In Inpatient Rehab you cannot see more than one patient as a time unless they are part of a group. If they are a group they have to have similar goals that are part of each patients individual plan that can be matched together. While there is no set limit on how much group therapy a patient can receive as a proportion of their therapy, Skilled nursing facilities are limited to 25% and it is recommended that rehab does not exceed this as well.
While some of patient's goals often include being able to use their affected upper extremity one should really focus on the clients occupational goals. The problems generally start with the evaluation process. If you do not identify occupational issues and patient goals in your evaluation but identify upper extremity issues that is where you will focus your treatment. Has anyone used the "Cardinal Hill Occupational Framework documentation that identifies documentation that focuses on the occupational framework and hence helps to guide the clinical reasoning process to a more occupationally focuses manner. This then means that generally the clinical setting needs to change particularly in rehab, so that the treatment media would need to be focused on various occupational options. I built boxes or kits with a variety of options that my clients expressed interest in. It is best to use the real objects and occupations. Hope this helps some. Sue D > From: mltaylo...@hotmail.com > To: otlist@otnow.com > Date: Thu, 23 Jul 2009 19:40:03 -0500 > Subject: Re: [OTlist] Vision ~vs~ Reality > > > Ron can you provide some examples of how you made it work in the in-patient > rehab setting. You mentioned that you would see 2-3 people at a time, how did > you work with each of them on their own occupations? > > > > Also, why is a cooking group, folding towels, not good occupations to work on? > > Thanks, > > ~ Miranda ~ > > > > > > Date: Thu, 23 Jul 2009 20:31:45 -0400 > > From: rdcar...@otnow.com > > To: OTlist@OTnow.com > > 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 <spark...@rcn.com> > > Sent: Thursday, July 23, 2009 > > To: OTlist@OTnow.com <OTlist@OTnow.com> > > 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. > > > > > > -- > > Options? > > www.otnow.com/mailman/options/otlist_otnow.com > > > > Archive? > > www.mail-archive.com/otlist@otnow.com > > _________________________________________________________________ > Windows Live™ Hotmail®: Celebrate the moment with your favorite sports pics. > Check it out. > http://www.windowslive.com/Online/Hotmail/Campaign/QuickAdd?ocid=TXT_TAGLM_WL_QA_HM_sports_photos_072009&cat=sports > -- > 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
