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COTA Thoughts

COTA Licenses and Registrations
April 18, 2014 10:11 AM by Tim Banish
OK, I'm a bit miffed yet again with how the OT license bureaus operate. As much as I submitted my retirement from the profession to both my state organization and NBCOT (National Board for Certification of Occupational Therapy) I've received renewal notices from both.

Sometimes I wonder if anyone in these offices actually does anything, or if there is any inter-office communication. After three emails back and forth to one, and confirmed that my status was in retirement, I still received a renewal notice.

Of course going way back to when I first entered the profession the only license needed to practice was the one from AOTCB (American Occupational Therapy Certification Board). Once you passed the certification test it was issued to you with lifetime authorization to practice, and included the use of the title COTA. Then NBCOT came along with the idea that picking every OTs pocket for a license every three years was a good way to protect the public.

Then state by state a license was required in order to practice, and now almost every state has an OT license bureau. What is their job? Why do we need both a state and national organization to control OT? (Yes, I'll probably upset a few people with that statement.)

My thought here is if the public needs to know if their therapist is actually a licensed therapist then let them pay to find out that information. That's how most information is acquired now days anyway. With pay cuts, Medicare cutbacks and mostly part time work, therapists are already financially challenged enough. Finally, why is licensure reimbursement considered a benefit by most employers? Without it you couldn't work for them anyway.


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


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A COTA’s First
April 11, 2014 9:36 AM by Tim Banish
This month marks my first year of retirement, and of course another birthday. As I continue to adapt to that change I got to thinking about some of the first things I did as a COTA. Some were fun, some were not. There were even a few things that made me quite nervous, for a while anyway.

As a male one of the issues that often came up was ADLs with a female. I can understand, and always respected, a female who did not want to complete personal care in front of an unknown male. I was able to find ways around that. I do remember the first female I completed a shower with, I'm not sure who was more nervous. Fortunately before long it became just another part of the job.

Personal care is an area where you really have to handle things in a matter of fact way. Nothing is a big deal; you are simply doing what needs to be done. I remember the first male that I had to change his brief. The poor guy was afflicted with C-diff, had a new hip replacement and a never to be seen nurse aide. All I can say is it's a good thing I already had children of my own and I had been initiated in diaper duty.

Of course one of the fun things I remember is my first time with a muscle stimulator. Actually with a lot of medical electronics, this was at one of my first continuing education classes. After I took the three day certification course my boss decided to buy a stim unit for the OT department. We had a perfect patient to trial it with, and it helped improve their active motion.

Everything from using a gait belt to pushing a wheelchair was new to me, and as a therapist just starting a career it was strange to have such close personal contact with so many people. However as time passed and experience was gained all things therapy became routine. After becoming comfortable with the personal contact a therapist needs to use it was always nice to see other new therapists experiencing the same apprehension when dealing in personal matters.

My only thought here is how all that experience changed me. Before becoming a therapist I was more of a shy, sit in the back type of guy. Speaking before an audience terrified me. Since school, and through my therapy experience, I changed. Today I lector at my church often, I have taught classes, and am currently the president of a church group. Beginning OTA school years ago I never imagined how a job would change me.


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


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OT and the ACA
April 4, 2014 9:32 AM by Tim Banish
Now that the Affordable Care Act (ACA) is in full force I did some research on how it has affected Occupational Therapy (OT). What I'm seeing is confusing because in some areas OTs are not finding jobs, but in other areas there doesn't seem to be enough OTs.

One new grad from the D.C. area is having a difficult time finding any job, while news from California report many open positions. However across most areas I'm finding that hours have been reduced, especially in the higher demand areas like Florida and Texas. Many OT and COTA jobs have been cut to part-time in efforts to reduce employee costs.

One staffing industry analyst states the unemployment rate in OT is just 1%, with a projected growth rate of 43% by 2020. As much as the new regulations for healthcare insurance require coverage of therapy services, only 30 visits per year are allowed between OT and PT combined. That isn't much therapy if you're recovering from a stroke or heart attack. So I don't see the growth in the field as projected, and if so the jobs may all be part-time only.

My thought here is that even with healthcare insurance available to everyone many are still going to avoid purchasing a policy, mainly due to financial limitations. The high cost of a policy, and co-pays, definitely limit a person earning minimum wage. And with that I think we'll still see many people without insurance, but needing healthcare, today and into the future.


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


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The Cost of Affordable Healthcare
March 28, 2014 9:03 AM by Tim Banish

As much as anyone, I believe that healthcare should be available to anyone and everyone.  That is the basis of the Affordable Care Act; however it seems to have its negative side as well. In this case taking the good with the bad is costing Americans a lot of money.

Since the number of people enrolling has not met expectations the deadline to register has been extended. With a simple click of a button you can state that you've tried to enroll previously, even if you haven't. That's the good part. The bad that is attached to the extended deadline is it will cost American taxpayers an additional 1.5 trillion dollars.

Without a healthcare plan, as one man found out, going to see the doctor is a big expense. As much as he had signed up for the plan weeks prior and received his medical card, at the doctor he was still not listed in the system. That meant he had to pay cash. The doctor visit cost $135, but then a prescription and lab work the doctor issued would run another $300 per month for the medicine and over $1,000 for the lab work. Ouch!

The issue here is the ACA web portal continues to run slow despite the hundreds of millions of dollars spent developing it. The last check by a web-site rating company placed it in the poor category, with response speeds falling well below standard. There are also seventeen qualifiers to enroll, however it was found that most of them elicit errors or fail to be applied.

My thoughts are mixed here. A large number of enrollees have failed to make a payment for their new plan, and the majority of enrollees have qualified for Medicaid. With the White House priding themselves about the five millionth person to sign up, they neglected to mention the six million kicked off their former plan because of their plan not meeting the required standards. It seems like the statement of "Keep your own plan" was blurted out before thinking how the new requirements would affect insurance. If you include the fact that about one third of uninsured people will still not enroll, I think the only ones coming out good from this are the insurance companies and government.

Until next time I hope all your thoughts are good.


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Retire Comfortably
March 21, 2014 9:03 AM by Tim Banish
In my last blog I addressed the proposed reduction of Social Security increases. As much as that cut got left on the table during the national budget talks, it probably won't be long before Congress figures out a way to pin it to another bill. That will mean less money when you retire, so it's time to plan ahead.

In 2011 the oldest of the Baby Boomer generation began to reach retirement age. From now until 2026 about 8,000 more will join the ranks of the retired every day. In my book that means more people drawing Social Security, which will equal Congress searching for additional ways to cut benefits. Medicare is still in the picture for proposed cuts too.

For a retiree medical costs will be one of the highest expenditures to the checkbook. If both Social Security and Medicare benefits are reduced then that cost will be passed to consumers, meaning it comes out of your savings, 401K, or other investments. That means you need to start saving now. Utilize your company's retirement program (if you have one) or start your own savings. Putting away a few dollars every paycheck, and not touching it, will add up when it's your turn to retire.

My thought here is for the medical field. With the number of people retiring caseloads will be higher. However if people can't afford healthcare due to cuts I expect to see one of two things: first will be patients who are in worse shape because they delayed treatment due to financial burdens, and two is defaults on medical bills that will financially strain companies resulting in lower salaries or lost jobs.

With America pushing "affordable" healthcare for everyone, why does it seem like seniors are losing out here? It's time to align Social Security and Medicare with the same plans our members of Congress have when they retire. After all, we spend forty or fifty years to earn our retirement benefit. Congress members receive (way better) retirement benefits after just three years!


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



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Social Security Misses Budget Cut
March 14, 2014 1:40 PM by Tim Banish

If you've been keeping an eye on things happening in Washington that never receive national news attention you might have missed this one. As much as I keep up on happenings on budget cuts, especially with Social Security, this one slipped by me. As always, they seem to be targeting people's money without them knowing about it.

In the latest planned budget cuts, Social Security was planned to be switched to a different formula to determine Cost of Living Allowances (COLA). This move would have changed the determination of rates from a higher financial status, and not based on the true economic status of the majority of American seniors. This would have lowered the annual COLA increases.

The good part is these cuts had been promised by President Obama, and he is now under fire from the Republican Party for not following through. The national budget didn't get cut as much as expected, and the deficit will continue to build they say.

My though here is Whew, for now. Probably before long a bill will pass with this cut tagged onto it. Again, Americans need the power to vote on any budget issues proposed by Congress, beginning with their salary.


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



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Home Health Assessments
March 7, 2014 9:49 AM by Tim Banish
One question that has always come up is if a COTA is allowed to do a home assessment. I'm not sure if all states have similar regulations, but in Ohio the language regarding this is pretty vague. The perception is that an OTR has to do the home assessment because an assistant is not qualified to make home recommendations.

Every time I heard this I would think "What? We can't make recommendations for our patients? Since when?" On a daily basis we recommend exercise programs, techniques to dress, or a splint for a contracted hand among other things. What is the difference if we go to the person's home? Granted, the COTA must have the knowledge to do a thorough assessment, and any supervising therapist should assure that this is the case before agreeing to assign a COTA this task and co-sign paperwork.

The home assessment goal is to identify any obstacles or hazards in the home, and recommend adaptive equipment needs. Things like figuring out room arrangement for wheelchair access or the correct seat for the shower. These are the things COTAs work with every day, educating our patients with the needed equipment and skills to return home.

The regulation from my state reads something like this "a home assessment must be done with the collaboration of the supervising therapist". I believe that is the same relationship we use to treat our patients on a daily basis when the OTR is not present. By having the supervising therapist co-sign our documentation this collaboration is confirmed.

So if an assistant (COTA or PTA) complete a home assessment, by having their supervising therapist review and agree with any recommendations made and sign off on the paperwork it should be acceptable to any insurance and/or Medicare for billing.

My thoughts with all of this? If an assistant has the experience and knowledge to do a home assessment then any recommendation made is just that, a recommendation. The patient has the right to use or not use the advice offered.

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


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My Grumpy Old Patient
February 28, 2014 8:46 AM by Tim Banish
If you work with patients that are in the geriatric range you know that some can be quite grouchy, mostly the result of them being unhappy due to the aging process. This is something that I always had to keep in mind as I worked with people, especially when I was younger and had an abundance of energy. As I aged it was a bit easier to remember. Now that I've reached the senior age I can attest to why some patients can be grumpy.

The first thing to remember is that old bodies move slower. Arthritis, prior injuries and balance deficits can make a person anxious about trying to keep up with a young therapist. Add the fact that about 70% of seniors do not exercise on a regular basis which impacts their energy level. I've seen some seniors that can pedal a bike for thirty minutes, but most are lucky to last ten to fifteen minutes. If you, as their therapist, ask for more than they can handle expect some resistance.

Of course their current medical diagnosis will be a factor here too. If the person has had a major illness or has been bed-ridden for an extended period their energy levels will be decreased. Yes the object of therapy is to build that energy level back up, but you also need to remember that due to their advanced age it takes more time to recover.

You also need to consider the remaining bodily functions that slow down with age. Every birthday tends to see a decrease in sight, hearing, digestion and more. One patient, a male in his 80's, once told me the worst thing he lost was his ability to make love to his wife. "And that's why I stay so grumpy!" he would joke. It's not a joking matter, but again just one more thing that leads to having a grumpy patient.

My thought here is to keep their pace in mind when working with geriatric patients. You'll sometimes find an exceptional senior who has lots of energy and it will be easy to forget their age, but for the most part this age bracket will need lots of TLC when working with them.


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



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Watch Your Back!
February 21, 2014 9:27 AM by Tim Banish
No, I'm not referring to your supervisor or co-worker checking up on you, but injuries to your back. In 2012 there were over 177,000 reported injuries to the back from job related accidents. Numerous methods for back protection exist, but variable circumstances can make some ineffective.

Injuries to the back throughout the entire work force can be the result of improper lifting, over-lifting, poor posture or repetitious lifting. In the world of therapy lifting is an activity that, although limited, involves so many variables that your awareness during a lift needs to be at 100%.

In therapy what is lifted most often is another person, and that is the first variable. You never know how that person is going to react. Most times therapists do not do a total lift of a person, but more standing pivot transfers. However if the person has a flash of pain, gets nervous or otherwise fails to do their part it can result in an injury.

If you're working in a nice open area it is easier to follow all the steps to protect your back while lifting. If you're working in a patient's room of a long term care facility you'll probably find space is limited. Rooms with two beds, two wheelchairs, and other assorted belongings can dictate how and where you can transfer a person from/to.

As one who has had back injuries, I can't stress how important it is to always be aware of your surroundings and the person you're working with. Keep your thoughts during a lift on the lift only, and keep your back safe.


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


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How Many COTAs Are Really COTAs?
February 14, 2014 10:48 AM by Tim Banish

Not so many years ago after you finished schooling and passed the national test to become a COTA, that's the title you were given. Then around the mid-90's things changed when credentialing switched to a separate entity. This was done to raise public trust in OT as a valuable part of the rehabilitation process.

Since that time one has had the option to retain the use of the "C" providing you accumulate the required amount of CEUs and pay the registration fee. If you decide not to do so you may only use "OTA" as your title.

Over my years of working as a COTA I always kept my "C". There are only one or two other OTAs I've known over the years that didn't, but mainly because they worked so few hours. I have known several OTs who didn't register for their "R", same reasons. It is hard to justify a significant fee when you only work a few hours here and there.

So how many COTAs are really COTAs? According to the latest report from NBCOT, 94% are registered and entitled to use the "C".

My thought is, where are the other 6%?


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


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Weather Related Injuries
February 7, 2014 11:11 AM by Tim Banish
With all the nasty cold weather the country has been experiencing I'm reminded of a trend noted in my years of working as a COTA. Whether it is long term care or out-patient rehab you work in, one thing for sure is the bad weather can increase your caseload.

While working in long term care there is usually an increase in hip fractures seen following ice or snow storms. It does make sense, people still need to get out shopping or go to appointments. Unfortunately some people will take a fall, and since seniors have weaker bone structures many of them will suffer a fracture. I can't tell you how many times I've heard the same story of a person saying they were trying to be careful but ice seems to always win. My grandma was one of these years ago. She just had to get out and cover her roses after an ice storm.

As an out-patient therapist working in a hand clinic you could always bet to see several fractured wrists after a severe storm. This isn't limited to just seniors though, all ages are subject to a fall. Since our internal system tells us to stick a hand out to break the fall, the wrist is the weak link. With today's modern techniques, a wrist fracture is normally surgically repaired with plates and screws. Following surgery the person may spend from four to eight weeks in a cast or splint then begin rehab. My oldest brother is in rehab now following his fall in early December resulting in three fractures of the wrist.

My only thought for a way to avoid falling on ice and suffering a fracture is to retire and stay in the house. Seriously, other than moving to a warmer climate where they have no ice or snow there is not a 100% guaranteed solution for avoiding a fall. All I can say is when you do have to go out in the ice and snow you should wear proper shoes/boots, and be careful!

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



After a COTA
January 31, 2014 10:47 AM by Tim Banish
So I've had a lot of people ask me, what are you doing now that you've retired? After 20+ years working as a COTA the one thing I still miss is working with people. So here are a few things I've done since leaving the practice.

With the people skills gained working for so long as a COTA the most obvious answer was to find something involving people. However another thing necessary was to have a passion or obsession with what that may be. Another consideration was time, as much as I have all the time in the world, I didn't want to have whatever consume all my free time.

Since I've been involved in my church, and our St. Vincent de Paul Conference (SVDP), I knew there were plenty of people in need. My church is located in the inner city, a modest neighborhood with a mix of people. The economic status of the area shows that 42% of the population lives below the federal poverty level. Our SVDP operates a food pantry once a week. As much as I didn't spend much time in the past helping in the pantry, after one of our members suffered a serious health issue I found myself more involved. Now I'm there almost every Saturday assisting with whatever is needed.

I'm guessing by now most of you know my passion with computers. I love to work on them and have repaired and built several recently. I also create websites, something started years ago when asked by my pastor if I could put the church on the WWW. I continue to update the church and school websites as needed. I have also begun a small business for my computer work, mostly working from home at my leisure.

Both of these activities involve people. One of my web clients actually mentioned how people oriented I was and asked what type of work I used to do. Being retired I feel I have the best of both worlds now; no productivity pressures and I still get to meet and work with a number of people.


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


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Billions of Social Security Dollars Stolen
January 24, 2014 9:44 AM by Tim Banish
After the latest group of people was indicted trying to fraud Social Security for disability payments they didn't qualify for, Congress is asking for a total review of the agency's management practices. The saddest part of this is the fact that a number of retired New York police and firefighters were part of the guilty.

Estimates say that billions of dollars have been stolen from Social Security recently by groups that can involve patients, lawyers and doctors. These groups often exploit people for their information, giving the "patient" a small cut. In the United States and abroad schemes are set up to claim fraudulent benefits.

One recent case involved a number of retired firefighters and police officers claiming mental stress disorders from responding to the September 11, 2001 attack on the World Trade Center. Another case from Puerto Rico involved a former Social Security Administration employee assisting three doctors on how easy it was to fraud the government.

Since nearly 58 million Americans receive Social Security benefits totaling $816 billion annually, this fraud could reduce the years benefits can continue to be paid. Current estimates say the fund will be exhausted by mid-2030, earlier if criminals are allowed to continue their ways.

My thoughts here are quite mixed. I am sad to hear people, especially a doctor, can falsely report medical claims to get a few dollars being fully aware of the consequences if they get caught. I also think about the people who are currently paying in to the Social Security fund wondering if there will be any money left when they retire. My final thought is with all the resources the government agencies have access to, why is fraud so prevalent?


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


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Yesterday's Occupational Therapy
January 17, 2014 8:58 AM by Tim Banish
Things have changed in our profession over the years. Between insurance regulations, productivity requirements and Medicare cut-backs the field has become more about dollars than treating people in need. So today I thought I would do a "Throw-back" blog.

One of the biggest changes over the years has been adaptive equipment. Not the way it's used, but the way it's issued. Prior to PPS Medicare paid for all adaptive equipment. In one hospital before the first visit to a person with any knee or hip surgery you headed to the supply room and got them a reacher, sock-aid, shoe horn, bath brush, and elastic laces. What ended this were the places that overbilled for equipment. An overcharge percentage was allowed by Medicare for providing adaptive equipment, but many would buy minimal items and use that as their base price. They then bought in bulk, saved more, but continued to charge at the minimal purchase prices. That made a reacher, which cost about $8 in bulk, about $25 when billed to Medicare.

Productivity requirements are a new monster. When I began as a COTA treatments consisted of whatever time the person was willing to work on therapy. If they were feeling ill, we cut therapy time short. On days the person felt like working we might go for an hour or more. Every goal we addressed during the week was written in their weekly update note, and all notes were done on Friday. The notes then went to a group of therapists in the office who determined what and how much was billed. As a therapist we didn't have to keep track of paperwork, minutes, CPT codes or anything else, we just did therapy. The max caseload per therapist was five people per day. I remember once when my caseload went to six people and the boss was in a panic trying to find me another OT to see that one person.

The last change I want to recall today is what we used to call techs. That was an aide who had been trained with therapy knowledge. Their job was to go pick up people to bring to the gym, assist with treatments, file paperwork, and sanitize the gym and equipment. They were the extra hand a therapist needed at times, but done away with when PPS arrived.

I could mention many more, but even though all these changes have occurred over the years the bottom line is we are still therapists. Ones with many new "jobs" to do around the gym, but in my thoughts still the person responsible to rehab the patients.


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



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Small Gym, Big Caseload
January 10, 2014 9:58 AM by Tim Banish
Do you work in a facility where the rehab gym is quite small? Or with all the equipment needed for the gym there is hardly any floor space left? Can you comfortably seat 20% of your caseload in the gym at the same time without stepping on feet or over objects?

I've always found that a small gym can be a distraction to some of the patients. People sitting too close together tend to chat. Others may tend to withdraw due to the close proximity of "sick people" near them. And some may be claustrophobic and not tolerate being in a small area.

Safety-wise, in a small gym you might find equipment hanging on the walls or in cabinets will be inaccessible once a few patients in their wheelchairs are parked there. Having to step over foot rests, walkers, etc. to get to a piece of equipment can lead to a fall or someone's toes getting stepped on. In addition, activities like transfers, ambulating and standing balance tasks are difficult to complete when you're cramped for space.

I remember one place I covered years ago in a small town where we actually worked out of a storage closet! In this closet we had all the spare walkers and wheelchairs, two cabinets for supplies and equipment, and a desk for all the paperwork. If someone was sitting at the desk, you couldn't get in the room. In another facility I worked, the therapy room consisted of the director's desk and a storage cabinet. This room was located at the end of a hallway in what used to be a small resident sitting room converted into the therapy gym.  Both were tough spaces to work out of. However in another facility I worked where there was a huge gym, the caseload was so large that the room always seemed crowded anyway.

I know there isn't much you can do when you're faced with this situation. Pleading to the facility administrator for more space is like asking for their first born. My only thought about working in small or crowded gyms is to try to keep things organized, a place for everything, and everything in its place (most of the time, anyway).


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



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