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COTA Thoughts

The Revolving Door

Published June 23, 2014 9:34 AM by Tim Banish

One thing I used to see working Long Term Care therapy was the repeat offenders, or the Part B patients that seemed to need therapy every few months. Some would have a hospital stay which placed them back to Part A, or skilled status patient. But it seemed like no matter where I worked there were nursing home residents who could not stay healthy.

I remember a few residents who would not adhere to their diabetic precautions, and continued to eat all kinds of sweet treats. A few who were a fall risk yet refused any interventions. There were the ones who refused their medications for one reason or another. Then there were the ones who were just physically challenged and continued to lose skills in areas that therapy was supposed to fix.

There was one person who gained more than forty pounds in twelve months. This necessitated two new wheelchair backs, a new arm trough, several new wheel bearings, and then finally a whole new wheelchair. Not only did this cost the facility over two thousand dollars, but the person's health suffered as well. Yes, this person was a diabetic whose family continued to bring in donuts, candies and the like despite being educated with the problems it causes. Therapy had to intervene several times one year.

Another resident refused to use a personal alarm despite the fact that they were unsafe with any transfer, and had fallen several times. They ended up in the hospital from injuries from one fall, and were back in therapy for the fourth time one year.

One patient would refuse her medicine thinking it was poison.  The poor nurses tried everything to explain how the meds were important, but nothing seemed to work. The person would get so sick they had to administer meds through an IV, no refusals taken. After each episode therapy would be ordered so she could regain her strength.

Another issue was the residents who were just so physically challenged that they continued to lose skills little by little. When they couldn't complete simple tasks therapy would be ordered. Usually therapy had already been there, done that, but once again ordered to give it another round. When every reasonable method had been tried and failed, you would hear things like "therapy doesn't work" or that therapy was only ordered to make the home money.

My thought here, no I wouldn't deny any of these people therapy. The issue was always the length of time they stayed on therapy. You would know they've reached their maximum potential but goals would be altered to keep them on caseload.  There were many whose benefits were exhausted, and then another incident would happen.


Until next time, hope all your "Thoughts" are Good-


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It seems many elderly people are without close family ties that support and sustain their aging gracefully.  Belonging is a strong need in all of us.  Maybe some of your clients use therapy to fulfill that need.  At the very heart of therapy is the desire to provide the best care. Hope fully a transition to self motivate reappears and the patient or family continue to progress in the best quality of life they can achieve.

Karen, OT - COTA July 2, 2014 7:26 AM
Traverse City MI

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