Minutes, Minutes, MINUTES!!
Have you ever had one of those patients? You know, the one who started off therapy like a gangbuster, then quickly fizzled out? Whether the person slows down because it's too hard, medical complications, or other issues, once they are in the "Magical" week of assessment there is no looking back.
I can't tell you how many of these patients I've had lately, but it's been a bunch. They do great on the eval, and then for the first two days or so and then BOOM. Either they get depressed because they aren't getting better fast enough, have a medical set back, or complain about having sore muscles. But whatever you do, you just can't find enough things to work on that they are agreeable to in order to get enough minutes to keep them in that UH RUG category. AND... telling the boss that Mrs. X just refuses to work so long gets you a reply that is most often unmentionable here.
Yes, some of these patients are in an unrealistic category. Again, telling the boss who is getting pressured to increase productivity usually gets you another unmentionable reply.
So what do you do? I find that seeking out my patients in the midst of an activity that you can make therapeutic helps. This is a real matter of timing mainly, but I find that around mealtime is always a good time to find someone needing the restroom, to get in or out of bed or to transfer to a different chair. Many times before lunch I move from room to room finding that one or two persons that needed a few more minutes. Getting someone to the gym in the morning is another good time to pick up a few minutes. I try to get 15 minutes or so doing ADL's before taking them to the gym, where PT can start while I go for someone else. I also find that bouncing disciplines back and forth on patients will keep them in the gym longer. Moving from activity to activity helps keep their interest peaked.
These past few weeks I've really been teed off with the system. Our caseload is high, and our staff is down. The minutes have stayed high, and several of my current patients are the type who really can't tolerate the extended therapy time, or don't want to. Finding creative ways to get their minutes has really become a challenge. Ahhh......... excuse me, Mrs. X, do you need to get into that dining room chair for lunch?
Until next time, hope all your thoughts are good,
Tim