Re: [OTlist] Vision ~vs~ Reality

[shirley roberson]

Ron, 
 
Maybe somehow you could inform the public..?  I sure have learned about OT this 
past year.   I know this week when I told my son-in-law to contact the agency 
and ask for you, he was given first a CNA and then a PT, but I had to have him 
call again to get you, the OT.  It seems that as patients and family we are 
beginning to see how well OT works for our loved ones, but for whatever reason, 
the agencies want to send out personnel as ie: 1,2,3 and the OT seems to be 3.

Shirley

--- On Wed, 7/22/09, Ron Carson  wrote:


From: Ron Carson 
Subject: [OTlist] Vision ~vs~ Reality
To: OTlist@OTnow.com
Date: Wednesday, July 22, 2009, 9:35 AM


Part  of  AOTA's  vision statement is that our profession will be widely
recognized. When is our centennial: 2014?

Why  is  is that TODAY, I am writing up a flyer to distribute to my home
health office explaining OT and yet in 5 years, OT is going to be widely
recognized?

Why is it that after almost 100 years, OT is not known?

Why is that my home health agency has 3 times as many PT's as OT's?

What  is  going  to  happen  in  the  next 5 years to make a significant
difference in OT's presence?

I am one frustrated OT..

Ron

~~~
Ron Carson MHS, OT
www.OTnow.com


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Re: [OTlist] Vision ~vs~ Reality

[Ron Carson]

Shirley,  what  if  I  did  OT  the way past OT's had done? If I focused
treatment  on  the upper extremity would you still say "we are beginning
to see how well OT works for our loved ones"?

Just  to  remind  everyone,  Shirley is the mother of a patient that I'm
seeing. She has been exposed to a LOT a therapy.


- Original Message -
From: shirley roberson 
Sent: Wednesday, July 22, 2009
To:   OTlist@OTnow.com 
Subj: [OTlist] Vision ~vs~ Reality

sr> Ron, 
sr>  
sr> Maybe somehow you could inform the public..?  I sure have learned
sr> about OT this past year.   I know this week when I told my
sr> son-in-law to contact the agency and ask for you, he was given first
sr> a CNA and then a PT, but I had to have him call again to get you,
sr> the OT.  It seems that as patients and family we are beginning to
sr> see how well OT works for our loved ones, but for whatever reason,
sr> the agencies want to send out personnel as ie: 1,2,3 and the OT seems to be 
3.

sr> Shirley



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Re: [OTlist] Vision ~vs~ Reality

[shirley roberson]

Unfortunatly I probably would not have been inpressed.  I say that because we 
had OT's in the hospital and in rehab, they did just what you 
explainedfocused on the upper extremities and it did not help my daughter 
very much.  By that I mean it did not help her to get back to the normal way of 
doing things, it did not put her whole body together.  I know that sounds a 
little unprofessional, but that's the way I see it.  Seems when a patient, 
especially like my daughter,  has been in bed for so long, they have forgotten 
how everything works together.
Shirley

--- On Thu, 7/23/09, Ron Carson  wrote:


From: Ron Carson 
Subject: Re: [OTlist] Vision ~vs~ Reality
To: "shirley roberson" 
Date: Thursday, July 23, 2009, 7:41 AM


Shirley,  what  if  I  did  OT  the way past OT's had done? If I focused
treatment  on  the upper extremity would you still say "we are beginning
to see how well OT works for our loved ones"?

Just  to  remind  everyone,  Shirley is the mother of a patient that I'm
seeing. She has been exposed to a LOT a therapy.


- Original Message -
From: shirley roberson 
Sent: Wednesday, July 22, 2009
To:   otl...@otnow.com 
Subj: [OTlist] Vision ~vs~ Reality

sr> Ron, 
sr>  
sr> Maybe somehow you could inform the public..?  I sure have learned
sr> about OT this past year.   I know this week when I told my
sr> son-in-law to contact the agency and ask for you, he was given first
sr> a CNA and then a PT, but I had to have him call again to get you,
sr> the OT.  It seems that as patients and family we are beginning to
sr> see how well OT works for our loved ones, but for whatever reason,
sr> the agencies want to send out personnel as ie: 1,2,3 and the OT seems to be 
3.

sr> Shirley



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Re: [OTlist] Vision ~vs~ Reality

[cmnahrwold]

Well put Shirley!  I wish all OTs would have an understanding of their 
own profession.  You seem to understand the concept, and you are not 
even in the profession.  What has Ron done in his treatment sessions 
with your daughter that has made the most impact for her well being and 
her independence?  Thank you so much for sharing your insight.


Chris Nahrwold

-Original Message-
From: shirley roberson 
To: OTlist@OTnow.com
Sent: Thu, Jul 23, 2009 7:40 am
Subject: Re: [OTlist] Vision ~vs~ Reality

Unfortunatly I probably would not have been inpressed.  I say that 
because we had OT's in the hospital and in rehab, they did just what 
you explainedfocused on the upper extremities and it did not help 
my daughter very much.  By that I mean it did not help her to get back 
to the normal way of doing things, it did not put her whole body 
together.  I know that sounds a little unprofessional, but that's the 
way I see it.  Seems when a patient, especially like my daughter,  has 
been in bed for so long, they have forgotten how everything works 
together.

Shirley

--- On Thu, 7/23/09, Ron Carson  wrote:


From: Ron Carson 
Subject: Re: [OTlist] Vision ~vs~ Reality
To: "shirley roberson" 
Date: Thursday, July 23, 2009, 7:41 AM


Shirley,  what  if  I  did  OT  the way past20OT's had done? If I focused
treatment  on  the upper extremity would you still say "we are beginning
to see how well OT works for our loved ones"?

Just  to  remind  everyone,  Shirley is the mother of a patient that I'm
seeing. She has been exposed to a LOT a therapy.


- Original Message -
From: shirley roberson 
Sent: Wednesday, July 22, 2009
To:   otl...@otnow.com 
Subj: [OTlist] Vision ~vs~ Reality

sr> Ron,
sr>  
sr> Maybe somehow you could inform the public..?  I sure have learned
sr> about OT this past year.   I know this week when I told my
sr> son-in-law to contact the agency and ask for you, he was given first
sr> a CNA and then a PT, but I had to have him call again to get you,
sr> the OT.  It seems that as patients and family we are beginning to
sr> see how well OT works for our loved ones, but for whatever reason,
sr> the agencies want to send out personnel as ie: 1,2,3 and the OT 
seems to be 3.


sr> Shirley



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Re: [OTlist] Vision ~vs~ Reality

[Diane Randall]

I am with you about the UE problem in rehab but I really need to know how we 
can fix this...I have 14 patients to see within 6 hours, some are ADL's but I 
cannot have one on one treatments most of the time. I cannot do a shower 
transfer and have 6 patients waiting in the gym. I am kind of at a loss and 
wondering what a typical gym SNF would look like in ideal circumstances. I 
think a lot of blame is one therapists when we are the ones in the trenches 
just trying to get the minutes in and figuring out how to do it and it is the 
corporate structure that has forced UE rehab into the SNFs as a majority 
treatment by packing the gym full of patients each day. Home health is totally 
different. There is so much you can do one on one especially within the home. I 
am doing my best and frankly...I am Peds is my first love and I will be dong 
outpatient one on one in a a clinic full-time by sept. I will continue PRN in 
the SNF but it is overwhelming at times.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of cmnahrw...@aol.com
Sent: Thursday, July 23, 2009 18:02
To: OTlist@OTnow.com
Subject: Re: [OTlist] Vision ~vs~ Reality


Well put Shirley!  I wish all OTs would have an understanding of their 
own profession.  You seem to understand the concept, and you are not 
even in the profession.  What has Ron done in his treatment sessions 
with your daughter that has made the most impact for her well being and 
her independence?  Thank you so much for sharing your insight.

Chris Nahrwold

-Original Message-
From: shirley roberson 
To: OTlist@OTnow.com
Sent: Thu, Jul 23, 2009 7:40 am
Subject: Re: [OTlist] Vision ~vs~ Reality

Unfortunatly I probably would not have been inpressed.  I say that 
because we had OT's in the hospital and in rehab, they did just what 
you explainedfocused on the upper extremities and it did not help 
my daughter very much.  By that I mean it did not help her to get back 
to the normal way of doing things, it did not put her whole body 
together.  I know that sounds a little unprofessional, but that's the 
way I see it.  Seems when a patient, especially like my daughter,  has 
been in bed for so long, they have forgotten how everything works 
together.
Shirley

--- On Thu, 7/23/09, Ron Carson  wrote:


From: Ron Carson 
Subject: Re: [OTlist] Vision ~vs~ Reality
To: "shirley roberson" 
Date: Thursday, July 23, 2009, 7:41 AM


Shirley,  what  if  I  did  OT  the way past20OT's had done? If I focused
treatment  on  the upper extremity would you still say "we are beginning
to see how well OT works for our loved ones"?

Just  to  remind  everyone,  Shirley is the mother of a patient that I'm
seeing. She has been exposed to a LOT a therapy.


- Original Message -
From: shirley roberson 
Sent: Wednesday, July 22, 2009
To:   OTlist@OTnow.com 
Subj: [OTlist] Vision ~vs~ Reality

sr> Ron,
sr>  
sr> Maybe somehow you could inform the public..?  I sure have learned
sr> about OT this past year.   I know this week when I told my
sr> son-in-law to contact the agency and ask for you, he was given first
sr> a CNA and then a PT, but I had to have him call again to get you,
sr> the OT.  It seems that as patients and family we are beginning to
sr> see how well OT works for our loved ones, but for whatever reason,
sr> the agencies want to send out personnel as ie: 1,2,3 and the OT 
seems to be 3.

sr> Shirley



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Re: [OTlist] Vision ~vs~ Reality

[shirley roberson]

Diane, I do know how demanding your work is in rehab.  I have seen the OT's and 
PT's running around trying to get to everyone.  The trouble with it from the 
patients side is when one of them comes to your room (with no set time given) 
and the patient is not ready, off they go never to return that day.  If the 
patient is mobile, they can come to the therapy room and "wait" until someone 
can get to them, jumping back and forth between other patients.  There is no 
continuity of treatment.  This is not your fault, I am not blaming any 
therapist.  I blame the system that is so greedy to get the dollars that they 
sacrifice the patient and do not allow the professionals to do their job 
correctly.  It really makes me angry.
I really do not know or have any idea how you could change that.  If you tried 
to do what you know is right, you would probably get fired.
 
 
Chris,  When Ron first came to my daughters home, he sat done and talked with 
us about what Susan wanted to accomplish and how he would go about it.  He also 
stated, very kindly I might add, that if in 3 or 4 weeks he didn't see that she 
was progressing or was not trying, he would feel that he needed to discharge 
her.  I don't know if it got my daughters attention, but it sure got mine!  I 
believe that you need to have people, family, whoever, interested in the 
progress of the patient.  That being said, Ron developed a relationship with 
her.  She saw that he wanted her to get better and he worked very hard for a 
full hour with her 5 days a week for over 3 months.  He didn't let her slack, 
reprimanded her when she balked some.  Had her trying to do things that she 
would be doing when he is gone.  Gives her cognition tests to see where she is 
mentally.  In other words, he is working to get her better all around.  The 
family gives credit to Susan
 coming so far to the treatment that has come from Ron.  He does whatever he 
thinks will help.  The balancing ball, the standing disc, walking, getting up 
from the bed and chair, playing catch, talking and listening when she is down, 
you name it, I think Ron has tried it...
 
I commend all of you for trying to find ways to do your job better for the help 
of others..My thanks go to all of you..

Shirley

--- On Thu, 7/23/09, Diane Randall  wrote:


From: Diane Randall 
Subject: Re: [OTlist] Vision ~vs~ Reality
To: OTlist@OTnow.com
Date: Thursday, July 23, 2009, 6:24 PM


I am with you about the UE problem in rehab but I really need to know how we 
can fix this...I have 14 patients to see within 6 hours, some are ADL's but I 
cannot have one on one treatments most of the time. I cannot do a shower 
transfer and have 6 patients waiting in the gym. I am kind of at a loss and 
wondering what a typical gym SNF would look like in ideal circumstances. I 
think a lot of blame is one therapists when we are the ones in the trenches 
just trying to get the minutes in and figuring out how to do it and it is the 
corporate structure that has forced UE rehab into the SNFs as a majority 
treatment by packing the gym full of patients each day. Home health is totally 
different. There is so much you can do one on one especially within the home. I 
am doing my best and frankly...I am Peds is my first love and I will be dong 
outpatient one on one in a a clinic full-time by sept. I will continue PRN in 
the SNF but it is overwhelming at times.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of cmnahrw...@aol.com
Sent: Thursday, July 23, 2009 18:02
To: OTlist@OTnow.com
Subject: Re: [OTlist] Vision ~vs~ Reality


Well put Shirley!  I wish all OTs would have an understanding of their 
own profession.  You seem to understand the concept, and you are not 
even in the profession.  What has Ron done in his treatment sessions 
with your daughter that has made the most impact for her well being and 
her independence?  Thank you so much for sharing your insight.

Chris Nahrwold

-Original Message-
From: shirley roberson 
To: OTlist@OTnow.com
Sent: Thu, Jul 23, 2009 7:40 am
Subject: Re: [OTlist] Vision ~vs~ Reality

Unfortunatly I probably would not have been inpressed.  I say that 
because we had OT's in the hospital and in rehab, they did just what 
you explainedfocused on the upper extremities and it did not help 
my daughter very much.  By that I mean it did not help her to get back 
to the normal way of doing things, it did not put her whole body 
together.  I know that sounds a little unprofessional, but that's the 
way I see it.  Seems when a patient, especially like my daughter,  has 
been in bed for so long, they have forgotten how everything works 
together.
Shirley

--- On Thu, 7/23/09, Ron Carson  wrote:


From: Ron Carson 
Subject: Re: [OTlist] Vision ~vs~ Reality
To: "shirley roberson" 
Date: Thursday, July 23, 2009, 7:41 AM


Shirley,  what  if  I  did  OT  the way past20OT

Re: [OTlist] Vision ~vs~ Reality

[Miranda Hayek]

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!!!

Re: [OTlist] Vision ~vs~ Reality

[Ron Carson]

Folding  towels  is  not  an  occupation, it's an activity. IF a patient
TRULY, and I mean truly, had a goal of doing laundry and for some reason
they  could not fold towels and by folding towels, the OT was addressing
the  underlying  medical,  social,  environmental barriers, then folding
towels would be a fine activity. In fact, Susan transferred laundry from
the washer to the dryer. Why? Because laundry was one of her occupations
and  is something she will need/want to do as she get's better. Plus, it
worked  on  the numerous underlying issues which impairs many of Susan's
other occupations.

When  I  first  started  working  on  occupation  after I read "Enabling
Occupation:  An Occupational Therapy Perspective". This book outlines my
treatment philosophy an goes hand and hand with the COPM.

So, I started administering the COPM. This assessment helped me identify
patient's  most  needed  goals.  It  was my job to identify the problems
impeding  their  goals.  Once  I  had  painted the "portrait", I started
addressing the problems.

The 1st thing I found is that patients are mostly interested in mobility
issues.  The primary goals were almost always mobility related. Patients
want  to  be  able to walk to the kitchen and cook, they want to walk to
the  toilet and poop. They want to stand at the sink. They want to stand
up and walk to do their occupations in as normal a fashion as possible.

So,  I  got  busy helping people be more mobile. If they couldn't sit, I
worked on sitting. If they couldn't stand, I worked on standing. If they
couldn't  walk, I worked on mobility. I almost never did pure exercises.
Instead, I engaged patients to their maximum potential and beyond in the
necessary  components of the desired occupation which was missing in the
patient.

I  also found out about their homes. I had people bring in measurements.
I  found  out  if  they  had steps. I learned about the bathroom and the
layout  of  the shower. I simulated these home environments in the rehab
gym.  If someone had 3 steps into theirs house, we went to the stairs of
the  hospital.  If  someone  had  a  6  inch threshold to get into their
shower,  we practiced stepping over bolsters of the same height. If they
had  a tub, I explained tub transfer benches and we practiced. And these
are just the things I did in the gym. I did car transfers in the parking
lot,  I  had patient get their own trays and go through the food line in
the hospital. If patient's needed and wanted to cook at home (very few),
we  did  cooking. I had patients engaging all sorts of daily occupation.
BUT  ONLY  BECAUSE  it  was  THEIR  goal.  I  hate the idea of OT having
patient's washing windows because there's some magical therapeutic power
in the fact that it "meaningful". Hooey!, that's what I say!

The  list was endless. I was never at a loss of what to do. Sometimes, I
didn't  know  HOW to do something but I always knew what to do. And that
was  very  different. Before the COPM, I had no REAL idea what patient's
wanted.

I don't know, does that help?

- Original Message -
From: Miranda Hayek 
Sent: Thursday, July 23, 2009
To:   otlist@otnow.com 
Subj: [OTlist] Vision ~vs~ Reality


MH> Ron can you provide some examples of how you made it work in the
MH> in-patient rehab setting. You mentioned that you would see 2-3
MH> people at a time, how did you work with each of them on their own 
occupations?

MH>  

MH> Also, why is a cooking group, folding towels, not good occupations to work 
on?

MH> Thanks,

MH> ~ Miranda ~ 


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Re: [OTlist] Vision ~vs~ Reality

[Ron Carson]

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 
Sent: Thursday, July 23, 2009
To:   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

Re: [OTlist] Vision ~vs~ Reality

[Diane Randall]

The problem that I have noticed is that there is no set time where I am at.
Patients just start showing up at random. Sometimes I have to go get them
myself.  I never know when someone will arrive and I can have six or more at
a time in the gym that I have to share with PT and Speech. I am right out of
school and certainly not superwoman. One or two at a time is managable but
SIX. It is not that I think I would be fired for doing the right thing, I
just just think it is darn near impossible with the way everything is set
up. I have only been doing this a month. I think I am looking forward to
working in Peds.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of shirley roberson
Sent: Thursday, July 23, 2009 20:21
To: OTlist@OTnow.com
Subject: Re: [OTlist] Vision ~vs~ Reality


Diane, I do know how demanding your work is in rehab.  I have seen the OT's
and PT's running around trying to get to everyone.  The trouble with it from
the patients side is when one of them comes to your room (with no set time
given) and the patient is not ready, off they go never to return that day. 
If the patient is mobile, they can come to the therapy room and "wait" until
someone can get to them, jumping back and forth between other patients. 
There is no continuity of treatment.  This is not your fault, I am not
blaming any therapist.  I blame the system that is so greedy to get the
dollars that they sacrifice the patient and do not allow the professionals
to do their job correctly.  It really makes me angry.
I really do not know or have any idea how you could change that.  If you
tried to do what you know is right, you would probably get fired.
 
 
Chris,  When Ron first came to my daughters home, he sat done and talked
with us about what Susan wanted to accomplish and how he would go about it. 
He also stated, very kindly I might add, that if in 3 or 4 weeks he didn't
see that she was progressing or was not trying, he would feel that he needed
to discharge her.  I don't know if it got my daughters attention, but it
sure got mine!  I believe that you need to have people, family, whoever,
interested in the progress of the patient.  That being said, Ron developed a
relationship with her.  She saw that he wanted her to get better and he
worked very hard for a full hour with her 5 days a week for over 3 months. 
He didn't let her slack, reprimanded her when she balked some.  Had her
trying to do things that she would be doing when he is gone.  Gives her
cognition tests to see where she is mentally.  In other words, he is working
to get her better all around.  The family gives credit to Susan
 coming so far to the treatment that has come from Ron.  He does whatever he
thinks will help.  The balancing ball, the standing disc, walking, getting
up from the bed and chair, playing catch, talking and listening when she is
down, you name it, I think Ron has tried it...
 
I commend all of you for trying to find ways to do your job better for the
help of others..My thanks go to all of you..

Shirley

--- On Thu, 7/23/09, Diane Randall  wrote:


From: Diane Randall 
Subject: Re: [OTlist] Vision ~vs~ Reality
To: OTlist@OTnow.com
Date: Thursday, July 23, 2009, 6:24 PM


I am with you about the UE problem in rehab but I really need to know how we
can fix this...I have 14 patients to see within 6 hours, some are ADL's but
I cannot have one on one treatments most of the time. I cannot do a shower
transfer and have 6 patients waiting in the gym. I am kind of at a loss and
wondering what a typical gym SNF would look like in ideal circumstances. I
think a lot of blame is one therapists when we are the ones in the trenches
just trying to get the minutes in and figuring out how to do it and it is
the corporate structure that has forced UE rehab into the SNFs as a majority
treatment by packing the gym full of patients each day. Home health is
totally different. There is so much you can do one on one especially within
the home. I am doing my best and frankly...I am Peds is my first love and I
will be dong outpatient one on one in a a clinic full-time by sept. I will
continue PRN in the SNF but it is overwhelming at times.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of cmnahrw...@aol.com
Sent: Thursday, July 23, 2009 18:02
To: OTlist@OTnow.com
Subject: Re: [OTlist] Vision ~vs~ Reality


Well put Shirley!  I wish all OTs would have an understanding of their
own profession.  You seem to understand the concept, and you are not
even in the profession.  What has Ron done in his treatment sessions
with your daughter that has made the most impact for her well being and
her independence?  Thank you so much for sharing your insight.

Chris Nahrwold

-Original Message-
From: shirley roberson 
To: OTlist@OTnow.com
Sent: Thu, Jul 23, 2009 7:40 am
Subject: Re: [OTlist] Vision ~vs~ Reality

Unfortunatly 

Re: [OTlist] Vision ~vs~ Reality

[Diane Randall]

Honestly Ron, you speak of ideal situations...but many of my patients do not
have occupations that they want to work on specfically and I don't even
think some are appropriate for therapy...but as a new COTA, I don't think my
opinion counts for much. I don't do evals, or set goals or even treatments
plan...I just do treatment and bill. I know what functional treatment looks
like. My FW rotation represented that but I only had at most two patients at
a time that I did not have to share with other professionals. I do what I
can to make sure that whatever treatment I am doing is meaningful to the
patient in some way. When doing ADL's , I talk with them to find out thier
occupational goals. I don't have men who don't cook...cook etc. It seems to
be mostly focused on ADL's...which is occupation...I am just not permitted
to do that all day long. i guess i am learning as I go.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of Ron Carson
Sent: Thursday, July 23, 2009 20:32
To: Diane Randall
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,

Re: [OTlist] Vision ~vs~ Reality

[Joan Riches]

Rest assured Diane your patients benefit from your caring. For many of
those in an SNF the activity is the occupation. Many have no sense of
future but a powerful urge to use their hands. In the sterile
environment of an SNF there are few opportunities to do that and it
seems your gym is one place where it is possible. Goals are very
different in a situation where maintenance of abilities is difficult and
improvement unlikely. Handling things, especially familiar things,
grounds them with a sense of self. From what you say you are attempting
to match your folks with activities that will invoke procedural memory
based on what you know about what that memory may contain.
Ron and I disagree strongly about whether it is possible to do real
occupational therapy with people who cannot intellectually conceptualise
a goal. I advocate for them and I believe it definitely takes a skilled
therapist to provide the support that maintains a person's best
abilities to remain occupied until the end of life and to teach others
how to support them. 
You are going to have a great time in paeds. Many of them don't
conceptualise goals either but they are on their way and they leave you
in no doubt if your goals are not in line with theirs.
Blessings, Joan
403 652 7928


-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On
Behalf Of Diane Randall
Sent: July 23, 2009 8:35 PM
To: OTlist@OTnow.com
Subject: Re: [OTlist] Vision ~vs~ Reality

Honestly Ron, you speak of ideal situations...but many of my patients do
not
have occupations that they want to work on specfically and I don't even
think some are appropriate for therapy...but as a new COTA, I don't
think my
opinion counts for much. I don't do evals, or set goals or even
treatments
plan...I just do treatment and bill. I know what functional treatment
looks
like. My FW rotation represented that but I only had at most two
patients at
a time that I did not have to share with other professionals. I do what
I
can to make sure that whatever treatment I am doing is meaningful to the
patient in some way. When doing ADL's , I talk with them to find out
thier
occupational goals. I don't have men who don't cook...cook etc. It seems
to
be mostly focused on ADL's...which is occupation...I am just not
permitted
to do that all day long. i guess i am learning as I go.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of Ron Carson
Sent: Thursday, July 23, 2009 20:32
To: Diane Randall
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) De

Re: [OTlist] Vision ~vs~ Reality

[cmnahrwold]

Diane,
Can you work on creating a schedule board for the department. This is 
what we use in rehab, and it works out well.  With fourteen patients 
you can have one group treatment (3-4 pateints) once a day focusing on 
a general conditioning program for an hour or so. This group wuld 
rotate every day so only 25% of the time is devoted to group therapy 
per week. You then would have five hours to see the rest of other ten 
patients in which you can double and work on personal occupations.  
would only work if you have a rehab tech though, or you will be using 
all of your time seeking patients, and we all know how that works.


-Original Message-
From: Diane Randall 
To: OTlist@OTnow.com
Sent: Thu, Jul 23, 2009 9:21 pm
Subject: Re: [OTlist] Vision ~vs~ Reality

The problem that I have noticed is that there is no set time where I am 
at.
Patients just start showing up at random. Sometimes I have to go get 
them
myself.  I never know when someone will arrive and I can have six or 
more at
a time in the gym that I have to share with PT and Speech. I am right 
out of
school and certainly not superwoman. One or two at a time is managable 
but
SIX. It is not that I think I would be fired for doing the right thing, 
I
just just think it is darn near impossible with the way everything is 
set
up. I have only been doing this a month. I think I 
am looking forward to

working in Peds.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of shirley roberson
Sent: Thursday, July 23, 2009 20:21
To: OTlist@OTnow.com
Subject: Re: [OTlist] Vision ~vs~ Reality


Diane, I do know how demanding your work is in rehab.  I have seen the 
OT's
and PT's running around trying to get to everyone.  The trouble with it 
from
the patients side is when one of them comes to your room (with no set 
time
given) and the patient is not ready, off they go never to return that 
day. 
If the patient is mobile, they can come to the therapy room and "wait" 
until

someone can get to them, jumping back and forth between other patients. 
There is no continuity of treatment.  This is not your fault, I am not
blaming any therapist.  I blame the system that is so greedy to get the
dollars that they sacrifice the patient and do not allow the 
professionals

to do their job correctly.  It really makes me angry.
I really do not know or have any idea how you could change that.  If you
tried to do what you know is right, you would probably get fired.
 
 
Chris,  When Ron first came to my daughters home, he sat done and talked
with us about what Susan wanted to accomplish and how he would go about 
it. 
He also stated, very kindly I might add, that if in 3 or 4 weeks he 
didn't

see
that she was progressing or was not trying, he would feel that he 
needed

to discharge her.  I don't know if it got my daughters attention, but it
sure got mine!  I believe that you need to have people, family, whoever,
interested in the progress of the patient.  That being said, Ron 
developed a

relationship with her.  She saw that he wanted her to get better and he
worked very hard for a full hour with her 5 days a week for over 3 
months. 

He didn't let her slack, reprimanded her when she balked some.  Had her
trying to do things that she would be doing when he is gone.  Gives her
cognition tests to see where she is mentally.  In other words, he is 
working

to get her better all around.  The family gives credit to Susan
 coming so far to the treatment that has come from Ron.  He does 
whatever he
thinks will help.  The balancing ball, the standing disc, walking, 
getting
up from the bed and chair, playing catch, talking and listening when 
she is

down, you name it, I think Ron has tried it...
 
I commend all of you for trying to find ways to do your job better for 
the

help of others..My thanks go to all of you..

Shirley

--- On Thu, 7/23/09, Diane Randall  wrote:


From: Diane Randall 
Subject: Re: [OTlist] Vision ~vs~ Reality
To: OTlist@OTnow.com
Date: Thursday, July 23, 2009, 6:24 PM

0D
I am with you about the UE problem in rehab but I really need to know 
how we
can fix this...I have 14 patients to see within 6 hours, some are ADL's 
but
I cannot have one on one treatments most of the time. I cannot do a 
shower
transfer and have 6 patients waiting in the gym. I am kind of at a loss 
and
wondering what a typical gym SNF would look like in ideal 
circumstances. I
think a lot of blame is one therapists when we are the ones in the 
trenches
just trying to get the minutes in and figuring out how to do it and it 
is
the corporate structure that has forced UE rehab into the SNFs as a 
majority

treatment by packing the gym full of patients each day. Home health is
totally different. There is so much you can do one on one especially 
within
the home. I am doing my best and frankly...I am Peds is my first love 
and I
will be dong outpatient one on one in a a clinic ful

Re: [OTlist] Vision ~vs~ Reality

[Sue Doyle]

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 perso

Re: [OTlist] Vision ~vs~ Reality

[cmnahrwold]

Wow Joan, well put.  Wish I could shadow you for a month or two.  I 
also have a heart for people and their families who suffer from 
dementia, but sometimes I am at a loss for what to do.


-Original Message-
From: Joan Riches 
To: OTlist@OTnow.com
Sent: Thu, Jul 23, 2009 10:07 pm
Subject: Re: [OTlist] Vision ~vs~ Reality

Rest assured Diane your patients benefit from your caring. For many of
those in an SNF the activity is the occupation. Many have no sense of
future but a powerful urge to use their hands. In the sterile
environment of an SNF there are few opportunities to do that and it
seems your gym is one place where it is possible. Goals are very
different in a situation where maintenance of abilities is difficult and
improvement unlikely. Handling things, especially familiar things,
grounds them with a sense of self. From what you say you are attempting
to match your folks with activities that will invoke procedural memory
based on what you know about what that memory may contain.
Ron and I disagree strongly about whether it is possible to do real
occupational therapy with people who cannot intellectually conceptualise
a goal. I advocate for them and I believe it definitely takes a skilled
therapist to provide the support that maintains a person's best
abilities to remain occupied until the end of life and to teach others
how to support them.
You are going to have a great time in paeds. Many of them don't
conceptualise goals either but they are on their way and they leave you
in no doubt if your goals are not in line with theirs.
Blessings, Joan
403 652 7928


-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On
Behalf Of Diane Randall
Sent: July 23, 2009 8:35 PM
To: OTlist@OTnow.com
Subject: Re: [OTlist] Vision ~vs~ Reality

Honestly Ron, you speak of ideal situations...but many of my patients do
not
have occupations that they want to work on specfically and I don't even
think some are appropriate for therapy...but as a new COTA, I don't
think my
opinion counts for much. I don't do evals, or set goals or even
treatments
plan...I just do treatment and bill. I know what functional treatment
looks
like. My FW rotation represented that but I only had at most two
patients at
a time that I did not have to share with other professionals. I do what
I
can to make sure that whatever treatment I am doing is meaningful to the
patient in some way. When doing ADL's , I talk with them to find out
thier
occupational goals. I don't have men who don't cook...cook etc. It seems
to
be mostly focused on ADL's...which is occupation...I am just not
permitted
to do that all day long. i guess i am learning as I go.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of Ron Carson
Sent: Thursday, July 23, 2009 20:32
To: Diane Randall
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 i

Re: [OTlist] Vision ~vs~ Reality

[Ron Carson]

Dianne:  There is NOTHING ideal about any the situations I work in. They
all  have limitations and shortcomings. Some are better than others, but
they all have good and bad points.

Regardless of your title, you still have a moral and legal obligation to
provide  treatment  which  is  medically  necessary. In part, Medicare's
definition of medically necessary means:

1. A therapists skills are required

2. The patient will make significant progress towards their goals within
a reasonable period of time.

Let  me also say that the problem with OT is not so much people like you
who  are  stuck  in  "people mills". It's the rest of the adult phsy-dys
community  who  DO have the opportunity to address occupation but either
don't know how to do it, or don't want to.

Lastly,  find  another  job  and  quite  working  for  greedy healthcare
companies.  But,  they  are  all  pretty much the same. Driven by profit
rather than loving, compassionate care.

Finally,  if  finding a better job isn't an option, and it won't work to
change  the  system you are in, about the best you can do is shooting to
make it better for you and your patients.

- Original Message -
From: Diane Randall 
Sent: Thursday, July 23, 2009
To:   OTlist@OTnow.com 
Subj: [OTlist] Vision ~vs~ Reality

DR> Honestly Ron, you speak of ideal situations...but many of my patients do not
DR> have occupations that they want to work on specfically and I don't even
DR> think some are appropriate for therapy...but as a new COTA, I don't think my
DR> opinion counts for much. I don't do evals, or set goals or even treatments
DR> plan...I just do treatment and bill. I know what functional treatment looks
DR> like. My FW rotation represented that but I only had at most two patients at
DR> a time that I did not have to share with other professionals. I do what I
DR> can to make sure that whatever treatment I am doing is meaningful to the
DR> patient in some way. When doing ADL's , I talk with them to find out thier
DR> occupational goals. I don't have men who don't cook...cook etc. It seems to
DR> be mostly focused on ADL's...which is occupation...I am just not permitted
DR> to do that all day long. i guess i am learning as I go.


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Re: [OTlist] Vision ~vs~ Reality

[Ron Carson]

In  my  opinion,  the  VAST  majority  of  group  "therapy" isn't really
therapy.  It's  simply  a way for corporations and therapists to squeeze
more productivity and reimbursement out of Medicare. Additionally, in my
experience  most  group therapy done by OT is a total waste of patients'
time.  I can't tell you how many UE groups I've seen done by OT when the
absolute  last  thing  patient's  needed was UE strengthening. There are
certainly  times  when group THERAPY is indicated, but this NOT how it's
been traditionally done.

Ron

~~~
Ron Carson MHS, OT
www.OTnow.com

- Original Message -
From: Sue Doyle 
Sent: Thursday, July 23, 2009
To:   otlist@otnow.com 
Subj: [OTlist] Vision ~vs~ Reality


SD> In Inpatient Rehab you cannot see more than one patient as a time
SD> unless they are part of a group. If they are a group they have to
SD> have similar goals that are part of each patients individual plan
SD> that can be matched together. While there is no set limit on how
SD> much group therapy a patient can receive as a proportion of their
SD> therapy, Skilled nursing facilities are limited to 25% and it is
SD> recommended that rehab does not exceed this as well.

SD> While some of patient's goals often include being able to use their
SD> affected upper extremity one should really focus on the clients
SD> occupational goals. The problems generally start with the evaluation
SD> process. If you do not identify occupational issues and patient
SD> goals in your evaluation but identify upper extremity issues that is
SD> where you will focus your treatment. Has anyone used the "Cardinal
SD> Hill Occupational Framework documentation that identifies
SD> documentation that focuses on the occupational framework and hence
SD> helps to guide the clinical reasoning process to a more occupationally 
focuses manner.

SD> This then means that generally the clinical setting needs to change
SD> particularly in rehab, so that the treatment media would need to be
SD> focused on various occupational options. I built boxes or kits with
SD> a variety of options that my clients expressed interest in. It is
SD> best to use the real objects and occupations. 

SD> Hope this helps some.
SD> Sue D 





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Re: [OTlist] Vision ~vs~ Reality

[Joan Riches]

Absolutely agree. In my first job in the long term care the 'groups' had
been set up with OT and RT working together. This may have worked
previously with good collaboration between the disciplines but by that
time they had deteriorated to entertainment with very little planning
and no tracking of individual progress. Aides rushed around filling up
the group. When it was over the recreation staff took off and OT cleaned
up (vastly different requirements for payment etc. here). Over time we
took over some groups as specifically OT with patients assessed for
potential benefit and assigned and with drew our participation from the
others. In that particular setting at this time OT is essentially
individual with OT findings and suggestions shared with recreation staff
to enhance the quality of life for residents. It was necessary to
clarify our own professional goals and be clear about the purpose of OT
when declining participation in recreational activities.

Blessings, Joan
403 652 7928

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On
Behalf Of Ron Carson
Sent: July 24, 2009 6:09 AM
To: Sue Doyle
Subject: Re: [OTlist] Vision ~vs~ Reality

In  my  opinion,  the  VAST  majority  of  group  "therapy" isn't really
therapy.  It's  simply  a way for corporations and therapists to squeeze
more productivity and reimbursement out of Medicare. Additionally, in my
experience  most  group therapy done by OT is a total waste of patients'
time.  I can't tell you how many UE groups I've seen done by OT when the
absolute  last  thing  patient's  needed was UE strengthening. There are
certainly  times  when group THERAPY is indicated, but this NOT how it's
been traditionally done.

Ron

~~~
Ron Carson MHS, OT
www.OTnow.com

- Original Message -
From: Sue Doyle 
Sent: Thursday, July 23, 2009
To:   otlist@otnow.com 
Subj: [OTlist] Vision ~vs~ Reality


SD> In Inpatient Rehab you cannot see more than one patient as a time
SD> unless they are part of a group. If they are a group they have to
SD> have similar goals that are part of each patients individual plan
SD> that can be matched together. While there is no set limit on how
SD> much group therapy a patient can receive as a proportion of their
SD> therapy, Skilled nursing facilities are limited to 25% and it is
SD> recommended that rehab does not exceed this as well.

SD> While some of patient's goals often include being able to use their
SD> affected upper extremity one should really focus on the clients
SD> occupational goals. The problems generally start with the evaluation
SD> process. If you do not identify occupational issues and patient
SD> goals in your evaluation but identify upper extremity issues that is
SD> where you will focus your treatment. Has anyone used the "Cardinal
SD> Hill Occupational Framework documentation that identifies
SD> documentation that focuses on the occupational framework and hence
SD> helps to guide the clinical reasoning process to a more
occupationally focuses manner.

SD> This then means that generally the clinical setting needs to change
SD> particularly in rehab, so that the treatment media would need to be
SD> focused on various occupational options. I built boxes or kits with
SD> a variety of options that my clients expressed interest in. It is
SD> best to use the real objects and occupations. 

SD> Hope this helps some.
SD> Sue D 





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Re: [OTlist] Vision ~vs~ Reality

[Ron Carson]

For me, the COPM was a GREAT tool to begin my "training". Also, it's not
just  an  assessment.  Instead, it's part of a comprehensive approach to
treating  patients. Just identifying occupational deficits/goals without
treating them is really just a waste of time.

Enabling  occupation is really a way of 'being' with patients. It's much
more   than  being  client-centered  and  it's  more  than  just  having
occupational goals. I guess in reality, it's both.

Thanks for your message.

Ron

- Original Message -
From: Michael Holmes 
Sent: Friday, July 24, 2009
To:   otl...@otnow.com. 
Subj: [OTlist] Vision ~vs~ Reality

MH> Wonderful dialogue. Sometimes, with the overwhelming treatment regimen they
MH> press upon us it is necessary to take that one smile, or the "thank you", or
MH> the look of accomplishment upon a patient's face after an OT tx to tell
MH> yourself you have "won one" for quality of life. Perhaps that is why we
MH> enter the profession to begin with. Despite the corporate bull,
MH> productivity, etc., we must take those little battles that we "win",
MH> evidenced by our patients gratification, and use it to heal our souls. just
MH> a bit. This will allow us to continue to deliver the service to patients we
MH> believe to be valid and meaningful to out clients, patients, residents or
MH> whatever we call it these days. Finding meaning in occupation with a client
MH> doesn't necessarily require the COPM. The client and therapist have a
MH> relationship and the more meaningful the relationship the easier it is to
MH> find out the persons desired occupational pursuits. Let's not forget the
MH> client centered interview or the occupational profile. These are free, last
MH> time I checked the COPM was for sale. I am not knocking that assessment I do
MH> indeed see its' value. Sometimes just taking the time to "discover" your
MH> patients' goals through meaningful exchange of conversation is the best way
MH> to tap into a patient's desired end game for therapy.  

MH>  

MH> Michael A. Holmes MSOTR/L

MH> North Valley Health and Rehabilitation

MH> 203 S. Western Ave.

MH> Tonasket,WA 98855

MH>   o...@nvhospital.org

MH> (509) 486-2151 x500

MH>  

MH> --
MH> Options?
MH> www.otnow.com/mailman/options/otlist_otnow.com

MH> Archive?
MH> www.mail-archive.com/otlist@otnow.com


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Re: [OTlist] Vision vs Reality

[Brent Cheyne]

Everyone is making great points in this dialogue,
 
My practice patterns would fall closely in line with how a lot of you are 
describing- Ron, Chris, Diane, Joan too. It's nice to hear other people have 
the same challenges and frustraions.
 
Here are 2 that bug me alot!
 
1) Don't get me wrong, I love working with COTA's and with PRN OT Staff- we 
usually need the extra help at our busy SNF but...I find people don't read the 
evals and goals that I so pain-stakingly design and select with patients.
 Frequently, I can look across the treatment area as see a colleague of 
mine having the pt I evaluated doing pegs or bicep curls or some other task 
with a Total Knee patient whose goal are lower body dressing and shower 
transfers and meal prep etc..I had absolutely NO goal for UE ROM for 
strength or hand dexterity etcc.., I always try to teach and instill in new 
staff or students to read the eval, PLOF, goals and design treatment based on 
those, I am frequently frustrated by people just making up any old activity or 
exercise willy-nilly to put in time. 
If you are taking on a patient that you didn't eval, be sure the treatment 
matches the planned goals and treatment set out in the eval, also see if the 
eval matches what the patient is presenting with and talking about...talk to 
the patient.
 
2)  Despite high productivity and stressful schedules, therapists not taking 
time to know the patient, or engage and educate their family members and  
communicate to assess their needs and goals and incorporated them into the eval 
goals and planbasically making the interventions skilled.
 
There's an old adage that hopefully is appropriate here
--Management is all about doing "things right"-( productivity, filling out 
forms, schedules, compliance)
--Leadership is about doing the "right things", (client centered occupations 
and interventions)
 
 We clinicians may not be managers but we still can and should be Leaders.. 
Keep up the good work people!


  
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Re: [OTlist] Vision vs Reality

[Ron Carson]

Great post and I REALLY like the saying at the end...

- Original Message -
From: Brent Cheyne 
Sent: Friday, July 24, 2009
To:   Ron Carson 
Subj: [OTlist] Vision vs Reality

BC> Everyone is making great points in this dialogue,
BC>  
BC> My practice patterns would fall closely in line with how a lot of
BC> you are describing- Ron, Chris, Diane, Joan too. It's nice to hear
BC> other people have the same challenges and frustraions.
BC>  
BC> Here are 2 that bug me alot!
BC>  
BC> 1) Don't get me wrong, I love working with COTA's and with PRN OT
BC> Staff- we usually need the extra help at our busy SNF but...I find
BC> people don't read the evals and goals that I so pain-stakingly design and 
select with patients.
BC>  Frequently, I can look across the treatment area as see a
BC> colleague of mine having the pt I evaluated doing pegs or bicep
BC> curls or some other task with a Total Knee patient whose goal are
BC> lower body dressing and shower transfers and meal prep etc..I
BC> had absolutely NO goal for UE ROM for strength or hand dexterity
BC> etcc.., I always try to teach and instill in new staff or students
BC> to read the eval, PLOF, goals and design treatment based on those, I
BC> am frequently frustrated by people just making up any old activity
BC> or exercise willy-nilly to put in time. 
BC> If you are taking on a patient that you didn't eval, be sure the
BC> treatment matches the planned goals and treatment set out in the
BC> eval, also see if the eval matches what the patient is presenting
BC> with and talking about...talk to the patient.
BC>  
BC> 2)  Despite high productivity and stressful schedules, therapists
BC> not taking time to know the patient, or engage and educate their
BC> family members and  communicate to assess their needs and goals and
BC> incorporated them into the eval goals and planbasically making the 
interventions skilled.
BC>  
BC> There's an old adage that hopefully is appropriate here
BC> --Management is all about doing "things right"-( productivity,
BC> filling out forms, schedules, compliance)
BC> --Leadership is about doing the "right things", (client centered 
occupations and interventions)
BC>  
BC>  We clinicians may not be managers but we still can and should be Leaders..
BC> Keep up the good work people!


BC>   
BC> --
BC> Options?
BC> www.otnow.com/mailman/options/otlist_otnow.com

BC> Archive?
BC> www.mail-archive.com/otlist@otnow.com


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Re: [OTlist] Vision vs Reality

[Diane Randall]

I looked and looked and I did not see real personal goals on our evals. The
goals are the same for everyone (ADL's, transfers etc), not written in a
goal sentence, and recommended treatments which tend to get checked off a
list (self-care, theraputic activity, theraputic exercise) and the
occasional cognitive goals. It is up to me, the COTA, to infuse a sense of
purpose in the treatment I suppose.

-Original Message-
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of Brent Cheyne
Sent: Friday, July 24, 2009 20:44
To: Ron Carson
Subject: Re: [OTlist] Vision vs Reality


Everyone is making great points in this dialogue,
 
My practice patterns would fall closely in line with how a lot of you are
describing- Ron, Chris, Diane, Joan too. It's nice to hear other people have
the same challenges and frustraions.
 
Here are 2 that bug me alot!
 
1) Don't get me wrong, I love working with COTA's and with PRN OT Staff- we
usually need the extra help at our busy SNF but...I find people don't read
the evals and goals that I so pain-stakingly design and select with
patients.
 Frequently, I can look across the treatment area as see a colleague of
mine having the pt I evaluated doing pegs or bicep curls or some other task
with a Total Knee patient whose goal are lower body dressing and shower
transfers and meal prep etc..I had absolutely NO goal for UE ROM for
strength or hand dexterity etcc.., I always try to teach and instill in new
staff or students to read the eval, PLOF, goals and design treatment based
on those, I am frequently frustrated by people just making up any old
activity or exercise willy-nilly to put in time.
If you are taking on a patient that you didn't eval, be sure the treatment
matches the planned goals and treatment set out in the eval, also see if the
eval matches what the patient is presenting with and talking about...talk to
the patient.
 
2)  Despite high productivity and stressful schedules, therapists not taking
time to know the patient, or engage and educate their family members and 
communicate to assess their needs and goals and incorporated them into the
eval goals and planbasically making the interventions skilled.
 
There's an old adage that hopefully is appropriate here
--Management is all about doing "things right"-( productivity, filling out
forms, schedules, compliance)
--Leadership is about doing the "right things", (client centered occupations
and interventions)
 
 We clinicians may not be managers but we still can and should be Leaders..
Keep up the good work people!



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