I work in a SNF as an OTR and as much as I want to do ADL's, productivity requirements and evals override that. I do the best I can to incorporate ADL's in my tx sessions and follow up any rote exercises with functional tasks. And yes, I agree that those who seem to get high mins doing anything BUT ADL's are the most praised. Sometimes this is very frustrating...it seems as though management does not care how you get the mins as long as you get them!!! The client loses out...Personally, I try my best to stagger my ADL's among clients over the week so that I get to address everyone's ADL goals directly a few times a week. Not the ideal way, but I have high productivity requirements to meet! E. H.From: Joanne Bosse de Melgosa <bounce-melgosa@aota.org> Sent: 10/28/2009 11:08:15 PMADLs are required where I work in a rehab hosp. I'm not a manager, but I'm an OTR supervising COTAs and it is frustrating when the ADLs are not done. What are the productivity standards? I have worked in SNFs that wanted high productivity and staff w/ the most units were highly praised. Often those staff members got those high numbers by doing exercise groups or concurrent Rx, not ADLs. Perhaps if you praised or awarded staff members who did more ADLs or had higher improvement in ADLs it would help. Also, the exercises that are done need to be explained to pts. If doing pegs, explain that FMC will improve and fastening buttons or tying shoes will be easier. Pts that aren't concerned about FMC won't want to do pegs. You have your work cut out for you, but w/ good direction it can be done.
I work in a SNF as an OTR and as much as I want to do ADL's, productivity requirements and evals override that. I do the best I can to incorporate ADL's in my tx sessions and follow up any rote exercises with functional tasks. And yes, I agree that those who seem to get high mins doing anything BUT ADL's are the most praised. Sometimes this is very frustrating...it seems as though management does not care how you get the mins as long as you get them!!! The client loses out...Personally, I try my best to stagger my ADL's among clients over the week so that I get to address everyone's ADL goals directly a few times a week. Not the ideal way, but I have high productivity requirements to meet!
E. H.
From: Joanne Bosse de Melgosa <bounce-melgosa@aota.org> Sent: 10/28/2009 11:08:15 PM
ADLs are required where I work in a rehab hosp. I'm not a manager, but I'm an OTR supervising COTAs and it is frustrating when the ADLs are not done.
What are the productivity standards? I have worked in SNFs that wanted high productivity and staff w/ the most units were highly praised. Often those staff members got those high numbers by doing exercise groups or concurrent Rx, not ADLs. Perhaps if you praised or awarded staff members who did more ADLs or had higher improvement in ADLs it would help. Also, the exercises that are done need to be explained to pts. If doing pegs, explain that FMC will improve and fastening buttons or tying shoes will be easier. Pts that aren't concerned about FMC won't want to do pegs.
You have your work cut out for you, but w/ good direction it can be done.
Yes, I see this as a huge problem, several of the COTA's I work w/ spend large amounts of time doing UE exercise on people w/ normal ROM and strength of the UE's. I constantly ask them what functional activity are they working toward, is the pt's strength insufficient for an activity they need or want to do. Having been a manager for many years, I have been aware it is up to me to keep close contact w/ the therapist's constantly asking them to think about whether their tx program is moving directly toward increasing a pt's function, if it isn't, then the tx needs to be reconsidered. I think there is a robot mentality among many therapists to do rote exercises to pass the tx time, still feel that the heart of OT is function - on the pt's terms. Currently our OT schedules in the morning are almost completely devoted to ADL's - but it takes ongoing input of the OT's to coordinate closely with the COTA's to make sure this happens.
From: Karla <bounce-karlajo@aota.org>Sent: 10/26/2009 11:51:38 PM
I'm a rehab manager at a SNF and also an OT though I rarely practice now due to management responsibilities. My OT team seems to have drifted from the roots of what I feel is OT. I rarely see them in early to do morning basic ADL's with the clients (or reverse ADL's in the evenings). I see them in the gym doing FM/GM coordination activities/ Cog. Skills/ Exercises/ and practicing putting clothes over clothes. I have heard clients complain about playing with pegs, painting, etc. Has anyone else had this experience? As an OT it blows my mind that you wouldn't do ADL retraining when the person actually needs to do their ADL's for best buy in and for most meaningful treatment session and carryover. If you have had this experience either as an OT or as a supervisor - please share with me how you handled the situation. Do you require your staff to be in at a certain time in the morning? I understand that ADL retraining can be completed at all times of the day but with the geriatric population you would be extremely lucky to have them get dressed once let alone getting dressed and undressed in the middle of the day (unless it's shower day - then yippee!). And I do know that what I'm seeing in the gym are in general components needed to do some ADL but I'm seeing the actual dressing skills maybe being addressed once a week if I'm lucky. By the way the CPT codes being billed reflect that ADL's are not being completed at a level that you would expect. Thanks for any input.
I am an early bird every day at my work place, and I spend most of my morning in my pts room working on ADLs and IADLs. Pts get board every time they go to the gym doing the same thing ( dowel, therabands, restorator bike). So I prefer to get them to do IADLs overhead reaching, trunk extension, reaching in closet shelves, organizing and dusting pictures on the wall, and at the same time Im working on dynamic or static standing balance, postural stability, eduaction for fall prevention, energy conservation. So many things you can do what is meaninful fot the pt. I seeing many OTs and COTAs not creativity at all and all they do is puzzles, is very sad to hear and said that but is the truth.
I worked in a facility that required most treatments to be in the gym for OT and PT. There was an issue with verifying that patients were seen. Some patients would say they didn't get therapy because they did not consider dressing and grooming therapy.
We also had a very high pressure productivity requirement where at the time the expectation was to see 3-4 part A patients at the same time, back to back throughout the day. It was impossible to do ADLS (one on one) and consistently meet productivity requirements at the time.
The other issue was that my facility was very PT centered and they had PT techs (they called them rehab techs but they only followed PT orders). There were 4-5 PT clinicians to our 2 OTs. In the morning the PT staff would grab all of the patients which meant 4 for every PT/PTA and take them to the gym. That meant by the time OT finished an ADL session in the morning with one or two patients, we had no one else we could treat until PT finished there treatments.
That translated into PTs finishing their treatments around noon or 1 while OT was still treating until 5 or 6. I recognize changes have been made and I think that my facility was the extreme and not the norm, but I vowed I would never do SNF again. It was like do factory work just to manage the volume of patients seen in a day. I hope it is better quality care these days. But from my experience that was the least functional environment to work in. In addition, I never wanted to do full showers with people because the bathing areas were unsanitary and would not subject a patient to something I am not willing to do.
Wow., I am really sorry. We recently got "push back" from the PT dept when we lost the budget for a transporter. and went to the "RN model losing all our LPN< CNA.< support staff - its hard- but I think we found a compromise
Meredith,
Please would you give me more information about this new orthopedic procedure? I work in a SNF and I am so grieved at the seeing the numbers of elderly people with misery and pain after hip surgery, and who are trying to adhere to those THP for so long. The people with dementia have it even worse since they cannot remember to be careful.
I'd love to know about this, even though your post if from 2 years ago!! Perhaps I can help spread the word here in GA...
Thanks,
Nancy Fowler, OTR/L
Nancy, I wonder if you could google "Biomet magnum hip" and then find a nice surgeon in your area and just speak to him about your worries and how difficult it is for the elderly to adhere to the precautions and maybe ask him to give an inservice on how much "wiggle room" he allows in the precautions? After working with the surgeons on a daily basis for the two years we supported them in changing their surgery protocols and developing a new program I found them to be very compassionate and wanted to ease the burden on their patients in any way they could. I must tell you though, It took a year and a half for these surgeons, who all worked for the same office, under the same medical director, developing the same program to get even THEM to agree on the protocols and precautions. It was insane for a while. If you have surgeon "A" your precautions are "B" and you can only exit the bed from the "C" side, if you have surgeon "B" your precautions are "E" and you can exit the bed from "F" side, if you have surgeon "C" you don't have any precautions and can exit the bed any side you want to. I would just approach the surgeon in a humble manner and find one that is willing to speak to your concerns in a caring manner.
Nancy L. Fowler, MS, OTR/L
Admissions Counselor
College of Health & Science
School of Occupational Therapy
Brenau University
Office: 678-707-5001 Fax: 678-707-5015
nfowler1@brenau.edu
Nancy, I wonder if you could google "Biomet magnum hip" and then find a nice surgeon in your area and just speak to him about your worries and how difficult it is for the elderly to adhere to the precautions and maybe ask him to give an inservice on how much "wiggle room" he allows in the precautions? After working with the surgeons on a daily basis for the two years we supported them in changing their surgery protocols and developing a new program I found them to be very compassionate and wanted to ease the burden on their patients in any way they could. I must tell you though, It took a year and a half for these surgeons, who all worked for the same office, under the same medical director, developing the same program to get even THEM to agree on the protocols and precautions. It was insane for a while. If you have surgeon "A" your precautions are "B" and you can only exit the bed from the "C" side, if you have surgeon "B" your precautions are "E" and you can exit the bed from "F" side, if you have surgeon "C" you don't have any precautions and can exit the bed any side you want to. I would just approach the surgeon in a humble manner and find one that is willing to speak to your concerns in a caring manner. From: sixsons7 <bounce-sixsons7@aota.org> Sent: 5/7/2012 7:56:34 PMMeredith, Please would you give me more information about this new orthopedic procedure? I work in a SNF and I am so grieved at the seeing the numbers of elderly people with misery and pain after hip surgery, and who are trying to adhere to those THP for so long. The people with dementia have it even worse since they cannot remember to be careful. I'd love to know about this, even though your post if from 2 years ago!! Perhaps I can help spread the word here in GA... Thanks, Nancy Fowler, OTR/L
From: sixsons7 <bounce-sixsons7@aota.org> Sent: 5/7/2012 7:56:34 PM
I too am an OTR and a rehab manager. I agree with your observations and am too concerned with this trend among our colleagues. Moreover, my deepest concern is the one dimensional aspect in which we allow ourselves to be defined. It is in our deepest roots as human beings to remain productive not stagnant this becomes even more important when dealing with the geriatric population. Why are we not advocating for more than the basic dressing, toileting, bathing, feeding and mobility issues? These are the basic necessities needed to be productive. What about the occupations that are important to the individual? For instance, Jane Doe wants to return to being a great wife and an active grandmother. Those are her occupations; they go beyond the boundaries of ADL activities. Why are we just focusing on ADL's? Why are occupational therapists not working on OCCUPATION!!!???? And why to so many does this seem like such a foreign concept? Just bc Jane Doe can feed or dress herself does NOT equal success in her goal to be a good wife and or grandmother. In conclusion, our end goals should be more complex, more meaningful not just the basic necessities for we are complex individuals and this is why our training is so unique so diverse in educational background. We alone are the practionioners who are not only able but it is our duty to give freedom, passion, drive and ambition back to the ever-aging elderly population.
I too am an OTR and a rehab manager. I agree with your observations and am too concerned with this trend among our colleagues. Moreover, my deepest concern is the one dimensional aspect in which we allow ourselves to be defined. It is in our deepest roots as human beings to remain productive not stagnant this becomes even more important when dealing with the geriatric population. Why are we not advocating for more than the basic dressing, toileting, bathing, feeding and mobility issues? These are the basic necessities needed to be productive. What about the occupations that are important to the individual? For instance, Jane Doe wants to return to being a great wife and an active grandmother. Those are her occupations; they go beyond the boundaries of ADL activities. Why are we just focusing on ADL's? Why are occupational therapists not working on OCCUPATION!!!???? And why to so many does this seem like such a foreign concept? Just bc Jane Doe can feed or dress herself does NOT equal success in her goal to be a good wife and or grandmother. In conclusion, our end goals should be more complex, more meaningful not just the basic necessities for we are complex individuals and this is why our training is so unique so diverse in educational background. We alone are the practionioners who are not only able but it is our duty to give freedom, passion, drive and ambition back to the ever-aging elderly population. From: Karla <bounce-karlajo@aota.org>Sent: 10/26/2009 11:51:38 PM I'm a rehab manager at a SNF and also an OT though I rarely practice now due to management responsibilities. My OT team seems to have drifted from the roots of what I feel is OT. I rarely see them in early to do morning basic ADL's with the clients (or reverse ADL's in the evenings). I see them in the gym doing FM/GM coordination activities/ Cog. Skills/ Exercises/ and practicing putting clothes over clothes. I have heard clients complain about playing with pegs, painting, etc. Has anyone else had this experience? As an OT it blows my mind that you wouldn't do ADL retraining when the person actually needs to do their ADL's for best buy in and for most meaningful treatment session and carryover. If you have had this experience either as an OT or as a supervisor - please share with me how you handled the situation. Do you require your staff to be in at a certain time in the morning? I understand that ADL retraining can be completed at all times of the day but with the geriatric population you would be extremely lucky to have them get dressed once let alone getting dressed and undressed in the middle of the day (unless it's shower day - then yippee!). And I do know that what I'm seeing in the gym are in general components needed to do some ADL but I'm seeing the actual dressing skills maybe being addressed once a week if I'm lucky. By the way the CPT codes being billed reflect that ADL's are not being completed at a level that you would expect. Thanks for any input.