Re: [OTlist] How Would YOU Treat This Patient?
Susanne, Maybe it is because here in America, we place many things under the Medical system rubric. That way we can try to get Government and insurance to pay for services. Even in Community health which is what is sounds like you work under, we have to make it into a medical issue to fix it. It is very driven by the doctors giving permission and different professions battling it out for control of access in other ways. (eg, who gets to open a case, be a diabetes educator, etc) And it all goes back to the doctor to be the gatekeeper. Elizabeth Thiers, OTR/L FECTS [EMAIL PROTECTED] > -Original Message- > From: [EMAIL PROTECTED] > [mailto:[EMAIL PROTECTED] On Behalf Of susanne > Sent: Sunday, October 19, 2008 9:52 PM > To: OTlist@OTnow.com > Subject: Re: [OTlist] How Would YOU Treat This Patient? > > Ron wrote on Monday, October 20, 2008 2:16 AM: > > > > Susanne: > > > > Tell us a little about Denmark's medical system and your > particular > > practice. > > Hi Ron! > > Short answer would be: A lot like Canada, I'm told. And, I > wrote the group some weeks ago about my new job - which is in > care, in a nursing home. > > But I worked for several years as an in-home support > person/OT for people with TBI - guess that especially > strengthened my "look at the whole family" view. It's not > really assigned to (most) OT's here to be the ones to > coordinate the different kinds of support needed - more often > this is assigned to a social worker - but as we are often the > (only) ones who can evaluate and describe the needs, and the > "total situation", we often do set things in motion for some > kind of family support (fx respite care). Can recommend, but > usually not prescribe that - unless one is employed as a > "visitator" of home health services - and a few OT's are, but > still most are nurses. > > I guess I could tell you more if I got specific questions - > finding the words to describe things in English is difficult > for me... Medical system - hmmm - I'm not really part of that > - only the OT's that work in hospitals are, I think. Aha - > that might explain some of the difference, right? > > Warmly > > susanne, denmark > > > > -- > 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] How Would YOU Treat This Patient?
Ron wrote on Monday, October 20, 2008 2:16 AM: > Susanne: > > Tell us a little about Denmark's medical system and > your particular practice. Hi Ron! Short answer would be: A lot like Canada, I'm told. And, I wrote the group some weeks ago about my new job - which is in care, in a nursing home. But I worked for several years as an in-home support person/OT for people with TBI - guess that especially strengthened my "look at the whole family" view. It's not really assigned to (most) OT's here to be the ones to coordinate the different kinds of support needed - more often this is assigned to a social worker - but as we are often the (only) ones who can evaluate and describe the needs, and the "total situation", we often do set things in motion for some kind of family support (fx respite care). Can recommend, but usually not prescribe that - unless one is employed as a "visitator" of home health services - and a few OT's are, but still most are nurses. I guess I could tell you more if I got specific questions - finding the words to describe things in English is difficult for me... Medical system - hmmm - I'm not really part of that - only the OT's that work in hospitals are, I think. Aha - that might explain some of the difference, right? Warmly susanne, denmark -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How Would YOU Treat This Patient?
Susanne:
Tell us a little about Denmark's medical system and your particular
practice.
Ron
--
Ron Carson MHS, OT
- Original Message -
From: susanne <[EMAIL PROTECTED]>
Sent: Sunday, October 19, 2008
To: OTlist@OTnow.com
Subj: [OTlist] How Would YOU Treat This Patient?
s> "Ron Carson" wrote, in two parts:
s>
s> ...even if the
>> daughter voiced a desire to see change in her mother,
>> insurance limitations do not allow me to address the
>> daughter's needs, only the patients.
s>
>> Yes, I believe that some family's actually desire to
>> take care of their members. Or at least they see it as
>> their obligation.
s> Agreed - what I would like to address is prevention of caregiver
s> burn-out - a well known issue here. When the diagnosis is dementia,
s> there's often services available like respite care - could be in
s> house ("sitting") or otherwise - by private organizations or
s> otherwise. For "just" physical disability this might be more
s> difficult to find, but offering help with finding it would to me be
s> an OT intervention in the line of prevention and compensation.
s> Also, the caregiver might need to know what to do if she ie got
s> sick/hospitalized -> more peace of mind for both.
s> Warmly
s> susanne, denmark
s> --
s> Options?
s> www.otnow.com/mailman/options/otlist_otnow.com
s> Archive?
s> www.mail-archive.com/otlist@otnow.com
--
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Re: [OTlist] How Would YOU Treat This Patient?
"Ron Carson" wrote, in two parts:
...even if the
> daughter voiced a desire to see change in her mother,
> insurance limitations do not allow me to address the
> daughter's needs, only the patients.
> Yes, I believe that some family's actually desire to
> take care of their members. Or at least they see it as
> their obligation.
Agreed - what I would like to address is prevention of caregiver burn-out - a
well known issue here. When the diagnosis is dementia, there's often services
available like respite care - could be in house ("sitting") or otherwise - by
private organizations or otherwise. For "just" physical disability this might
be more difficult to find, but offering help with finding it would to me be an
OT intervention in the line of prevention and compensation. Also, the caregiver
might need to know what to do if she ie got sick/hospitalized -> more peace of
mind for both.
Warmly
susanne, denmark
--
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Re: [OTlist] How Would YOU Treat This Patient?
Yes, I believe that some family's actually desire to take care of their members. Or at least they see it as their obligation. Lastly, I have great difficulty justifying OT intervention when the patient has no clear cut occupational needs/goals. By justification, I mean that I think significant progress is unlikely when patients are unmotivated to improve or when they don't see any "problems" in their performance. Ron -- Ron Carson MHS, OT - Original Message - From: Marie Henderson <[EMAIL PROTECTED]> Sent: Sunday, October 19, 2008 To: OTlist@OTnow.com Subj: [OTlist] How Would YOU Treat This Patient? MH> was your intuition satisfied with her response...did you see a MH> satisfying demonstration of this? I've found a real difference in MH> what people say and actually do...(on all levels). -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How Would YOU Treat This Patient?
Susanne, better late than never, right? The patient does ambulate independently, but the supervision was because of my comfort level. During the eval, the patient reported that she toilets without assistance. I did not actually evaluate this, so I'm going on her report only. But, your point is well made. Also, the daughter was NOT asked about her satisfaction with assisting her mother. However, she was involved in the evaluation. In all honesty though, even if the daughter voiced a desire to see change in her mother, insurance limitations do not allow me to address the daughter's needs, only the patients. Good questions! Ron -- Ron Carson MHS, OT - Original Message - From: susanne <[EMAIL PROTECTED]> Sent: Saturday, October 18, 2008 To: OTlist@OTnow.com Subj: [OTlist] How Would YOU Treat This Patient? s> Hi Ron - bit late reply, I know:-) But I would wonder - when she s> needs supervision for ambulating - thus can't be REALLY independent s> with toileting - that means she can't be alone for long, right? s> Seems to me that may easily turn into an occupational problem for s> the daughter living with her - did she get a say? s> To me, it would also be OT to figure out a way for the daughter to s> have a life besides caregiving. s> Warmly s> susanne s> Original Message s> From: "Ron Carson" <[EMAIL PROTECTED]> s> To: "Mary Alice Cafiero" s> Sent: Sunday, October 19, 2008 4:59 AM s> Subject: Re: [OTlist] How Would YOU Treat This Patient? >> Thanks Chris and Mary Alice for your replies. >> >> This was my last patient for the week and I elected to >> NOT pick her up for OT. The reason is simple; She >> stated she was satisfied with her currently occupational >> performance (of course, she didn't use those words >> ). >> >> I posted the message because I'm wondering if other >> OT's would have picked her up. I guess I'm second >> guessing my cut back to PRN and wondering if I should be >> LESS selective in the patient's I see. >> >> I don't know though. I've always said that if a >> patient has no identifiable occupational performance >> goals then there' no role for OT. And while there may >> be exceptions to this approach, I generally try to follow >> it. s> -- s> Options? s> www.otnow.com/mailman/options/otlist_otnow.com s> Archive? s> 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] How Would YOU Treat This Patient?
was your intuition satisfied with her response...did you see a satisfying demonstration of this? I've found a real difference in what people say and actually do...(on all levels). --- On Sat, 10/18/08, Ron Carson <[EMAIL PROTECTED]> wrote: From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] How Would YOU Treat This Patient? To: "Mary Alice Cafiero" Date: Saturday, October 18, 2008, 10:59 PM Thanks Chris and Mary Alice for your replies. This was my last patient for the week and I elected to NOT pick her up for OT. The reason is simple; She stated she was satisfied with her currently occupational performance (of course, she didn't use those words ). I posted the message because I'm wondering if other OT's would have picked her up. I guess I'm second guessing my cut back to PRN and wondering if I should be LESS selective in the patient's I see. I don't know though. I've always said that if a patient has no identifiable occupational performance goals then there' no role for OT. And while there may be exceptions to this approach, I generally try to follow it. Thanks again, Ron -- Ron Carson MHS, OT - Original Message - From: Mary Alice Cafiero <[EMAIL PROTECTED]> Sent: Friday, October 17, 2008 To: OTlist@OTnow.com Subj: [OTlist] How Would YOU Treat This Patient? MAC> I would ask both her and her daughter about their goals and start from MAC> there. Maybe it is just education with the daughter on the safest most MAC> effective way for her to offer help when she is alone with her mom. MAC> In any case, I wouldn't see it as a very long term thing! MAC> Mary Alice MAC> Mary Alice Cafiero, MSOTR, ATP MAC> [EMAIL PROTECTED] MAC> 972-757-3733 MAC> Fax 888-708-8683 MAC> This message, including any attachments, may include confidential, MAC> privileged and/or inside information. Any distribution or use of this MAC> communication by anyone other than the intended recipient(s) is MAC> strictly prohibited and may be unlawful. If you are not the recipient MAC> of this message, please notify the sender and permanently delete the MAC> message from your system. MAC> On Oct 17, 2008, at 6:58 PM, Ron Carson wrote: >> Did an eval today and wondering how other OT's might address the >> situation. >> >> 94 y/o female living with her 70 y/o daughter. Recent fall resulting >> in femur fracture. Ambulates with a rolling walker and supervision. >> Independent with toileting. Requires assistance with upper body >> dressing, independent with LE dressing. Requires assistance with >> bathing. Patient previously received assistance with bathing and >> dressing. >> >> Patient has pain 8/10 in right femur with weight bearing. She is >> unable to raise her bi-lateral shoulders past approximately 90 degree >> flexion/abduction. >> >> How would you treat this patient and WHY??? >> >> Thanks, >> >> Ron >> -- >> Ron Carson MHS, OT >> >> >> -- >> Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/otlist@otnow.com MAC> -- MAC> Options? MAC> www.otnow.com/mailman/options/otlist_otnow.com MAC> Archive? MAC> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com __ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How Would YOU Treat This Patient?
Hi Ron - bit late reply, I know:-) But I would wonder - when she needs supervision for ambulating - thus can't be REALLY independent with toileting - that means she can't be alone for long, right? Seems to me that may easily turn into an occupational problem for the daughter living with her - did she get a say? To me, it would also be OT to figure out a way for the daughter to have a life besides caregiving. Warmly susanne Original Message From: "Ron Carson" <[EMAIL PROTECTED]> To: "Mary Alice Cafiero" Sent: Sunday, October 19, 2008 4:59 AM Subject: Re: [OTlist] How Would YOU Treat This Patient? > Thanks Chris and Mary Alice for your replies. > > This was my last patient for the week and I elected to > NOT pick her up for OT. The reason is simple; She > stated she was satisfied with her currently occupational > performance (of course, she didn't use those words > ). > > I posted the message because I'm wondering if other > OT's would have picked her up. I guess I'm second > guessing my cut back to PRN and wondering if I should be > LESS selective in the patient's I see. > > I don't know though. I've always said that if a > patient has no identifiable occupational performance > goals then there' no role for OT. And while there may > be exceptions to this approach, I generally try to follow > it. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How Would YOU Treat This Patient?
Thanks Chris and Mary Alice for your replies. This was my last patient for the week and I elected to NOT pick her up for OT. The reason is simple; She stated she was satisfied with her currently occupational performance (of course, she didn't use those words ). I posted the message because I'm wondering if other OT's would have picked her up. I guess I'm second guessing my cut back to PRN and wondering if I should be LESS selective in the patient's I see. I don't know though. I've always said that if a patient has no identifiable occupational performance goals then there' no role for OT. And while there may be exceptions to this approach, I generally try to follow it. Thanks again, Ron -- Ron Carson MHS, OT - Original Message - From: Mary Alice Cafiero <[EMAIL PROTECTED]> Sent: Friday, October 17, 2008 To: OTlist@OTnow.com Subj: [OTlist] How Would YOU Treat This Patient? MAC> I would ask both her and her daughter about their goals and start from MAC> there. Maybe it is just education with the daughter on the safest most MAC> effective way for her to offer help when she is alone with her mom. MAC> In any case, I wouldn't see it as a very long term thing! MAC> Mary Alice MAC> Mary Alice Cafiero, MSOTR, ATP MAC> [EMAIL PROTECTED] MAC> 972-757-3733 MAC> Fax 888-708-8683 MAC> This message, including any attachments, may include confidential, MAC> privileged and/or inside information. Any distribution or use of this MAC> communication by anyone other than the intended recipient(s) is MAC> strictly prohibited and may be unlawful. If you are not the recipient MAC> of this message, please notify the sender and permanently delete the MAC> message from your system. MAC> On Oct 17, 2008, at 6:58 PM, Ron Carson wrote: >> Did an eval today and wondering how other OT's might address the >> situation. >> >> 94 y/o female living with her 70 y/o daughter. Recent fall resulting >> in femur fracture. Ambulates with a rolling walker and supervision. >> Independent with toileting. Requires assistance with upper body >> dressing, independent with LE dressing. Requires assistance with >> bathing. Patient previously received assistance with bathing and >> dressing. >> >> Patient has pain 8/10 in right femur with weight bearing. She is >> unable to raise her bi-lateral shoulders past approximately 90 degree >> flexion/abduction. >> >> How would you treat this patient and WHY??? >> >> Thanks, >> >> Ron >> -- >> Ron Carson MHS, OT >> >> >> -- >> Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/otlist@otnow.com MAC> -- MAC> Options? MAC> www.otnow.com/mailman/options/otlist_otnow.com MAC> Archive? MAC> 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] How Would YOU Treat This Patient?
Sounds like she might be back to her baseline with her ADL performance.? Her bi-lateral shoulder problem sounds like either severe arthritis or torn RTCs.? At her age surgery not?likely for the RT.? Is she ok with receiving assistance with bathing and dressing or is it a goal of hers to improve?? If it a goal for her to improve in ADL performance, I would attempt to teach her how to use adaptive equipment like a dressing stick to pull the shirt over her head so her arms would not have to go over 90 degrees.? I would also instruct the patient and family on heat and slow stretching so the limitation in her arms will not become worse and perhaps so she can lift her arms on a table or sink to slip on her shirt over her head and to groom/eat.? I just had a man in a similiar situation, but he was much younger.? The basic compensation techniques and exercises worked like a charm, and he was very happy about the progress, but he was very motivated to improve because his wife was unable to help him much. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson <[EMAIL PROTECTED]> To: OTlist@OTnow.com Sent: Fri, 17 Oct 2008 6:58 pm Subject: [OTlist] How Would YOU Treat This Patient? Did an eval today and wondering how other OT's might address the situation. 94 y/o female living with her 70 y/o daughter. Recent fall resulting in femur fracture. Ambulates with a rolling walker and supervision. Independent with toileting. Requires assistance with upper body dressing, independent with LE dressing. Requires assistance with bathing. Patient previously received assistance with bathing and dressing. Patient has pain 8/10 in right femur with weight bearing. She is unable to raise her bi-lateral shoulders past approximately 90 degree flexion/abduction. How would you treat this patient and WHY??? Thanks, Ron -- Ron Carson MHS, OT -- 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] How Would YOU Treat This Patient?
I would ask both her and her daughter about their goals and start from there. Maybe it is just education with the daughter on the safest most effective way for her to offer help when she is alone with her mom. In any case, I wouldn't see it as a very long term thing! Mary Alice Mary Alice Cafiero, MSOTR, ATP [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Oct 17, 2008, at 6:58 PM, Ron Carson wrote: Did an eval today and wondering how other OT's might address the situation. 94 y/o female living with her 70 y/o daughter. Recent fall resulting in femur fracture. Ambulates with a rolling walker and supervision. Independent with toileting. Requires assistance with upper body dressing, independent with LE dressing. Requires assistance with bathing. Patient previously received assistance with bathing and dressing. Patient has pain 8/10 in right femur with weight bearing. She is unable to raise her bi-lateral shoulders past approximately 90 degree flexion/abduction. How would you treat this patient and WHY??? Thanks, Ron -- Ron Carson MHS, OT -- 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
[OTlist] How Would YOU Treat This Patient?
Did an eval today and wondering how other OT's might address the situation. 94 y/o female living with her 70 y/o daughter. Recent fall resulting in femur fracture. Ambulates with a rolling walker and supervision. Independent with toileting. Requires assistance with upper body dressing, independent with LE dressing. Requires assistance with bathing. Patient previously received assistance with bathing and dressing. Patient has pain 8/10 in right femur with weight bearing. She is unable to raise her bi-lateral shoulders past approximately 90 degree flexion/abduction. How would you treat this patient and WHY??? Thanks, Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
