Re: [OTlist] hello company...it's misery calling!
Here's a link to a site with the knee walkers: http://www.activeforever.com/s-127-knee-walkers.aspx My orthopedist used one when he was non-weightbearing from a foot/ankle injury and said it was great for using in the OR during surgery. I've had a pt that used one too and she loved it since she didn't have enough UB strength for crutches or hopping with a walker. Mary -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of cmnahrw...@aol.com Sent: Thursday, February 26, 2009 1:18 PM To: OTlist@OTnow.com Subject: Re: [OTlist] hello company...it's misery calling! 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
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 brentche...@yahoo.com Sent: Saturday, February 21, 2009 To: OTlist@OTnow.com 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
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 rdcar...@otnow.com To: Brent Cheyne OTlist@OTnow.com 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 brentche...@yahoo.com Sent: Saturday, February 21, 2009 To: OTlist@OTnow.com 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
Re: [OTlist] hello company...it's misery calling!
Ron, Ilene, and Mary Alice and the rest of you I love reading this listserv and enjoy your comments...though somedays reading it makes me want to quit my OT career and join the Circus or start that pumpkin carving business...(maybe not...too seasonal for steady cash flow!;)) MARY ALICE: I wanted to respond to you because you have such good comments and DONT STOP contributing...I agree with you that patients come to rehab and have a lot of preconcieved notions about what efforts/methods will create what results, they think I just need strengthening orI just need to walk.. they don't make the connections about the rehab process that we know so well. So much of the challenge is to educated people on the process of OT, addressing the goals. This requires very good communication skills on the part of the OT. Pt's with chronic illnesses or even subacute health issues are reluctant to attempt the process of adapting to their condition because of denial of the loss function. They really are in phase of wanting to FIX IT NOW back to normal. As we know this is not always possible or realistic. OTs are superior to most other professions at teaching adaptation to Enable Occupation. In some cases we fix things in an innovative and effective way.The disadvantage is in the OT concepts where ,of course ,we know that occupation is that complex multifactorial phenomena that is the essence of performing daily life and is so much a part of our lives, and so individually subjective. Peeple don't think about it in the same terms we describe it in but they often get the connection when we do our jobs well. It is a tough job but rewarding. RON: I related so well to your well written response to Ilene (Message 4,2/21/09), I have a similar history to you and worked in the SNFs in the late 1990's, but woe is me... I still do today. As you stated the business model doesn't foster the best that OT can be as a profession. It is very inflexible and stifles innovation, creativity, and quality in favor of effeciency, profit, and bureaucratic compliance to Medicare rules and regs which set the system up to be as lame as it is. Some how I have found a way continue in this practice setting for almost 15 years and have sought out the most high quality employers and facilities with a bit of luck had good results. But I too am growing VERY WEARY of all the issues you so effectively stated. I even spent one week as a Rehab Manager and quit..it made me physically ill, tried o/p hand therapy for 6months and was quite unsatisfied. I have thought of leaving the SNF setting, but every now and then I get a patient or case or two that goes so well and is so satisfying that it draws me back in...it's like trying to leave the Mafia :), Ron do you think home health is the best OT practice setting? ILENE: I could totally relate to you comments about SNF and goal setting and treatment ideas. Isn't this such a challenging population. SPEAKING OF THEORIES:My theory is that people who know the value of occupation to health status practice what they preach in that they engage in meaningful occupations and enjoy a high quality of life and health status, and when they do get sick or have issues they are quick to self -treat with the motivation, and goal-oriented mind set to get back to living and and the flexibility to adapt to their condition. And they use their OT as a resource to achieve goals. I see a few of these kinds of patients in SNFS, BUT, the greater majority of the SNF patient's I see have an ongoing Occupation deficit which correlates with their poor health status and issues and lack of ability to adapt. We are often faced with the toughest cases, with people who's prior level of occupation is so dysfunctional/deficient or co-dependent on a caregiving relationship that they just don't have a OT-like outlook. Many clients outsource their occupation by expecting spouses, neighbors, hired caregivers, meals on wheels, etc..to provided ADL.So I think we are often faced with the most challenging and ill fitting clients for OT at the SNF setting, Hello company...it's misery calling. So should I begin selling snow cones at the north pole, or take my sock puppet show on a national tour as a new career? What Say you RON? (LOL) Brent -- 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!
Brent, Great comments Do you need an understudy for the sock puppet show? Simply hilarious! Chris -Original Message- From: Brent Cheyne brentche...@yahoo.com To: OTlist@OTnow.com Sent: Sat, 21 Feb 2009 6:37 pm Subject: Re: [OTlist] hello company...it's misery calling! Ron, Ilene, and Mary Alice and the rest of you I love reading this listserv and enjoy your comments...though somedays reading it makes me want to quit my OT career and join the Circus or start that pumpkin carving business...(maybe not...too seasonal for steady cash flow!;)) MARY ALICE: I wanted to respond to you because you have such good comments and DONT STOP contributing...I agree with you that patients come to rehab and have a lot of preconcieved notions about what efforts/methods will create what results, they think I just need strengthening orI just need to walk.. they don't make the connections about the rehab process that we know so well. So much of the challenge is to educated people on the process of OT, addressing the goals. This requires very good communication skills on the part of the OT. Pt's with chronic illnesses or even subacute health issues are reluctant to attempt the process of adapting to their condition because of denial of the loss function. They really are in phase of wanting to FIX IT NOW back to normal. As we know this is not always possible or realistic. OTs are superior to most other professions at teaching adaptation to Enable Occupation. In some cases we fix things in an innovative and effective way.The disadvantage is in the OT concepts where ,of course ,we know that occupation is that complex multifactorial phenomena that is the essence of performing daily life and is so much a part of our lives, and so individually subjective. Peeple don't think about it in the same terms we describe it in but they often get the connection when we do our jobs well. It is a tough job but rewarding. RON: I related so well to your well written response to Ilene (Message 4,2/21/09), I have a similar history to you and worked in the SNFs in the late 1990's, but woe is me... I still do today. As you stated the business model doesn't foster the best that OT can be as a profession. It is very inflexible and stifles innovation, creativity, and quality in favor of effeciency, profit, and bureaucratic compliance to Medicare rules and regs which set the system up to be as lame as it is. Some how I have found a way continue in20this practice setting for almost 15 years and have sought out the most high quality employers and facilities with a bit of luck had good results. But I too am growing VERY WEARY of all the issues you so effectively stated. I even spent one week as a Rehab Manager and quit..it made me physically ill, tried o/p hand therapy for 6months and was quite unsatisfied. I have thought of leaving the SNF setting, but every now and then I get a patient or case or two that goes so well and is so satisfying that it draws me back in...it's like trying to leave the Mafia :), Ron do you think home health is the best OT practice setting? ILENE: I could totally relate to you comments about SNF and goal setting and treatment ideas. Isn't this such a challenging population. SPEAKING OF THEORIES:My theory is that people who know the value of occupation to health status practice what they preach in that they engage in meaningful occupations and enjoy a high quality of life and health status, and when they do get sick or have issues they are quick to self -treat with the motivation, and goal-oriented mind set to get back to living and and the flexibility to adapt to their condition. And they use their OT as a reso urce to achieve goals. I see a few of these kinds of patients in SNFS, BUT, the greater majority of the SNF patient's I see have an ongoing Occupation deficit which correlates with their poor health status and issues and lack of ability to adapt. We are often faced with the toughest cases, with people who's prior level of occupation is so dysfunctional/deficient or co-dependent on a caregiving relationship that they just don't have a OT-like outlook. Many clients outsource their occupation by expecting spouses, neighbors, hired caregivers, meals on wheels, etc..to provided ADL.So I think we are often faced with the most challenging and ill fitting clients for OT at the SNF setting, Hello company...it's misery calling. So should I begin selling snow cones at the north pole, or take my sock puppet show on a national tour as a new career? What Say you RON? (LOL) Brent -- 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
