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COTA Thoughts

Is It Friday Yet?

Published September 5, 2014 8:59 AM by Tim Banish

A question every worker asks sometimes as early as Wednesday, maybe earlier depending on how the week has gone. Even in my last few years working as a COTA, only working part time, I asked that question more than a few times.

Were you aware that in the past Medicare recognized holidays and week-ends? Therapy was a Monday to Friday thing, the only time weekend therapy was done was to make up a missed treatment for a patient who requested it. Holidays were just written off, no treatments were made up nor any therapy done.

Of course then along came the numbers game. It is all about profits and saving a few dollars in hopes of moving a person out of skilled care a few days earlier. However it seems like every provider tries to maximize the dollars they can pull out of Medicare and will push to use all a patient's 100 skilled days up.

I can't tell you how many times I've seen a patient show enough independence to return home only to have the supervisor increase goals because the patient has several more skilled days of Part A to use. The sad part of this is what happens if there is another need for therapy in the near future? The patient is then responsible for any therapies provided, and as you know that isn't cheap.

So my thoughts here? Friday can now be any day of the week, depending on a therapists work schedule. Holidays, weekends, and birthdays are all the same now, just another day on the calendar. So when your Friday comes around, enjoy it. When you end up in Long Term Care there will be no more, the only day you'll want to see is that 100th.

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

Tim

5 comments

To all healthcare providers the situation of the weekend, and holidays are not a benefit of compensation for my particular setting. We do work 5 days a week with a rotation of one Saturday a month. We also perform the same scenario with increasing goals once pt. has accomplished STG/LTG. At our facility we complete ADLs as a d/c and will engage into pt. IADLs and treat as holistic as possible because that is what Occupational Therapy is. GO OT!!

Austin Bryson, Inpatient Rehab/Acute Care - COTA/L September 30, 2015 7:55 PM
Spartanburg SC

All I can say is wow...And Tim I get you!

Isabella, COTA April 9, 2015 4:07 PM

What about client centered care? What if our goals are not their goals? What if they and their family are comfortable going home at min assist level with help of their family?  It is what they want and that is their right. We have to look at the whole person not just giving them the most we can. If they are competent they can determine their goals and objectives.  If they are not competent we shouldn't be treating them for 100 days.

Virginia boyle, 1970 September 12, 2014 9:09 PM
SOUTHPORT NC

Leanne-

I'm sorry you fail to see my sarcasm in this blog. I'm all about moving a patient along as fast as possible to return them home, but hated seeing the ones who were ready and then coerced to stay a bit longer for whatever reason. Upgraded goals never met yet still D/C'd home on day 100.

Over my years I often found a patients view to be different though. I heard from many a patient when I worked a weekend or holiday "What? Therapy today? It's a Saturday/holiday/my birthday! Go away!"

Yes, medical care is 24/7 and I'm fine with that. I've worked every day of the week, early mornings to late evenings, and every holiday at one time or another. But another thing I found is some patients fatigued much easier after having therapy several days in a row without a break. Many begged to have a day off, some would fake illness to get out of therapy. But if the nurse said vitals were fine we HAD to complete minutes regardless. That is not focus on the patient, that is focus on profits.

Tim Banish, COTA, Retired September 8, 2014 1:22 PM
Cincinnati OH

Tim,

Shouldn't it be everyone's objective to help move a patient through the continuum of care and out of 'skilled' need as soon as possible?  

As an occupational therapist with 20+ years experience in various roles, I tell you that we are a spoiled profession at large.  We have been allowed to dictate our schedules, be privileged enough to work in healthcare while getting holidays and weekends off, and collect rather nice compensations for doing so.

Bottom line- All care should be provided with the patient's needs in mind.  Not to accommodate our weekend plans, not to unnecessarily use patient benefits, but to promote the healing of our patients.  

We all know that there are more falls, less activities, and less staff on weekends- so wouldn't it be to the patient's best interest to receive therapy on the days where the patient can be at the highest risk?  Aren't those the days, evenings, weekends when staff education needs are the highest?

We need to step outside ourselves for a moment here and stop blaming the reimbursement system, take control of our own professions and plans of care and focus on achieving outcomes which should include promoting function and education during those times when the patient and environment are most vulnerable.

If our patient's have to be confined to a skilled nursing setting and it is medically appropriate for the plan of care, then we should be providing interventions 7 days a week with the absolute goal of discharge to the next level of care if that enhances progress.  

Medicare does not dictate frequency and our documentation should clearly justify any frequency/duration we say we need whether that be 3 times a week or 7.  Our patients do not have the privilege of 'days off in skilled care, so why should we-  and education needs are too often focused on the staff who need the least training.

I suggest that you meet with your supervisor more frequently to discuss appropriate goal changes.  If you continue to have concerns with the reasons why your supervisor is upgrading goals, perhaps you should speak with their supervisor or your company's compliance team.

Your post saddens me deeply Tim.  What we do, the education we received to be able to impact people so deeply... is not a game it is an honor 24/7.  

Sincerely,

Leanne Gabriel, OTR/L

Leanne Gabriel, , Occupational Therapist RehabCare September 5, 2014 6:50 PM
Louisville

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