What’s Our Job?
As a COTA, I've always thought my job was to get people better so they can resume their life. What ever they need that I, as an OT, can offer to help them achieve that goal is what I want them to have.
Of course with geriatric rehab, most of the patients' wishes are to be able to return home. This is a big task for some, with safety and self care issues often hindering many from achieving this goal. Some can survive with simple adaptations to areas of the house; others require assistance from others in order to maintain a safe and healthy lifestyle.
Lately however, administration has suggested that therapy encourage people to stay longer. Yes, there are some that definitely need to. Of course those are the ones who usually won't stay. No encouraging of any kind can change their mind. But then there are the ones who have met their goals, or reached their maximum potential. The last couple of weeks of therapy notes are quite similar; they are completing tasks at the same level. They are ready to go home or some place where they can be cared for.
Mostly, the ones who are "highly encouraged" to stay are the ones who have a significant reimbursement rate from their insurance, are in a high rehab category, or have low medical expenditures required. Uh huh, the ones who they make the best profit on are the ones we get suggestions about to have them stay longer. And the suggestions have included developing new goals that are often not appropriate for the person or the environment they are returning to.
Another issue related to this is the frequency of treatment. Most often the frequency is "suggested" to be five times a week. With a recent eval, the person's functional abilities were quite high, and the supervising OTR set treatments for three times per week. She returned the next day and informed me that the frequency was changed to five times. When asked why the response was that upper management had highly recommended that this change occur. Sounds like they were counting their chickens before the eggs were even laid.
But again, as I see my job it is to get my patients better and send them home ASAP. I feel that keeping them there for an extra week or two just for the benefit of the company's bank account is fraudulent. Continued actions like this will only lead to another PPS type revision of Medicare. And if that happens, you can bet your bottom dollar it will be our paycheck that suffers the most.
Until next time, hope all your "Thoughts" are Good-
Tim