[OTlist] Nursing
Today, a nurse is accompanying me on an eval. Our home health director has asked nursing to do this so they can learn more about OT. While this is a GOOD thing, it's also sort of sad that nursing doesn't know what OT does in home health. 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
Re: [OTlist] vestibular
Hi Elayne, congratulations on passing your degree! Sensory processing and treatment thereof is not strictly an OT area. There are physios and speech and language therapists who have an interest in this area too. There is however the need for further training before you are 'equipped' to work in this area. And you are correct in saying that the 'vestibular' system is part of the focus of Sensory Integration/Sensory Processing Disorders. Veronica Groenewald Hi I'm also just a reader of all your emails. I've not contributed because I just graduated last December and about to take the NBCOT exam. So I am going to be brave and boldly askisn't "vestibular treatment" simply a part of treating sensory integration disorders (providing vestibular problems are present)? In my review book, deficits in modulation of vestibular input include over and under responsivity, sensory seeking or aversion, and gravitational insecurity. Are you referring to another kind of treatment? And why would a PT provide it? I thought that was strictly in OT's domain. I did one of my clinicals in the public school system and SI was most often used with autism, but with other psychological/psychiatric problems as well. Looking forward to any comments/feedback. Elayne V Nashville, TN -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] vestibular OT
It would be helpful to me for those with experience to talk about the differences in "vestibular" disorders and how you use this in an occupational model. Example, BPPV vs Meniere's disease vs sensory processing deficits. Thanks Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of ehthiers Sent: Tuesday, February 24, 2009 4:46 PM To: OTlist@OTnow.com Subject: Re: [OTlist] vestibular OT Ot's have been doing vestibular work since Jean Ayers (much of the basis for Sensory integration treatment starts at the vestibular system). However, with fall prevention becoming a big thing with Medicare everyone and their brother is becoming a vestibular specialist. I have vertigo and went through many local providers before I finally went to the one recommended by me in a course I took. Less physcial depends on if you have aides to help you out. It is a fascinating field and you would be mistaken for PT if you don't know how to bring an OT perspective to the program. Vestibular disorders association (VEDA) has lots of great information, here on the east coast an OT from the Ear Clinic in Atlanta does some great trainings. It all depends on what age group you want to work with. Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net > -Original Message- > From: otlist-boun...@otnow.com > [mailto:otlist-boun...@otnow.com] On Behalf Of d. chang > Sent: Tuesday, February 24, 2009 12:10 AM > To: OTlist@otnow.com > Subject: [OTlist] vestibular OT > > Hello !! > > I've been on this list for a while, but just as an owl. I > love reading > everything here. Im learning new things from each and every > one of you. > Education is just totally endless. There are so much stuff > to learn. Oh, before I go on, my name is Diana and Im in my > last year of OT program !! > > I'm very interested in vestibular field. A friend of mine > told me that the vestibular is an up and coming field for OT > AND its less physical demanding, which is perfect for me > because I have a meniere's disease and a low back pain. > > Does anyone know about this particular field? > > diana. > -- > 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
Re: [OTlist] Nursing
Hi Ron, as a former Nurse who got to "see the light" after working with OTs for a few years (and asking them lots of questions about the kinds of things they did and why they did them) I have to say I am favour of this kind of interdisciplinary orientation . Moving to OT was the best career move I ever made -went from close to burnt out to someone who loves most days on the job. We're sure you won't miss the chance to promote the profession Ron ; - ) David, OT Melbourne Australia Ron Carson wrote: Today, a nurse is accompanying me on an eval. Our home health director has asked nursing to do this so they can learn more about OT. While this is a GOOD thing, it's also sort of sad that nursing doesn't know what OT does in home health. 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 __ NOD32 3889 (20090225) Information __ This message was checked by NOD32 antivirus system. http://www.eset.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Female Urinal devices
A 91-year old friend who originated a low vision support group that I help facilitate has been partially bed-ridden since falling in her home in December. She has been using a Depend-type underwear and requires help from her husband to change the pant. She is very anxious to start helping with her toileting activities, in order to assist her husband with the burden of her care, and to reduce the associated frustration of leaking, etc. She is able to independently get into a reclining position in bed, but cannot yet get out of bed without assistance. I noticed various types of female urinals while surfing the net and wondered if anyone has had success with a particular design that would work for someone of her abilities. She is legally blind, but is cognitively as sharp as a tack. She broke some ribs from her fall, but I believe her manual dexterity is good for someone of her age. Even if she was able to use the urinal with her husband's assistance, it might eliminate some of the negative issues attached to the current toileting method (odor, spills, etc). I would appreciate feedback from anyone who has had experience with these devices. Sue -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Female Urinal devices
You might check the Sammon Preston catalog Sammonspreston.com -Original Message- From: Sue Mikolajczak [mailto:susanjmikol-...@twmi.rr.com] Sent: Wednesday, February 25, 2009 3:38 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Female Urinal devices A 91-year old friend who originated a low vision support group that I help facilitate has been partially bed-ridden since falling in her home in December. She has been using a Depend-type underwear and requires help from her husband to change the pant. She is very anxious to start helping with her toileting activities, in order to assist her husband with the burden of her care, and to reduce the associated frustration of leaking, etc. She is able to independently get into a reclining position in bed, but cannot yet get out of bed without assistance. I noticed various types of female urinals while surfing the net and wondered if anyone has had success with a particular design that would work for someone of her abilities. She is legally blind, but is cognitively as sharp as a tack. She broke some ribs from her fall, but I believe her manual dexterity is good for someone of her age. Even if she was able to use the urinal with her husband's assistance, it might eliminate some of the negative issues attached to the current toileting method (odor, spills, etc). I would appreciate feedback from anyone who has had experience with these devices. Sue -- 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
Re: [OTlist] vestibular OT
Hi, This "vestibular" stuff is interesting to me. It seems I've gotten lots of continuing ed. brochures concerning "Vestibular Rehabilitation" that are put on by PTs. I do use sensory integration in my practice as a school OT, but from what I've done and seen in practice, the vestibular activities we do under this frame of reference look different than what people who practice "Vestibular Rehab", as it is termed, do. I was looking at a site (looks like it's written by a neurologist) that claims that mostly PTs do this sort of rehab, but that some OTs do it as well. "Vestibular Rehab", according to this site, seems to involve different techniques, maneuvers and tests that I'm not familiar with, and seems to be directed toward definite conditions that involve balance issues. For reference, here's the site (http://www.dizziness-and-balance.com/treatment/rehab.html#definition) There seem to be slight differences in terminology that may determine what field the majority of practitioners come from. There is a course put on by OTs, Sheila Frick & Mary Kawar called "Vestibular Habilitation From the Core", and I do also use this in practice via the "Astronaut Training" protocol. Just my two cents...perhaps this will clarify (or confuse more ;-)) the question from the person who initially began this thread. ~Jamie --- On Wed, 2/25/09, Neal Luther wrote: From: Neal Luther Subject: Re: [OTlist] vestibular OT To: OTlist@OTnow.com Date: Wednesday, February 25, 2009, 6:20 AM It would be helpful to me for those with experience to talk about the differences in "vestibular" disorders and how you use this in an occupational model. Example, BPPV vs Meniere's disease vs sensory processing deficits. Thanks Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of ehthiers Sent: Tuesday, February 24, 2009 4:46 PM To: OTlist@OTnow.com Subject: Re: [OTlist] vestibular OT Ot's have been doing vestibular work since Jean Ayers (much of the basis for Sensory integration treatment starts at the vestibular system). However, with fall prevention becoming a big thing with Medicare everyone and their brother is becoming a vestibular specialist. I have vertigo and went through many local providers before I finally went to the one recommended by me in a course I took. Less physcial depends on if you have aides to help you out. It is a fascinating field and you would be mistaken for PT if you don't know how to bring an OT perspective to the program. Vestibular disorders association (VEDA) has lots of great information, here on the east coast an OT from the Ear Clinic in Atlanta does some great trainings. It all depends on what age group you want to work with. Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net > -Original Message- > From: otlist-boun...@otnow.com > [mailto:otlist-boun...@otnow.com] On Behalf Of d. chang > Sent: Tuesday, February 24, 2009 12:10 AM > To: OTlist@otnow.com > Subject: [OTlist] vestibular OT > > Hello !! > > I've been on this list for a while, but just as an owl. I > love reading > everything here. Im learning new things from each and every > one of you. > Education is just totally endless. There are so much stuff > to learn. Oh, before I go on, my name is Diana and Im in my > last year of OT program !! > > I'm very interested in vestibular field. A friend of mine > told me that the vestibular is an up and coming field for OT > AND its less physical demanding, which is perfect for me > because I have a meniere's disease and a low back pain. > > Does anyone know about this particular field? > > diana. > -- > 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
Re: [OTlist] vestibular OT
I see a lot of the different types of visual, vestibular, reflex integration, core work programs have a lot of overlap. What's good about the trainings though are the program specifics regarding the different diagnosis. Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net > -Original Message- > From: otlist-boun...@otnow.com > [mailto:otlist-boun...@otnow.com] On Behalf Of Sue Doyle > Sent: Tuesday, February 24, 2009 11:05 PM > To: otlist@otnow.com > Subject: Re: [OTlist] vestibular OT > > > This again is a very interesting topic. There are many OTs > who are trained and work in vestiblular therapy. There are > many issues involved and to do it well one needs advanced > training but there is so much overlap with visual problems > etc and impacts on so many occupational areas. It also > involve understanding balance in a multifaceted manner. > > I did a lot of work in the area in trauma with mild brain > injuries. We see a significant number of clients with > impairments after strokes. > > Sue D > > > > > > From: spark...@rcn.com > > To: OTlist@OTnow.com > > Date: Tue, 24 Feb 2009 18:36:44 -0500 > > Subject: Re: [OTlist] vestibular OT > > > > Hmm. not sure but I used to babysit for a vestibular PT. He > once told > > me that OT's cannot do vestibular therapy. Not sure why or > even if it > > is accurate? I am not sure what vestibular OT would look > like as a treatment. > > > > -Original Message- > > From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on > > Behalf Of d. chang > > Sent: Tuesday, February 24, 2009 00:10 > > To: OTlist@otnow.com > > Subject: [OTlist] vestibular OT > > > > > > Hello !! > > > > I've been on this list for a while, but just as an owl. I > love reading > > everything here. Im learning new things from each and > every one of you. > > Education is just totally endless. There are so much stuff > to learn. > > Oh, before I go on, my name is Diana and Im in my last year > of OT program !! > > > > I'm very interested in vestibular field. A friend of mine told me > > that the vestibular is an up and coming field for OT AND its less > > physical demanding, which is perfect for me because I have > a meniere's > > disease and a low back pain. > > > > Does anyone know about this particular field? > > > > diana. > > -- > > 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
Re: [OTlist] hello company...it's misery calling!
Hello Brent: The question of home health being the best practice setting is complicated. In a perfect world, I say unequivocally "yes", but in the real world, I say "no". It seems to me that in home health, like other settings, OT has no TRULY unique and HIGHLY valued role. There seems to be very little that OT does which isn't already covered by either PT, nursing or the aide. Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Brent Cheyne Sent: Saturday, February 21, 2009 To: OTlist@OTnow.com Subj: [OTlist] hello company...it's misery calling! BC> RON: I related so well to your well written response to Ilene (Message BC> 4,2/21/09), I have a similar history to you and worked in the SNFs in BC> the late 1990's, but woe is me... I still do today. As you stated the BC> business model doesn't foster the best that OT can be as a profession. BC> It is very inflexible and stifles innovation, creativity, and quality in BC> favor of effeciency, profit, and bureaucratic compliance to Medicare BC> rules and regs which set the system up to be as lame as it is. Some how BC> I have found a way continue in this practice setting for almost 15 years BC> and have sought out the most high quality employers and facilities with BC> a bit of luck had good results. But I too am growing VERY WEARY BC> of all the issues you so effectively stated. I even spent one week as a BC> Rehab Manager and quit..it made me physically ill, tried o/p hand BC> therapy for 6months and was quite unsatisfied. I have thought of BC> leaving the SNF setting, but every now and then I get a patient or case BC> or two that goes so well and is so satisfying that it draws me back BC> in...it's like trying to leave the Mafia :), Ron do you think home BC> health is the best OT practice setting? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] Lost your job...
Has anyone ever lost their job for refusing to practice in a way inconsistent with your values and beliefs as an OT? Just curious. Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Female Urinal devices
I am not a big fan of bed pans or urinals but I undestand how useful they are in "emergencies" especially at night. I would strongly suggest a bed side commode for that needed out of bed activity during the day, and perhaps a female urinal and a standard bed pan at night. I have used a female urinal for a client found in the Sammons and Preston catelog with moderate success, but this lady was a bilateral above the knee amputation so it was easier to place the urinal where it belonged. I imagine it will take some practice. I remember that the easiest position was being completely supine versus reclined secondary to some spilling that occured in the reclined position. Again, I strongly recommend that the patient is out of bed as much as possbile because the effects of bed immobility and atrophy is lethal if left untreated. These pieces of adaptive equipment often becomes a crutch which hinders a patient's progress. Chris Nahrwold MS, OTR -Original Message- From: Robertson, Susan (NIH/CC/RMD) [E] To: OTlist@OTnow.com Sent: Wed, 25 Feb 2009 4:58 pm Subject: Re: [OTlist] Female Urinal devices You might check the Sammon Preston catalog Sammonspreston.com -Original Message- From: Sue Mikolajczak [mailto:susanjmikol-...@twmi.rr.com] Sent: Wednesday, February 25, 2009 3:38 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Female Urinal devices A 91-year old friend who originated a low vision support group that I help facilitate has been partially bed-ridden since falling in her home in December. She has been using a Depend-type underwear and requires help from her husband to change the pant. She is very anxious to start helping with her toileting activities, in order to assist her husband with the burden of her care, and to reduce the associated frustration of leaking, etc. She is able to independently get into a reclining position in bed, but cannot yet get out of bed without assistance. I noticed various types of female urinals while surfing the net and wondered if anyone has had success with a particular design that would work for someone of her abilities. She is legally blind, but is cognitively as sharp as a tack. She broke some ribs from her fall, but I believe her manual dexterity is good for someone of her age. Even if she was able to use the urinal with her husband's assistance, it might eliminate some of the negative issues attached to the current toileting method (odor, spills, etc). I would appreciate feedback from anyone who has had experience with these devices. Sue -- 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
Re: [OTlist] vestibular OT
The name of the person that I am thinking of is by the name Cohen. Check out OTseeker.com to review article abstracts that you may find interesting and then take a few abstracts to a librarian for assistance of finding them, perferably a hospital librarian or a university librarian. Here is one abstract from Pubmed that has a few case studies from Cohen that use her hierachy of occupations to treat vestibular dysfunction. http://www.ncbi.nlm.nih.gov/pubmed/7785720 Really interesting concept. Chris Nahrwold MS, OTR -Original Message- From: Sue Doyle To: otlist@otnow.com Sent: Tue, 24 Feb 2009 11:05 pm Subject: Re: [OTlist] vestibular OT This again is a very interesting topic. There are many OTs who are trained and work in vestiblular therapy. There are many issues involved and to do it well one needs advanced training but there is so much overlap with visual problems etc and impacts on so many occupational areas. It also involve understanding balance in a multifaceted manner. I did a lot of work in the area in trauma with mild brain injuries. We see a significant number of clients with impairments after strokes. Sue D From: spark...@rcn.com To: OTlist@OTnow.com Date: Tue, 24 Feb 2009 18:36:44 -0500 Subject: Re: [OTlist] vestibular OT Hmm. not sure but I used to babysit for a vestibular PT. He once told me that OT's cannot do vestibular therapy. Not sure why or even if it is accurate? I am not sure what vestibular OT would look like as a treatment. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of d. chang Sent: Tuesday, February 24, 2009 00:10 To: OTlist@otnow.com Subject: [OTlist] vestibular OT Hello !! I've been on this list for a while, but just as an owl. I love reading everything here. Im learning new things from each and every one of you. Education is just totally endless. There are so much stuff to learn. Oh, before I go on, my name is Diana and Im in my last year of OT program !! I'm very interested in vestibular field. A friend of mine told me that the vestibular is an up and coming field for OT AND its less physical demanding, which is perfect for me because I have a meniere's disease and a low back pain. Does anyone know about this particular field? diana. -- 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
Re: [OTlist] hello company...it's misery calling!
Ron, Are you saying that PT, nursing, and nursing aides is working on increased independence in clients' occupations? Or does it appear that they are addressing the issues by completing them for the patient? Perhaps it would be wise to have a tag along day with these disciplines to create a team approarch. I think one of the best things a home OT can do is become friends with the home aides because they can help with the needed correct repetiion of your treatment interventions outside of formal therapy time. You know Ron, I once thought like you in regards to the perception of OT in the setting in which I worked "OT has no TRULY unique and HIGHLY valued role", but there was a time in which I stopped listening to that unproductive self talk, and decided to put all of my efforts into the clients. I learned a few things in the past five years since changing my attitude and to help to chage the culture of a department a) respect is dependent on the hard work you put into your clients b) constant continuuing education and inservicing to the staff has helped change perceptions c) lowering my ego by helping out with toileting and bowel accident clean ups instead of calling the nurse and "running" has helped to build a more team approach and provides an opportunity to share important information d) the better I know the nursing and therapy staff on a personal level the more they learn about OT. A few months ago I had my friend and collegue Pat a nurse talk to me about how her opinion of OT has changed in the past few years. She admitted that she never really had a clear grasp on what we did because she never got the opportunity to see us in action when she worked in home care. But when she transitioned to the rehab unit she was outstounded by the the reality of what we worked on. She regrets that she did not have that knowledge prior and how that could of helped many patients in the home therapy setting. She told me that she once thought physical therapy was the "go to therapy", but now she understands how imperative OT is to the recovery of a client. I now get constant phone calls from Pat and the other nursing staff about certain things they see when they are helping clients with their morning ADLs and how they want my advise to deal with the problems. We then often work together to come up with a solution. Looking back at my career so far I learned it really was not the other hospital staff that devalued OT but in reality it was I whom came to hate what I was doing because my focus and passion was on myself and not on the client. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson To: Brent Cheyne Sent: Wed, 25 Feb 2009 8:41 pm Subject: Re: [OTlist] hello c ompany...it's misery calling! Hello Brent: The question of home health being the best practice setting is complicated. In a perfect world, I say unequivocally "yes", but in the real world, I say "no". It seems to me that in home health, like other settings, OT has no TRULY unique and HIGHLY valued role. There seems to be very little that OT does which isn't already covered by either PT, nursing or the aide. Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Brent Cheyne Sent: Saturday, February 21, 2009 To: OTlist@OTnow.com Subj: [OTlist] hello company...it's misery calling! BC> RON: I related so well to your well written response to Ilene (Message BC> 4,2/21/09), I have a similar history to you and worked in the SNFs in BC> the late 1990's, but woe is me... I still do today. As you stated the BC> business model doesn't foster the best that OT can be as a profession. BC> It is very inflexible and stifles innovation, creativity, and quality in BC> favor of effeciency, profit, and bureaucratic compliance to Medicare BC> rules and regs which set the system up to be as lame as it is. Some how BC> I have found a way continue in this practice setting for almost 15 years BC> and have sought out the most high quality employe rs and facilities with BC> a bit of luck had good results. But I too am growing VERY WEARY BC> of all the issues you so effectively stated. I even spent one week as a BC> Rehab Manager and quit..it made me physically ill, tried o/p hand BC> therapy for 6months and was quite unsatisfied. I have thought of BC> leaving the SNF setting, but every now and then I get a patient or case BC> or two that goes so well and is so satisfying that it draws me back BC> in...it's like trying to leave the Mafia :), Ron do you think home BC> health is the best OT practice setting? -- 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