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When OTs Wore White Shoes

Life as a Rural Occupational Therapist

Published April 28, 2014 9:15 AM by Debra Karplus

I've spent the majority of my OT years working in rural communities. Initially my work was in nursing homes. Later, my caseload shifted to group homes for adults with developmental disabilities. More recently, I worked for school cooperatives in rural counties south of Chicago.

I enjoyed working in small town. I felt like I really served a need as most of the facilities I serviced did not need an OT full or even part time. They needed a consultant.

My very earliest jobs provided consultation to nursing home activity staff. I observed their residents and made recommendations of tasks they would enjoy and benefit from, such as outings or visitors. I'd go to each facility monthly or more often if needed. It was a non-demanding job for an inexperienced OT.

In the mid-1980s, Illinois had state funded programs in skilled care facilities that aides who had taken specific training and had passed an exam could work as an occupational rehabilitation aide (ORA). My job was to visit their facility at least monthly, evaluate patients, set up occupational rehab programs and teach the ORAs how to implement these programs so that patients could achieve the measurable goals I had established. I also provided numerous all-staff in-services on topic such as patient positioning, and use and care of adaptive equipment. Patients on Medicaid were served by these programs. Sadly, they were phased out sometime in the 1990s.

My work in group homes for adults with developmental disabilities was enjoyable and never really felt like work. I often went on Saturday mornings, mainly because most of the sixteen house residents worked at the workshop or at jobs in the community during the week.  The homes on Saturday mornings were like your home or mine.  Residents were finishing breakfast when I arrived and doing chores like cleaning their rooms; some were in the living room watching TV or listening to music. I evaluated those that the Resident Service Director asked to be seen and made recommendations regarding exercises, activities of daily living and equipment that would make tasks easier such as elastic shoe laces or a swivel spoon, and help order these devices.

In schools I did evaluations and determined measurable goals, and typically a crew of occupational therapy assistants (COTA) carried out the treatment and training. I provided supervision to these assistants and was part of the interdisciplinary team (IDT) for meetings and planning.

My only regret about being a rural OT is that I didn't have as much contact with other OTs as I would have liked.  It would have been beneficial to share ideas.  Otherwise, it was a perfect work situation.



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