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.