Were you aware that there are 54.8 million people in the U.S. receiving Social Security benefits? That is 17.6% of our population. With the baby boomer generation adding to those numbers daily, the fund could be depleted by 2033.

Began in 1935 by Congress to provide "old age benefits" for families, workers and employers combined paid 2% of their annual salary. Today that figure is 12.4%, with the employee and employer each paying 6.2%. In 1956 the law was amended to allow disability benefits for blind or disabled people.

When the program first began Congress distributed a pamphlet that stated the most a person would ever have to pay is three cents on every dollar earned, with the maximum of around $1,700 per person. Currently that figure has increased over eight times that amount, and each person's maximum contribution is now $14,099. What you receive as your monthly benefit equals approximately 40% of your average income over your lifetime.

So as you can see it is important to plan ahead for retirement. Having a pay cut of 60% can really hurt your bottom line if you're not prepared. However if you continue to work after receiving benefits you'll need to watch how much you earn or your benefits can be taxed. For those who earn over $25,000 (single) or $32,000 (couple) per year 50% of your benefits are taxable. For those who earn $34,000 (single) or $44,000 (couple) the rate jumps to 85%.

One thing I discovered while researching this article is that Social Security Retirement benefits and Supplemental Security Income (S.S.I. or disability) are paid through two separate trust funds. However as both are handled by the Social Security Administration figures given include totals of both funds. I do have to credit justfacts.com for much of this information. Check out their site if you want to learn more.

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

Tim

Well as I mentioned in my last blog I have retired as a COTA. I don't miss getting up in the mornings to get ready for work, but I already miss meeting and working with people. That was one of the key matters considered as this decision was made because I knew it would leave a blank in my life.

As much as there were always a few patients I would rather not have to deal with, most people really want to get better and therapy, as tough as it can be at times, is the best way. The people who fight it, refuse, and complain are the ones who we don't want to work with, but our experience tells us we need to encourage everyone to get better.

Another issue for retirees is medical costs. Healthcare and medicines can eat up the biggest portion of your monthly earnings. While I am not on Medicare yet, I can see where doctor visits could be a drain on my income with co-pays. As much as some financial reports suggest shopping for a doctor to find the best prices, with a set co-pay there is no benefit in that. Most insurance also require generic drugs if there an option, but if you take a name brand prescription  the switch can save a few dollars.

One of the best suggestions is finding free community health services, as all medical plans must now offer some free preventative services. I actually used my doctor's free cancer screening just a few months ago, and was quite pleased with the service. Searching the Medicare.gov site you can find their Preventative Services page that tells what is available to Medicare users at reduced or no cost. http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx

Finally long term care insurance. A sizable cut into your pay now, but it sure can help IF you end up in a nursing home. This is one of the things that broke my heart during my years working, to see a couple drain their life savings because one ended up in a nursing home. After years of saving and paying on a mortgage, many couples have had to sell their house and/or drain their savings/401K to pay the nursing home bills. This is not a happy retirement.

I always said my plan for retirement was to buy a big motor home, then travel to one of my kid's houses and stay until they tired of me and pulled the plug. Then head off to the next kid's house and do the same. The only problem with this idea is we only have four kids, so I assume in six months or so we'd have all our kids mad at us and nowhere to park!

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

Tim

Hello readers, sorry I've been gone for a while. I had to take a bit of time away from the blog in order to deal with some personal issues. Life is always challenging, and sometimes a break is needed. Sometimes a break is just to refresh your spirit. For me this was both.

One personal issue is my mom, who fell recently and broke a leg. At 90 years old she still lives alone and drives a car, but this has set her back. She handled the surgery fine but got ill the following week with what seemed like a stomach virus that robbed more of her energy. She is now doing therapy daily, and has finally started regaining her strength.

Another issue I dealt with is my retirement from the profession. Ever since graduating school being a COTA has always been my life. The profession helped shape who I am, and from school on helped me grow to love this job of helping people. As I pondered retiring, many concerns ran through my mind.

Like anyone considering retiring it seems like the final step of life. I'm reminded of the type of people normally seen in long term care facilities, the ones I have worked with over my many years. As much as I have been blessed with fairly good health no one ever knows the future. My thoughts of ending up in a nursing home have run through my mind numerous times with this decision. However I have always said that if I end up in LTC I will be their worst nightmare, I know the regulations, who is responsible for what, and what is expected. So at least I'm one up on many who do end up in a nursing home.

One of the saddest things I have seen over the years are the males who have just retired and then have some major medical issue. This is one thing that I've learned from being a COTA, you can't wait until something goes wrong to fix it, staying healthy is a lifelong task. I see many males who have no hobbies, nothing to do after retiring but sit on the couch and work their thumb on the remote. I have promised myself that I will not fall into that mode. I like to walk, garden, camp and generally putz around the house fixing this and that.

So for the future I plan on continuing my blog. My thoughts will probably drift into more retirement stuff, Social Security and Medicare. Things everyone should be thinking of before you get here.

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

Working as a COTA I have noticed more and more people of larger size on my caseload recently. I tend to note that as much as their admitting diagnosis can vary, many have similar health issues. Working with people of size is no different than working with any other patient, but it will require good strength and body mechanics.

I'm not sure if it's me because I'm getting older or if I'm just noticing more, but everywhere I go these days I see people who are grossly overweight. I realize that weight management is a difficult task for many people, and some suffer from medical conditions that cause weight gain. Again, it seems like there is a much larger percentage of people in this country who would be classified as obese.

People with that extra weight of course suffer from more health issues. One of the diagnoses seen often is arthritis of the lower joints. Hip and knee replacements are wonderful medical technology, but for the person with many extra pounds the recovery can be difficult and much longer. Heart problems and shortness of breath seem to be other health issues often seen with this population, along with the variety of other illnesses humans suffer from. Another thing I note is it seems people in this category tend to be younger than the general population with the same complaints.

Working with a person of size can require good strength depending on their ability. I've worked with people where it took three to four staff to get them standing or transferred from bed to wheelchair. Use of good body mechanics is very important when lifting anyone, but even more important when that person is larger. My last thought is to use good verbal cues when having a person of any size transfer or stand. Sudden or unexpected movements due to miscommunication could be the next injury to you or your patient.

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

Tim

It was another day of treating low level patients for high minutes. This really makes me miss one of my old supervisors who stood his ground against management, allowing the therapy team to determine minutes. Completing nearly an hour of treatment with a person who is either barely responsive or has severe memory deficits is a challenge, often with little or no gain seen.

I tend to see when caseload is booming in a building, patients that fit the category mentioned above often have lower minutes scheduled. If there is enough staff though you can be sure there will be higher minutes set.

Years ago my manager used to tell the nursing home team what minutes we could do, and had all the therapists input as we treated each patient. If we had patients that were uncooperative or not highly motivated, their minutes were decreased. These days it seems like it's the other way around because the nursing home and the therapy company want to maximize profits.

I'm sure you've all had one of those patients, slow, uncooperative or lacking motivation. I'm all for giving every patient a chance, but as the weeks drag on and the minutes remain high, you know why.

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

Tim

Working as a COTA in a prn status has its advantages, but it also has it disadvantages too. As much as the flexibility of setting your own schedule is nice, some days there is no need for extra help.

So working prn status you can set the hours and days you prefer to work. That is nice for times when you need a day off for a doctor's appointment or other personal business. I just requested a day off for a visit from out of town company, and a short day next week to take care of some personal business. My company is great and always honors my requests. However on the occasional sick day sometimes they ask me to work a Saturday to cover missed minutes.

One downside is after my day off last week, there were no needs the following day so I missed two days of work in one week. Come next payday that will be some change out of my check, but that's the way things happen. I'll usually take the Saturday work to make up for a missed day unless I'm out of town. But as you can see unless you're independently wealthy or have another means of income working prn can be scary on the bank account at times.

Another downside to working prn is there are no benefits. If you work you get paid, if you don't work you don't get paid, period. Taking a vacation during the busy full time staff summer vacation period is discouraged. There are no health benefits or retirement plans.

You are usually receiving a much higher per hour rate than full time staff though. Earning the higher rate should allow you to put some aside for medical needs and vacations. I'm fortunate that my wife has a steady position with a solid company who offer great benefits to cover my medical. And I'm happy because some computer work and a writing job supplement my prn paycheck.

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

Tim

I really have to say the new computer system is really affecting my productivity. It is terrible, but lately all I do during a treatment is check minutes. In the many buildings I travel to therapists are dealing with the issue in different ways, and for the most part I don't like it.

So our daily log is now one page with a list of all your patients, their room number (in some buildings anyway), and the major category for billing (such as ADL, TherEx, etc.). I think each page would hold fifteen patients if full. That doesn't leave much room to take notes on what and how the patient did during their treatment. I find myself jotting notes as I go on the patient's level of assist required while addressing their goals. With the old daily sheets (one for each patient) that was all that was needed to be done. Now at the end of the day those notes have to be entered into the system. I could do that in minutes if the computers weren't so slow, but they remind me of dial-up internet where you had time to take a nap waiting for a page to load.

With the time needed for computer documentation I find myself looking at the clock often to make sure not to exceed minutes. You can't afford to give away a couple of minutes here and there in order to maintain productivity. Anymore I feel like it is business only and there's no time to be cordial with people.

One thing I see that bothers me is some therapists are using treatment time to document on the computer. The patient sits and waits as data is entered into the system. One therapist said that she couldn't remember what a patient looked like because she was too busy entering data into the system. Of course laptops are now all over the gym, often with someone logged in where data could be accessible. Or where it could fall off the mat table and be damaged.

Anyway, as much as I hate to see technology not used if it benefits the patient this computerization of treatment notes still continues to make no sense to me. It is cutting into patient treatment time and affecting productivity.

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

Tim

So at work this week one of my schedules had five patients on it. Four of these were in the facilities locked unit, meaning their major diagnosis was Alzheimer's or dementia. Three of the four refused to do any therapy without a lot of coaxing and encouragement. Spending the time to talk them into doing any therapy wasted so much time that productivity suffered. The fourth one slept through most of the treatment, and minutes were not completed.

Between the PT and me we did manage to get all the patients seen, for most of their time anyway. All of them were scheduled for high minutes, something you typically don't see with dementia or Alzheimer's diagnoses. So I'm guessing that because caseload was down in this building these patients were picked up to boost the revenue.

I'm not saying that these people did not warrant therapy, but not in the high categories they were scheduled for. I really miss the days when a supervising therapist refused to pick someone up just because they had a short hospital stay.  Many times it's for something unrelated to their day to day abilities, and these days I see goals written to actually surpass their previous status.  Come on now, if a person was max assist to dress prior to their hospital stay why does anyone think that now this person can learn to dress with less assist?

The funniest part of this day was the one patient who was not in the locked unit. He was pleasantly confused, mumbled, and stated he was ready to go home despite having a hip joint that was so unstable a special brace was made to protect it. It took two people at max assist to get him from bed to wheelchair, and that was really giving him the benefit of the doubt as it was one of the most unsafe transfers I have ever seen.

Anyway, I made it through the day and hopefully spending all the time coaxing patients into therapy didn't hurt productivity too much!

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

Tim

Just this week I had a patient who made my day. This person was very friendly, willing to participate addressing all of their goals, and had some great stories. It made the entire treatment pass so quickly I went way over the scheduled time.

But this got me thinking about patients I've worked with over the years, especially some who I will never forget. Being a COTA is often a tough job, but it's all made up by those few moments of enjoyable memories some patients will leave behind. Here's a few of my memories;

This is the story I tell the most, I'll call him Joe. He was 99 years old when I met him after an elective hip replacement. Joe didn't look his age, and had more energy than someone half his age. At the time I was working the contract thing and did visits in nursing homes, hospitals and home health. Anyway, Joe did great in the nursing home setting and went home, by himself, in just ten days. He went home that soon as he wanted to be at home to celebrate his 100^th birthday. Everyone was concerned due to his age, and it was a pleasant surprise when his name came up on my home health list. Week one and he was doing fine, but still lacking endurance, needing frequent rest breaks. I'm sure some of this was due to the huge birthday party his family held for him this week. By week two he was back to his "old self", as he said, and had completed or exceeded all his set goals. When I put his name in for discharge my supervisor said he can't be ready yet, keep working with him. Arriving for our first visit in week three I found Joe up a ladder on the side of his house cleaning the gutters! He was discharged the next day.

Females are normally hesitant to allow a male to be present during personal care, such as showering or dressing. My next memorable patient is a lady (I'll call her Sarah) who suffered a severe stroke and was not expected to survive. In fact her husband was scheduled to fill the bed at the nursing home after a heart attack, and this is what caused Sarah to have the stroke. Unfortunately he passed away. At the time I was pretty new as a COTA, and Sarah was very open to allow me to address any personal care. She was educated on adaptive methods for bathing and the use of adaptive equipment for dressing. Due to loss of movement of her dominant upper extremity using the reacher was a difficult task, and she struggled with it until discharge. Shortly after her discharge I left this facility, but passed by it every day. Several months later I finished work earlier than normal one day and decided to stop by this facility. Sarah was sitting by the front door, and immediately asked me to come down to her room. In her room she wheeled her chair past the bedside table and dropped her coin purse on the floor. As I went to pick it up for her, she stopped me. "I've been practicing what you taught me, watch what I can do now" she said as she took her reacher and picked the coins off the floor!

As much as I could tell many more stories about memorable patients I'll stop here. Hopefully working as a COTA you'll find some pleasurable memories with some of your patients.

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

How do things go in your LTC building when the state survey team walks in the door for their annual visit? I tend to find that projects get started, more staff is visible, and the pace picks up.

Of course the home is aware of when the survey will happen, which I believe is a three month window. In many places I've worked it seems like projects around the facility get started, new paint, floors or something to spruce up the place just before the survey is expected. (This year new wood laminate flooring replaced the hallway carpeting)

During the survey there always seems to be extra staff around. I'm not sure if some staff who are normally busy with management duties come out of their office to help or more staff are scheduled to work. Everyone is busy though, not the usual hanging out, telling stories or checking their cell phones. That makes it easy to find help if needed, but the best part is the patients get great care.

As you know, the annual survey is how the home is rated. Patient care must meet certain standards and the survey checks for this compliance. Deficiencies are dealt with depending on the severity. Simple issues may not get checked until the next survey, but severe issues can bring the team back for a re-visit in a week to a month. The home must develop a plan to correct deficiencies and initiate it before the team returns. Some deficiencies can result in fines for the home, and the fines increased if they are not corrected.

The annual survey gives a quality rating on the homes level of care. Of course the higher the rating the better chance the home has to attract clients. One thing I do think is the way some homes prepare for the survey are done solely to raise their rating, which I see as cheating. Adding extra staff during the survey week to show patient care is above requirements is not playing fair. But then I've seen a few surveyors that don't play fair either.

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

Tim

Computerized documentation and tracking for therapy have been around for some time now. Advancements in programming and internet access have helped create many new programs directed towards the therapy world. With the latest change at work I am wondering if they actually help save time.

My first computer at work was in 1985 when all data was sent and received on printed paper only, no monitor. Working for a therapy company in 1997 I was introduced to computerized billing. At that time I was just a novice computer user, since then my knowledge has expanded to building computers and creating web sites. One thing I've learned over the years is it always takes some time to learn a new program, especially if you are not computer friendly!

So the change at work was to a new internet based billing and tracking system. Of course there were glitches on start up, and launch was delayed a week. The first week of actual use didn't go well, and there were still some problems. Into the next week and everyone is on the new program, and complaining about the time it was taking to enter required information. Other issues mentioned include the fact that you can't see the patient's progress from the last few days unless you log on to the computer, and you still need to look through the binder of evals to find the goals.

So there are not enough computers for every therapist, and with everyone taking longer to enter their info it is difficult to find an open computer. In some buildings the computers do not have the required memory to handle the program and run very slow. Laptops have been sent to some buildings to increase accessibility but it is time consuming scrolling with the touchpad instead of a mouse.

I'm sure all of these issues will be taken care of over time. As staff becomes more comfortable using the program data entry will go faster. Computers will get updated as budget allows. But I'm thinking about packing a mouse next to my gait belt.

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

Tim

What type of clothing do you wear to work in a long term care setting? Over my years I have seen everything from a dress shirt/tie and three piece pant suits to scrubs and jeans. With the different activities we address as COTAs in LTC there are different opinions as to what is appropriate.

As I said the different clothing I've seen people wear to work encompasses a wide range. One OTR always wore a dress shirt and tie, tucking the tie into his shirt when doing personal ADLs. Another SLP I worked with years ago always wore a nice pants suit and heels to work. She would wear a lab jacket while working to protect her clothing.

Some companies may require a specific type of attire. Scrubs seem to be the norm for most, colors designated by each employer or facility. The dress code may or may not be strictly enforced, and some may go into detail on what is acceptable and what is not. The dress code policy usually applies only to full time staff.

As a prn employee I am fortunate to not have to follow a dress code, as much as all the full time staff are required to wear navy blue scrubs. Being older my taste in clothes, and what I'm comfortable in, are probably way different than most. Also because I have yet to find scrubs that fit me comfortably without having to sacrifice pocket space or continually having to pull up my pants! For work its normally casual dress pants with a belt, a button down casual dress shirt, and comfortable dress shoes. I always wear a name tag on my shirt too since I dress differently than the full time staff.

So what do you feel is appropriate wear for working in LTC? Are you comfortable enough if you are required to wear scrubs? If you are required to wear a specific uniform does your company reimburse any cost, or do you use it as a tax deduction?

All I know is no matter what I wear to work, once I get home its jeans, a t-shirt and my tennies to get truly comfortable.

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

Tim

I am one who will find a place to wash my hands as often as needed. However in some clinics there is not a sink handy, so what do you do? Waterless hand cleaner can work in some cases, but even then it is still recommended to wash with soap and water after two or three uses.

The next day found me in a different facility, and the same message. All activities and the main dining room were shut down to help prevent the spread of the bug going around. Again I was washing hands as often as needed, sometimes more.

This was a Friday. About 10 PM that night I had to rush to the bathroom, sick. This went on for most of the night, and I thought sure it was something I ate. I spent all day the next day in bed, and most of the next day too, drained of energy. Arriving at work Monday morning the same co-worker who spoke up first looked at me and immediately said "You had it over the weekend too, didn't you?" Two other staff reported the same symptoms I experienced and said that was the same as infected residents were having. So I caught the bug anyway despite all the hand washing precautions.

Does that mean proper hand washing techniques are wasted effort? My thought is No; frequent hand washing will still help minimize the spread of the germs from patient to patient.  Sometimes you are just bound to catch it anyway, especially after repeated exposure to the bug.

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

Tim

Some time ago I wrote a blog about COTA salaries, and in it I mentioned that with the increased cost of schooling and decrease in salaries that soon we may see a shortage of people seeking to enter the field. Was that a bad prediction?

The cost of the two required years of OTA school can vary greatly. At the local community college tuition runs about $15,000, and at the privately owned college tuition will set you back almost $40,000. These figures do not include books and other fees either. All I can say is OUCH! However more and more people are seeking to enter the field.

Many new grad OTAs are reporting an average starting salary of $20-25 per hour. Not a bad beginning wage but still not equal to the pre-PPS days. I remember starting out at $18 per hour back in 1990, when the minimum wage was $3.80 per hour. Today's minimum wage is $7.80, and although my math is not the best, that should mean starting pay (if salary percentages matched the minimum wage increase) should be close to $40 per hour. That would be if all the Medicare cuts and managed care never came into the picture.

One thing I do know is some COTAs are reporting annual earnings of $70-90,000. A more realistic figure would be in the $40-50,000 range for a full time 40 hour work week. Some COTAs make extra money working a second part time job. Maybe a couple hours at a nursing home, or a few home health patients, but typically when you work part time you can demand more per hour as you receive no vacation days or other benefits. If you're young and have the energy, the need is there and yes, you can make a good annual salary.

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

Tim

Beginning next January 1^st, insurers will no longer be able to deny coverage due to pre-existing conditions. At the same time the government will begin to subsidize those who have no access to health insurance through their work.

However $2.4 billion of the $5 billion congress set aside has already been spent on medical claims. That averages out to almost $18,000 per person. With administrative costs factored in, each enrolled person is spending around $20,000 per year in medical claims. At least to this point, as there are ten months left this year to cover medical claims for the 135,000 enrollees.

Now I'm all for everyone receiving healthcare that they need, but at that per person cost will insurance premiums skyrocket? I realize that most of the insured under this plan have severe medical problems, but it reminds me of what is happening with Medicare right now. Lots of people enrolled who are the largest users of prescription medication and health services. No matter how many people are enrolled, if the majority spends more on healthcare than they pay into the system there is going to be a deficit. Adding another hand for the money to go through (read - "administrative costs" here) just takes away from the total available for healthcare.

My last thought on this is I am fine with paying a bit more for my health coverage. However I believe most Americans don't want to pay for their own coverage plus someone else's. I also hope therapy remains a covered cost for those who need it. And since I'm in a joking mood today, here is a little something related that I found on the web.

http://www.dumpyourphoto.com/photo/view/203460/Oy8sbSlx

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

Tim