine, but one day I read a book that changed my practice. bcn> I changed my practice pattern from UE/ADL to occupation-based treatment. bcn> In this approach, a patients occupational needs/desires become the ONLY bcn> reason for treatment. In the absence of occupational problems that are bcn> improvable, there is no role for OT. bcn> This approach 100% clarified my treatment for both myself and patients. bcn> I no longer wondered what to do with patients. Suddenly, I began bcn> stepping away from typical OT activity and began addressing patient's bcn> most important needs. My treatment boundaries greatly expanded and I bcn> began feeling much better about my treatments. bcn> No longer did I do "contrived" OT treatment, instead I addressed the the bcn> ACTUAL needs of the patients. Since you asked for concrete ideas here bcn> they are: bcn> 1. Identify client's needs/desires bcn> 2. Identify why the can't do these things bcn> 3. Direct 100% of your treatment to: bcn> a. Remediating underlying issues bcn> b. Compensating for uncorrectable problems bcn> c. Changing environments bcn> Forget made up activities, forget games and other silly things. YOU CAN bcn> DO THIS! bcn> Ron bcn> -- bcn> Ron Carson MHS, OT bcn> www.OTnow.com bcn> ----- Original Message ----- bcn> From: bbh1...@comcast.net <bbh1...@comcast.net> bcn> Sent: Friday, February 13, 2009 bcn> To: OTlist@OTnow.com <OTlist@OTnow.com> bcn> Subj: [OTlist] The Saddest OT Statement I've Ever Heard bcn>> Thanks, Sue, for providing some specifics. I understand the need bcn>> for functional tx that is specific to the patient! I just need bcn>> some more specific, concrete ideas about how others do this in the bcn>> clinic environment. With productivity demands it is even difficult bcn>> for me to spend time in a patient's room alone with them. I seem bcn>> to be the ONLY OT in my department who takes the time to do ADLs with some of my patients. bcn>> So I am looking for more concrete ideas and less philosophical bcn>> ranting. I do get that part. I know venting is necessary bcn>> sometimes, but I joined this list to get more specific ideas to bcn>> help with my tx planning and so that is why I asked the question. bcn>> Thanks, bcn>> Barb Howard COTA bcn>> ----- Original Message ----- bcn>> From: "Sue Doyle" <sue...@hotmail.com> bcn>> To: otlist@otnow.com bcn>> Sent: Friday, February 13, 2009 7:46:09 AM GMT -05:00 US/Canada Eastern bcn>> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard bcn>> I am the lead therapist in an inpatient rehab center. We focus on the bcn>> clients goals and predominantly use functional tasks. Even spent the bcn>> afternoon knitting and compiling emails with a patient. I have a bcn>> carburetor that I have had out several times for some of the men to bcn>> work on as their goal has been to go back to working on their car. bcn>> Sue D >>> From: spark...@rcn.com >>> To: OTlist@OTnow.com >>> Date: Thu, 12 Feb 2009 19:46:44 -0500 >>> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard >>> >>> I do not have alot of experience yet ...I am still a student, but I have >>> been in places that simply sit patients up at tables and gave them >>> something to do that may or may not be functional for them specifically. >>> For example, a patient may get something out of cognitively out of sorting >>> colored pegs on a peg board but is has no meaning to their life. Our >>> challenge as professionals is to dig deeper and find something that we can >>> do to reach the same goal but make it applicable to the patients life. >>> However, I understand this has been all but impossible in many rehabs >>> because of productivity demands. I happen to be in a rehab setting that is >>> more flexible because the we smaller and it is acute rehab vs. SNF. I >>> cannot judge how other places are run, in fact, I do feel I am in a unique >>> facility and although I may never be employed there, I will take this >>> experience with me wherever I go. ADL's are the first priority and ususaly >>> what the patients say are goals for themselves but we can make meals, >>> simulate homemaking activites, and the list goes on..the point is that is >>> has some functional application to the patient...so it is always different >>> and changing. >>> >>> -----Original Message----- >>> From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on >>> Behalf Of bbh1...@comcast.net >>> Sent: Thursday, February 12, 2009 19:06 >>> To: OTlist@OTnow.com >>> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard >>> >>> >>> >>> >>> How about sharing some specifics - some typical tx sessions. >>> >>> When you say adult rehab, do you mean outpatient,..home health...? >>> >>> >>> >>> This is becoming a mantra - Productivity requirements impose cookie cutter >>> approaches. >>> >>> Therapists are caught in the middle and many give up swimming upstream. I >>> haven't given up, but >>> >>> I know I have to go elsewhere to accomplish this. I'd like to run my own >>> department someday, but >>> >>> I want to learn as much as I can specifically about functional treatment, >>> that is, in addition to doing ADLs >>> >>> with patients. >>> >>> Any info would be appreciated. >>> >>> Barb Howard, COTA >>> >>> >>> >>> >>> ----- Original Message ----- >>> From: "Diane Randall" <spark...@rcn.com> >>> To: OTlist@OTnow.com >>> Sent: Thursday, February 12, 2009 6:31:35 PM GMT -05:00 US/Canada Eastern >>> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard >>> >>> Wow..I am interning in adult rehab right now and UE therex is only used for >>> people who really need it. Been there six weeks and everything revolves >>> around function. >>> >>> -----Original Message----- >>> From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on >>> Behalf Of Ron Carson >>> Sent: Wednesday, February 11, 2009 18:40 >>> To: OTlist@OTnow.com >>> Subject: [OTlist] The Saddest OT Statement I've Ever Heard >>> >>> >>> Today, I met a new PT assistant who was just starting with our home >>> health company. He was just finishing with a patient as I was starting >>> my evaluation. The PTA came from 20 years of geriatric rehab and rehab >>> experiences. >>> >>> About 1/2 through my eval he said to me, and I quote: "I'm not use to >>> OT's working on functional things". He went on to say that at his rehab >>> facility, the OT's mainly did UE exercises. >>> >>> "Living life to the fullest". What a crock! >>> >>> Ron >>> >>> -- >>> Ron Carson MHS, OT >>> www.OTnow.com >>> >>> >>> -- >>> 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 >>> -- >>> 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
