Ron, thanks for sharing. Sounds like a difficult situation in which it
will take a long time to change the culture. Glad you made that phone
call to the PTA. I am so glad that we do not have that problem, we
walk patients all of the time around the rehab unit and the PT seems to
appreciate the carryover. One habit I have gotten into is asking the
PT her advise on how she wants the gait and stairs completed. I also
ask her about all changes in mobility aides (walker, canes, rollators)
for professional courtesy. Most of the time it is a no brainer, but it
has really helped to open up dialogue. The PT in the same respect has
asked me on my advise when it comes to ADLs, visual perceptual
processing, flaccid arm supports, wheelchair positioning, etc. So it
is a win win situation all around.
I am really fascinated about this knee walker. We have a lot of non
weight bearing patients whom want to go home, but it is nearly
impossible to maintain the weightbearing status pending on how weak and
cognitively impaired they might be.
Chris Nahrwold MS, OTR
-----Original Message-----
From: Ron Carson <rdcar...@otnow.com>
To: cmnahrw...@aol.com <OTlist@OTnow.com>
Sent: Thu, 26 Feb 2009 6:58 am
Subject: Re: [OTlist] hello company...it's misery calling!
Chris, you bring up very good and valued points and that's a great story
about your nurse friend. I think it also highlights that20EACH 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 other
s. 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 a
bout 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, nursin
g, 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
information20d)
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 the20
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 a
nd 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?
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cac> Archive?
cac> www.mail-archive.com/otlist@otnow.com
cac> --
cac> Options?
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cac> Archive?
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