Chris, you bring up very good and valued points and that's a great story about your nurse friend. I think it also highlights that EACH and every OT makes an impact. I guess what really matters is the type of impact being made! Now, let me TRY to answer your questions.
It seems to me that as aides become better trained through experience, they tend to make equipment recommendations which are designed to improved safety and independence with basic self-care. However, I also find that these equipment recommendations are not what I recommend. Also, my home health agency has a very low utilization rate for aides. In fact, I have a patient now where the LPN is doing bathing. When I say that OT has no unique or highly valued role in home health, I am primarily referring to OTHERS' perceptions of OT. To be sure, I STRONGLY believe that in home health OT, when practiced from an occupation-based approach, is the premier profession. But, and this is quite unfortunate, I think OT has pigeonholed itself into the upper-extremity role and in my experience, VERY few people are homebound because of upper-extremity dysfunction. But, there are problems when practicing OT from an occupation-based perspective. I've previously written that a true occupation-based approach may focus treatment on mobility-related daily occupations. Patient's want and often need to be able to sit to stand, ambulate and perform daily occupations with very little assistance from others. Thus, my treatment focuses on these things. BUT, this approaches encroaches on what is typically PT's domain. And for all the readers on this list who think the profession of PT is our "friend", try stepping on their professional toes and you see just how protective and reactive they can be. And, there's nothing wrong with that, in fact OT should be the same way. Every PTA in my home health agency has complained to the PT about my treatments. One PTA was highly agitated because I did not ask her opinion about getting a patient a knee walker. The patient was supposed to be non- weightbearing but was burning herself while cooking from her wheelchair. So, we talked about a knee walker and I picked one up from a local DME and trialled the patient in her home. She loved it so I contacted the MD. He initially refused an order but I later found out this was because he didn't have any knowledge of the equipment. The patient talked with the MD and after he literally went to the DME and looked at the equipment, he said "sure". In retrospect, I should have at least talked with the PTA but in 100% honest, it never even crossed my mind. I am used to working on my own in private practice and not talking with other professionals about mobility decisions. Once, I was informed of the "problem" with the PTA, I called her about my decision and she was better, at least on the outside. So, there are no easy answers or solutions. The entire "thing" is very confusing to me. Home health is SUPPOSED to be about making people safer and more independent in their homes. This is EXACTLY what OT is also supposed to do. However, there seems to be a BIG disconnect between home health and OT. Perhaps, the sad reality is that home health is really about making money and OT, at least my flavor of OT, isn't exactly a productivity boon. It seems to me that PT is very accustomed to seeing almost every home health patient for doing mindless and unskilled therapeutic exercises. These visits are easy for the PT, patient and make lots of money for the home health agency. I frequently d/c patients who are totally independent in their homes and PT will stay on for weeks and weeks. This of course, brings in big money for the HH agency. It's almost like the PT's goals revolve around the 60 day episode of care rather than the patient's actual needs. Wow, sorry for the long response!! Ron -- Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: cmnahrw...@aol.com <cmnahrw...@aol.com> Sent: Wednesday, February 25, 2009 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] hello company...it's misery calling! cac> Ron, cac> Are you saying that PT, nursing, and nursing aides is working on cac> increased independence in clients' occupations? Or does it appear that cac> they are addressing the issues by completing them for the patient? cac> Perhaps it would be wise to have a tag along day with these disciplines cac> to create a team approarch. I think one of the best things a home OT cac> can do is become friends with the home aides because they can help with cac> the needed correct repetiion of your treatment interventions outside of cac> formal therapy time. cac> You know Ron, I once thought like you in regards to the perception of cac> OT in the setting in which I worked "OT cac> has no TRULY unique and HIGHLY valued role", but there was a time cac> in which I stopped listening to that unproductive self talk, and cac> decided to put all of my efforts into the clients. I learned a few cac> things in the past five years since changing my attitude and to help to cac> chage the culture of a department a) respect is dependent on the hard cac> work you put into your clients b) constant continuuing education and cac> inservicing to the staff has helped change perceptions c) lowering my cac> ego by helping out with toileting and bowel accident clean ups instead cac> of calling the nurse and "running" has helped to build a more team cac> approach and provides an opportunity to share important information d) cac> the better I know the nursing and therapy staff on a personal level the cac> more they learn about OT. cac> A few months ago I had my friend and collegue Pat a nurse talk to me cac> about how her opinion of OT has changed in the past few years. She cac> admitted that she never really had a clear grasp on what we did because cac> she never got the opportunity to see us in action when she worked in cac> home care. But when she transitioned to the rehab unit she was cac> outstounded by the the reality of what we worked on. She regrets that cac> she did not have that knowledge prior and how that could of helped many cac> patients in the home therapy setting. She told me that she once cac> thought physical therapy was the "go to therapy", but now she cac> understands how imperative OT is to the recovery of a client. I now cac> get constant phone calls from Pat and the other nursing staff about cac> certain things they see when they are helping clients with their cac> morning ADLs and how they want my advise to deal with the problems. We cac> then often work together to come up with a solution. Looking back at cac> my career so far I learned it really was not the other hospital staff cac> that devalued OT but in reality it was I whom came to hate what I was cac> doing because my focus and passion was on myself and not on the client. cac> Chris Nahrwold MS, OTR cac> -----Original Message----- cac> From: Ron Carson <rdcar...@otnow.com> cac> To: Brent Cheyne <OTlist@OTnow.com> cac> Sent: Wed, 25 Feb 2009 8:41 pm cac> Subject: Re: [OTlist] hello c cac> ompany...it's misery calling! cac> Hello Brent: cac> The question of home health being the best practice setting is cac> complicated. cac> In a perfect world, I say unequivocally "yes", but in the real world, I cac> say "no". It seems to me that in home health, like other settings, OT cac> has no TRULY unique and HIGHLY valued role. There seems to be very cac> little that OT does which isn't already covered by either PT, nursing or cac> the aide. cac> Ron cac> -- cac> Ron Carson MHS, OT cac> www.OTnow.com cac> ----- Original Message ----- cac> From: Brent Cheyne <brentche...@yahoo.com> cac> Sent: Saturday, February 21, 2009 cac> To: OTlist@OTnow.com <OTlist@OTnow.com> cac> Subj: [OTlist] hello company...it's misery calling! BC>> RON: I related so well to your well written response to Ilene cac> (Message BC>> 4,2/21/09), I have a similar history to you and worked in the cac> SNFs in BC>> the late 1990's, but woe is me... I still do today. As you cac> stated the BC>> business model doesn't foster the best that OT can be as a cac> profession. BC>> It is very inflexible and stifles innovation, creativity, and cac> quality in BC>> favor of effeciency, profit, and bureaucratic compliance to cac> Medicare BC>> rules and regs which set the system up to be as lame as it is. cac> Some how BC>> I have found a way continue in this practice setting for almost 15 cac> years BC>> and have sought out the most high quality employe cac> rs and cac> facilities with BC>> a bit of luck had good results. But I too am cac> growing VERY WEARY BC>> of all the issues you so effectively stated. I even spent one week cac> as a BC>> Rehab Manager and quit..it made me physically ill, tried o/p cac> hand BC>> therapy for 6months and was quite unsatisfied. I have cac> thought of BC>> leaving the SNF setting, but every now and then I get a patient or cac> case BC>> or two that goes so well and is so satisfying that it draws me cac> back BC>> in...it's like trying to leave the Mafia :), Ron do you think cac> home BC>> health is the best OT practice setting? cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
