Being careful what you say and how you say it is one of the key elements of personal communication. You have to listen and hear what the other person says to respond appropriately. Then you have to think and choose the best words to reply with.

I had a strange comment this week from a patient. After just a couple of days in the rehab program she already voiced a great respect for the therapy team and what we offered her. She had already endured much, injured half way across the country while vacationing. She told me her story of being rushed through the hospital, seen by so many different staff and doctors she couldn't remember any of them. After discharge from the hospital but still not ready for travel she was admitted to a local SNF. She spent a few busy days there, receiving a bit of therapy. When she decided to travel back towards home, she came to our PCU Rehab unit. Within two days she was doing well and we were discussing discharge needs.

So at first when she said to me "I have found my angels" I wondered what she was referring to. This was an orthopedic patient, fully alert and oriented.

She told us she had yet to receive any information on her diagnoses. We had provided that, not only through handouts, but by spending the time to explain it to her. She also didn't know what type of doctor to see for follow up, and we referred her to a local orthopedic group.  We became her "angels" by just doing our job. By listening, and responding appropriately.

Aren't comments like this one of the best benefits of being a therapist?

Until next time, hope all your thoughts are good,

Tim

What can you do when you run into a situation that you can't find a answer for? Everything you try fails? Others who try may have the same failures. Then someone comes up with one off the wall idea that solves the problem.

This past week the catch phrase around the clinic was "Think outside the box".  After running into a couple of different situations that one or more of us could not find the best answer for, we found ourselves openly discussing solutions among the team. This always led to lots of suggestions, although many had been tried. The discussion would cover all the "normal" solutions, and then seem to drift off into some unusual methods.  Many times this would spark someone's thoughts and they would come up with an idea so unconventional, yet so simple, it was like a "duh" moment for the rest of us.

Anyway, we started saying this after we ran into a problem when a piece of equipment failed. As much as it put us in a semi-emergency state at the time, it's a funny story now, and proves that thinking outside the box can solve problems.  Using the electric Hoyer lift to return a resident to bed, all was going well, until with the resident suspended just touching the bed the unit failed and refused to lower further. The first procedure for the lift in this situation called for use of the power emergency release. With several staff positioned to assist, the button was pushed. Nothing. Pushed again, nothing. The next procedure was to use the mechanical release, and once more with all ready it was pulled. Nothing happened again. The lift was stuck in this position and would not move in either direction. We all stood there wondering how we were going to get the Hoyer to lower this person back down to the bed. Many ideas were being discussed when the resident spoke up and said "can't you raise the bed up to me?" DUH! Everyone was so focused on getting the lift to lower that no one considered raising the bed!  

Another situation we ran into was trying to increase resistance of a specific arm exercise, but due to the person's medical condition could not easily see how to accomplish it. Weights and exercise band had to be ruled out as solutions due to a rotator cuff tear and a mid-back injury. Again, a little discussion and someone suggested gravity. DUH! Again, we were so focused on resistance via weight or force we forgot to think outside the box.

(Did some of you already have answers before reading these entire paragraphs? You must be the ones who already think outside of the box!)

Things like this must happen in many clinics every day. Simple discussion between team members can usually lead to a successful solution for many problems you may encounter. And don't be afraid to think outside the box!

Until next time, hope all your thoughts are good,

Tim

This is a concept that would not only be a benefit to the patients, but it could help us in many ways. Just as a team depends on each other for covering specific positions, each team of therapists could depend on each other for many different assists throughout the day.

Mainly, this would concern patients and scheduling. If the disciplines can set an approximate schedule for seeing a patient, PT could finish their treatment, pass the person to OT or Speech, and treatments for the patient run consecutive.  The patient needs only one trip to the clinic for the day, so transport time is also reduced. By the same token, the OT patient can be passed off to the PT or Speech discipline as needed. The biggest concern here is the patient's endurance level. Some may not be able to tolerate being in the clinic for that long of time. Some may not tolerate having so much activity in such a short amount of time. The discipline completing the first treatment will have to realize this and allow the patient to conserve energy for the following discipline.

With disciplines doing treatments back to back, this also provides an excellent situation for the disciplines to work together to address common goals. At the end of treatments, and with two therapists present, could be a good time to work on some higher level standing and balance activities. One therapist could assist the patient and the other therapist could provide a dynamic activity for the patient.

Another part of being a team is to recognize the strengths and weaknesses of other team members. Everyone has certain things that they enjoy doing and are better at than others. So if one therapist is good at positioning, then the majority of the caseload that requires this should be delegated to that person.

And as much as the team should be discussing patient progress with each other on a regular basis, it helps to see how the patient responds and reacts to certain activities. Having two disciplines working together with one patient provides this opportunity. This allows us to assess how the patient is progressing in other areas, and with this knowledge makes it easier for each discipline to adjust goals to benefit the patient.

So working as a team can be a win-win situation. I find that when everyone plays fair, things really run smoother, patients are happier, and it's an easier day for us.

Until next time, hope all your thoughts are good,

Tim

Maybe this is just that your caseload is all too similar in need. If the majority of your caseload is orthopedics, or CVA's, or any other similar group of diagnoses, you may find yourself repeating the same words over and over again to every patient.  You might use the same technique to train every patient with a specific piece of equipment. This kind of repetition can get boring for a therapist.

I have to admit that I feel bored doing treatments sometimes. Being a contractor and moving from facility to facility usually finds me treating similar diagnoses over and over. And I do find myself using the same words and techniques to educate a patient with a reacher for donning a pair of slacks. Some might call this job burnout; however I prefer to call it experience. I have found a technique that seems to work for many, and with little change I educate each patient in the use of the reacher (or sock aid, or exercises, etc.).

Yes, it can get boring for me at times. Sometimes I wonder what my patients think. Can they tell I'm repeating the same spiel I just got done completing with the last patient? Or is all of this new and interesting to them?

Well, this question was answered for me this past week. I've been working in a newer facility with a diverse caseload.  Many of the patients in this facility are highly educated people from an established upscale part of town. And yes, I found myself repeating the same words and techniques that I've used many times to educate several of them in the use of adaptive equipment. Just as I began wondering if my treatments were boring, one of my patients expressed a simple thank you. And that's when it hit me. Even though I was bored of having done the same teaching thousands of times, it was still new learning for the patient. The patient had a need, I had an answer.

So, watch out. One of your patients, unknowing to them, and possibly with few words, may give you a new outlook on your "boring" treatments. 

Until next time, hope all your thoughts are good,

Tim

This part time work trend seems to be the norm these days not only in our field, but in many. Companies are using two or more part time workers to do one full time job. Of course at the same time these companies are saving lots of money because they aren't required to offer benefits to part time workers.

As much as many COTAs may have seen an increase in their hourly salary, working fewer hours can still mean taking home a smaller paycheck. Although the extra time to spend with family or on other activities can be nice, it can also be tough stretching your budget to finance these outside interests while working fewer hours.

Another implication to this trend though, is our benefits. As much as many companies are generous on figuring hours worked over a monthly time frame or longer, there have been a few people who have lost their medical coverage due to reduced hours. One of my former employers, after a significant drop in caseload, offered me an $8 per hour raise. However, my hours were also reduced from 32 to 20 per week, and medical coverage changed from 50% company match to having to pay the full premium. As much as working 20 hours at the increased rate was only slightly less than I was making before, the increase in insurance premiums really killed my take home pay.

For those who now work two or more part time jobs to make enough money, this possibly means paying an additional expense or use of a private policy to remain covered. Although it's in your best interest to have medical coverage, either of these methods will cut deeper into your weekly paycheck.

These are just a couple of the things I consider when job hunting. Many good offers (dollar wise) have been presented to me lately, however these are usually without guaranteed hours. I'm also finding that some companies are becoming a bit stricter on figuring hours for medical coverage. If your hours fall below a set threshold over a month's time, your benefits are cut off or you pay the full premium. I don't like either option here.

In today's job market, we have to do what we have to do. Someone has to keep the bread on the table. Hopefully someone, somewhere, sometime, will figure out how to keep a company profitable AND offer their employees full time employment with full benefits. (Yes, I'm dreaming again!)]

Until next time, hope all your thoughts are good,

Tim

I see a lot of questions asked about PPS. What is it? How does it figure into the OT world?

Many new grads, or OTs who have not worked in Long Term Care (LTC), may have never heard of PPS. However, in LTC it is the second most important thing to know besides the therapy techniques we employ.

PPS or Prospective Payment System, is the way Medicare (CMS) pays for the therapy we provide. Essentially, LTC residents are categorized into two groups, Part A Medicare, and Part B Medicare. The Part A Medicare group are the ones who will be classified into a RUG group (Resource Utilization Groups). The Part B Medicare group is billed differently, and I'll discuss this in a bit.

For the Part A group, minutes of therapy delivered is the key to reimbursement. Every Part A patient will be categorized into a RUG group, and each group level specifies the amount of therapy minutes needed weekly in order to be paid at that level. Weekly therapy minutes in every RUG group are always totaled from Sunday to Saturday. For a more in-depth explanation of the different RUG categories, visit this page.

The basic breakdown of RUG group minutes is like this:

Rehab Low - 45 minutes

Rehab Medium - 150 minutes

Rehab High - 325 minutes

Rehab Very High - 500 minutes

Rehab Ultra High - 725 minutes

In addition, some of these categories require additional requirements such as a certain number of days therapy is delivered per week, two disciplines must be involved, or Restorative Therapy in conjunction with traditional Therapy. There are other factors that may be included in a patient's rate too, but these will be calculated by the facilities MDS Coordinator.

The Part B patients are billed per CPT code, which normally are in 15 minute increments. For example, if you spend 30 minutes working on a dressing task with a patient, you would bill two units of self care under CPT code 97535. The CPT (Current Procedural Terminology) codes are a lengthy list of medical procedures that have been categorized and numbered. These include any and every procedure done by a doctor, nurse, therapist, etc. There are only a handful of codes commonly used in therapy, though.

So, that is PPS and Rug groups explained in a nutshell. If you click on the links included here you can read more detailed versions. For OT, we need to know how to use and bill correctly under these systems in order to maximize the reimbursement for our companies. But don't let all these numbers boggle your mind too much, as many contract companies have cheat sheets developed to summarize the minutes, groups and CPT codes commonly used. (Phew!)

Until next time, hope all your thoughts are good,

Tim

As COTAs, many of us are probably employed by a contracting company. These are companies that hire therapists, then market and sign contracts with LTC facilities or other rehab providers to provide the therapy needs of a building. Most contracts are written for one year increments, and are often re-negotiated yearly.

There are many contracts that have endured several years in one facility. On the other hand, there are some facilities that seem to change contractors yearly. In either scenario here, as an employee we are at the mercy of the powers that be for our job. If contract negotiations don't suit both the facility and the contractor, the therapists working there may be joining the unemployment line soon. If you are employed for a contractor that places you in a facility, this could be a situation you face at some time.

This contract is also not the only thing that could jeopardize your employment here. The facility has to maintain their part too. If their marketing staff becomes stagnant, so will the therapy caseload. If the administrator isn't doing a good job, he/she may be replaced, and the new administrator can change contracts. Of course, since many facilities are under a larger corporation, changes from upper level management can affect the terms of the contract.

When we have so many factors that can affect our employment status, sometimes it seems like we're just stuck riding out a storm. Hiring into one facility, I was told by the contractor that they had been there for seven years, had a great relationship with the facility and didn't expect to leave any time soon. However shortly after I hired, the facility marketing person resigned and his replacement was everything but efficient. It didn't take long before the therapy caseload dropped to the point that most of us were working only 20-30 hours per week. Of course this decreased profits which reflected on to the administrator, and before long the corporation replaced him. The new administrator just happened to have a friend that owned a therapy contracting company, so you can guess what transpired here.

Other factors to include here are that since the contracting company has no financial stake in the building, the contract is designed for their profit only. If the contract is ended, they simply pack up and move to another location to do business. Further, as the therapists are not facility employees, there are no thoughts about job losses when things do change. They are simply worried about providing therapy as required, and could care less who is doing it as long as they make a profit.

So, my thoughts here go many ways. When seeking employment, if at all possible try to find a facility that hires in-house. This way you are an employee of that company, and should enjoy more security in your position. If employment has to be with a contract company, ask questions first. Besides all the routine questions, I suggest these; When was the contract negotiated? What is the length of the contract? I would avoid hiring in if the contract is due for re-negotiation soon. (Another dumb move I made years ago; worked for three months and when the contract was not renewed, I got laid off. The worst part here is that I had already been paid a sign-on bonus, and there was not another facility close enough to transfer to) Which is another question I now add, does the company have other contracts nearby? If they do, is it possible to work there to get your hours in if caseload drops in your building?

Just like the facility and contractor negotiate a contract, we need to negotiate before hiring to secure our future employment.

Until next time, hope all your thoughts are good,

Tim

     First, home health consists of a visit/treatment in the person's home due to the fact that the person is homebound, or that attending therapy as an out-patient would be a hardship. These visits can be from a nurse, home aide, or therapist. There can be quite a difference of the actual time spent in the home depending on what type of visit you are completing, however for an Occupational Therapy visit I normally allow anywhere from 30-45 minutes.

     The time spent for a visit has always been a disputed fact. I'm not really sure if there is an official regulation that states the recommended length of time a home visit should last. Some companies do develop their own guidelines; others leave it up to the therapist. I have heard of a few therapy visits lasting less than 15 minutes. With a visit this short, I wonder if anything therapeutic is accomplished.

     Being homebound is another gray area. Normally home health is supposed to be limited to a homebound person, but an occasional doctor visit or other required trip outside the home is usually overlooked. For someone that shows it to be a hardship to attend therapy, consideration is also allowed. However, for a person who can easily and safely leave the home, whether that be by public transportation, a family member or friend, or drive themselves, they are not a true home health candidate. This determination is usually made by the nurse in charge of the case. Keeping the charge nurse informed of any discrepancies is one of your responsibilities though. I have shown up early at one home to find the patient just returning from a shopping trip where she drove to the store herself.

     Working with a person in their own home is one of the best ways to assure that they are safe and capable of daily tasks. From basic ADL's to higher level home chores, I find it easier to teach someone a skill within their own environment. Making adaptations or recommending equipment is also much easier due to the fact that you can actually see the need or barrier of the space. This means that the therapist must know what types of adaptive equipment are available for many different areas. It is also helpful to know something about home design and construction, or have someone to consult should the need arise.

     For documentation, I have always liked using a voice activated Dictaphone. This allows you to record any important notes about the visit to review later. After seeing several people in a day's time, this information will be invaluable and ensure you don't forget anything. With today's computer documentation, using a Dictaphone and software to convert voice to text is another helpful tool. This allows you to copy/paste parts of your documentation to forms specific to your company's requirements.  

     As far as job availability in home health for a COTA, this is something that I've found can really vary in different parts of the country. I have found that rural areas seem to have more need, but then you will be driving quite a few miles per day. Home health in a large metro area may mean fewer miles, but the possibilities of traffic jams or detours could mean more time spent in the car. Salaries are normally comparable or higher than LTC jobs, but one must factor in the costs of gas, higher insurance rates, and vehicle maintenance to your bottom line.

     All in all, I find home health to be a great area to work in as a COTA. Use of modern devices such as GPS's and Dictaphones do make it easier. Mostly though, I find that working with a patient in their own home to be challenging, yet quite rewarding.

Until next time, hope all your thoughts are good,

Tim

I've come across a few sites lately that can help you become more knowledgeable where the candidates stand. Being able to compare the issues and the candidates side by side gave me a new outlook. I have been totally against one person, but after reviewing some of these sites I had to change my vote. Even though I agree with the healthcare reform of this person, their stance on another issue will unfortunately still prevent me from supporting them.

The first site is Health08.org It is sponsored by the Kaiser Family Foundation. When you click on the site, from the main page head to the Analysis tab. (the link here should take you right to the Analysis page) Here is where you will be able to compare candidates side by side. Select the candidates you want to know about, and then click on the Compare button. The page that opens up will list the candidate's party, their main stated goal, and then list quite a few issues and their stand on them.

The next site I've come across is GlassBooth.org On this site, the issues are listed first. It gives you 20 points to use to assign them to different issues you are concerned about. You can give more points to issues you are more concerned with. Once you have all 20 points assigned, click on the Take the Quiz button. On the next page you will select your stand on the issues you gave points to, either for or against or somewhere in between. Once you have all your pros and cons selected, click on See My Result. This is where it will list the candidates who best match the views on your issues of concern.

With Super Tuesday long over, the field will start to narrow down to just a few candidates from each party. Hopefully, the right candidates will survive to the elections in November.

Just one final thought today, on a totally different note. I would like to extend my sincerest Thanks to all who have been reading my blogs, leaving comments, and sending me e-mails. I try to respond to posted comments at least once a week, and answer all e-mails ASAP. I have found a link to the Advance blogs on several different sites already. I have even been quoted on another blog! I am truly flattered that you value my opinion. I do hope to continue to write these blogs for a long time. Also, please know that any and all suggestions for topics are welcome, simply drop me an e-mail. Thanks again!

Until next time, hope all your thoughts are good,

When it comes to reporting abuse in a nursing home, I would be the first in line. And abuse is not just physical. Abuse can take on many forms, from physical and mental abuse to theft.

I remember the old story (on 60 Minutes) from the 80's that caught a nursing aide who had been stealing money from residents. With hidden cameras set up, it showed how a family member left a $5 bill in the resident's Bible. The visitor was not out of the door for a minute when the aide entered the room and went straight for the bedside table, removed the Bible and took the bill.

Another story that saddens me is how the therapy team finally figured out why a resident was always urine soaked each morning, despite her increasing awareness of needing to use the restroom. When this resident was shifted to early AM treatments, arriving in her room to complete ADL's received the comment of her needing to use the restroom, but she didn't have $5. After several days of this comment, we finally put two and two together when the family came for a meeting and asked if we had been taking the resident to the gift shop. They were concerned because she always requested having money to spend, but never noted any purchases. You may have guessed it; the aides on the night shift had been charging residents $5 to take them to the bathroom. Both of these stories are classic abuse, regardless that we are only talking petty theft. If the aides had been stealing from other aides, OK, fine, but to steal from a helpless resident just infuriates me.

The article also goes on to tell how some chains of SNF's are being sold at a low price, normally after a poor survey or decreased revenues. The new owner will spend a few dollars to "spruce up" the place, tend to a few major problems, and then sell for a huge profit after one good survey. This sounds familiar in the therapy world too, doesn't it?

I was just browsing this forum again, and saw a few old familiar names mentioned in a couple of posts. Hillhaven, Prism, and Kindred are all names of former therapy contract companies. I believe a similar thing has happened here. Some of these companies have had past problems with either fines or lawsuits. After soiling their good name, and losing staff, they simply change names and re-open. Hmmm.... sounds like a good future topic, so check back!

Until next time, hope all your thoughts are good,

Tim

Teaching an exercise routine to our patients is a good thing. But after you've taught a routine to your patients, how do you ensure they can follow through? I thought this would be a good subject to touch on today because I rarely see any exercise programs being handed out when I'm in the clinics, especially in LTC.

Expecting a patient to remember an entire exercise routine is asking a bit too much, and more so with older populations. Remembering your patient population is the first point to consider. If you're dealing with young adults, they will probably be able to remember several of the exercises. Completing the exercises correctly might be a different story though. I'm sure only a few would both remember and complete the entire routine as you instructed. If your patient is older, I'm sure the retention of what you just taught them will be even less.

Another thing I think about with exercises is variety. I really don't expect anyone to do the same routine every time they need to exercise, unless it's a specific injury. As human nature lends us to bore easily, I always try to have a couple of different routines that address the same deficit. I also find increased compliance doing this too.

So fire up those copiers! Dig out your old exercise routines and put them to use. Use one of the many popular programs out there that let you select cards to build a specific routine. Ask your colleagues for copies of routines. Search online, or use some of the Advance selection of free to copy and use programs. Just remember to follow up your teaching with handouts!

Until next time, hope all your thoughts are good,

Tim

Many of the places I've worked at restrict overtime. If you are close to your 40 hours for the week, you get sent home. I've also had times where I show up on Friday, having 35+ hours on the clock for the week, and am given just enough treatments to hit the 40 hour mark.

The patients that have not been scheduled on my load will usually be seen by a contractor or a part time therapist. While I am glad that the patient gets their therapy, I am saddened by the fact that the fill in therapist, not knowing what the current status of the patient is, may repeat things done in prior sessions. This is not very cost effective in many ways.

First, having the patient repeat lessons previously learned can be demeaning to the person. Although repetition is a good teacher in some cases, it does not always lead to enhanced knowledge.

Secondly, many temps will cover only the basics. They are there mainly to generate minutes so the SNF and contracting company don't lose money. This usually means having the patient complete a set of exercises, some transfers, or other mundane task. And I don't mean to be hard on temps since I've been there and done that, but not knowing the patient does limit the possibilities.

Third, I think of continuity. This is why temps are limited to what they can offer the patient. It takes time to get to know someone, their needs and deficits. Having the same therapist for the entire rehabilitation process has always been a key issue of mine. I tend to note a faster recovery of patients that rehab with one therapist.

Finally, since the salary for a temp therapist is always quite a bit higher, where is the savings for the company? Even at time and a half, I don't earn as much per hour as many contractors charge. I always wonder where some company's heads are at here. You have your full time dedicated employees trying to earn a living, but then give the best part away to some contractor who is only there for a short time, and often just because they can demand that big hourly wage.

Some companies are quite limited in this thinking too. In one position I've held, when the caseload grew and temps were not available, we were just expected, no questions asked, to stay and work to cover the caseload. When we hit overtime, our supervisor would complain. However, when a few temps became available and overtime was out of the question, our supervisor then complained about the cost of the temps.

It's never a perfect world, is it?

Until next time, hope all your thoughts are good,

Tim

I love to joke with my patients. Sometimes it's a personal funny story, other times it may be one of my corny old jokes. Occasionally the situation will remind me of another story from a former patient, and I relate that. What ever it takes, passing a smile on to your patients can help break the ice and just might make their day.

In one facility I work at, one lady from the dietary department often enters a room singing and dancing. Between that and her always present smile, everyone smiles back. It simple gestures like this that can lift spirits of all.

Some patients can give it right back though, so be prepared. I remember one neat lady I had the privilege to work with in a SNF some years ago. She was 101 years old at the time, and started every morning with her coffee and New York Times. She would read it front page to back then solve the daily crossword, and often was working on the Jumble when I would show up. We usually tried to solve it together as we worked on her exercises, leading to many funny made up words and of course many laughs. She was also a lover of my corny jokes. One day as I headed down the hall to the patient's room, I saw the floor nurse further up the hall. Wanting to speak with her, I passed my patients room and glanced in to see her sitting with her Times finishing the crossword. Just minutes later as I returned down the hall and entered the patient's room, there she was with the paper crumpled in her lap, slumped over in her chair. After a second of panic, I spun to head out for help. As I turned there was a snicker from behind me, which turned into a loud giggle. I turned to see the lady sitting up, smiling, and she says "Got Ya!"

Hope this gave you a smile. Pass it on.

Until next time, hope all your thoughts are good,

Tim

I might be walking on thin ice with this topic, but I feel it's one that needs to be discussed. Ever since the late 90's when AOTA created NBCOT to be our certification and licensing authority, things have not been exactly "happy" in the world of OT.

If you know any of the history of this change, you are probably aware of what has happened. For those of you who came into the field at a later date, here's my view of what transpired during and since the change.

AOTA was the power for all of OT, which also regulated AOTCB (American Occupational Therapy Certification Board), which was the former name for NBCOT. AOTA felt that it was in the best interest of consumers that a board be established which included lay people as members to better regulate the licensing and disciplinary measures of OT. So AOTCB was dismantled and NBCOT came on to the scene. Initially, this was a good thought. Since the regulating board was composed of only OTs, approving graduating students to become certified OTs seemed like a given. After all, what OT wouldn't approve a new license for another OT? (well, unless they had a felony record)

However NBCOT took another step. That was registering the OTR and COTA titles. Again, probably another good thought, initially. This change meant that no one could use the OTR or COTA title without being a registered applicant to the NBCOT board. AOTA didn't agree with this change though. They felt that they should have control of the titles, and initiated a lawsuit to block the action.

Here's where I begin to disagree with this change. As AOTA and NBCOT battled in court over the ownership of the titles, Congress was busy debating significant cuts to the Medicare system. Since most of OUR money (from membership dues) was now being spent on lawyers and court appearances, there was a much smaller portion of OUR money available to represent us as OTs in Congress to fight the Medicare cuts. After all, representation in government issues is the message that AOTA used to entice us to become members, and pay dues.

Fast forward about two years. NBCOT and AOTA finally finish their court battle. NBCOT wins the right to register and copyright the OTR and COTA titles. PPS is now in effect, and all around the country massive layoffs and salary cuts have happened in the therapy world. These cuts have affected not only every therapist, but has forced many companies to close or severely scale back. Salary cuts of up to 50% or more force many good therapists to seek other employment. Companies that employed 5-6 thousand therapists suddenly close their doors. Therapy in SNF's become almost non-existent due to many companies trying to figure out the new system, and how to bill Medicare.

Fast forward again to current time. AOTA membership has dropped significantly. Annual dues have increased greatly. For these dues, you receive a magazine once a month. NBCOT charges annual dues to use the title we earned in school. It's stated that you don't need to register, but then you can only use the title of OT or OTA. Some companies won't hire a therapist that is not a registered member of NBCOT and hold the "proper" title. The cost to take the certification exam rises yearly, and registration dues escalate with each new registration period.

Another issue is that during all of this developing regulation, states have initiated their own licensing boards to regulate therapy. In most states to be able to work, you must be registered, and of course, pay more dues for this right.

So, my "thought" here is where is our money going? AOTA sends out one magazine for your dues. Who are they hiring to write these articles? It must be some celebrity getting compensated big bucks. NBCOT gives us the right to use our title, and issues a card stating this fact. Are they buying these cards from a government source? State agencies also send out a card proving you are registered.

As much as there needs to be some authority for the regulation of therapy, why is it that we need several boards to accomplish this? Each board needs to have its administrator or CEO, who I'm sure receives a hefty salary. Then there's the support staff required to run an office. Not to mention just the cost of an office building, the utilities and supplies. I'm sorry, but to me there is too much regulation, and way too much money being wasted doing it. It seems like time to re-look at how regulation of therapy needs to be done, and in a more efficient manner. 

Until next time, hope all your thoughts are good,

Tim

One of the comments I hear often when working with older adults is something like "That young therapist thinks I can do 4 sets of 20 exercises, but I'm XX years old!"

I guess I hear these types of comments more because I am older too, but just today when one of my patients said this to me, I really got thinking about it again. And this is my blog topic tonight.

Yes, being older I can definitely relate to how our body changes with age. Every old injury from my past somehow rises up occasionally to remind me. Muscle aches and pains seem to take a couple of days to go away, unlike when I was 25 and a good night's sleep cured almost everything. And as much as I like to think I'm still as strong as I was at 25, that last jar of pickles was a bit tougher to open.

Now I'm not a health nut or anything. I don't belong to a gym but I do try to stay active. I eat healthy, except for my occasional chocolate cravings. I have been blessed with never requiring a major surgery or having anything worse than the flu, but I did have a severe back sprain some 20 years ago. I find that muscles that have had previous injury do tend to ache more. This unwelcome phenomenon seems to increase in intensity and frequency as I pass each birthday. Knowing how my back can flare up sometimes is what I thought about after the comment of my patient today.

Some of these older patients we work with have had multiple injuries throughout their life. Many have had a joint replacement or other major surgery. Most of them are currently getting over a major surgery, illness or accident. This is often why they are on current caseload.

So my thoughts rambled on to the type of exercises and other activities we are requesting patients to perform as part of their rehabilitation. Do we ask them to do too much at times? Probably. Do we think they feel the same way we do when it comes to muscle fatigue? I really doubt it.

I have always thought of building muscles as a slow process. Start slow with little resistance then increase repetitions and weight as we gain. Even athletes don't go to the gym today, and tomorrow have a bigger muscle mass. Developing a strong muscle is a long term commitment to exercising, eating right, and avoiding injury.

Of course, each patient is different. Some people love to exercise and stay active. Some have never done exercises in their entire life. However many will probably fall somewhere between these two lifestyles. Learning to correctly assess the person is what will tell us how much, and how many.

The other side of my thought here is this; when a patient is requested to do too much, and they get sore muscles from it, are we actually promoting activity and exercise? We all know that if something hurts us, we simply   avoid it. If you slam your finger in the car door, we do our best to never let it happen again. This is a human trait that we can't deny or change.

So, as you start with each new patient try to find out their previous lifestyle. Assess their current body mass and strength, past history of injuries, current diagnoses, and any other information available to come to a sound determination of what their level of exercises and activity should be. Don't stick to one set number of repetitions for every patient; try to set the number with their best interest in mind. Back off if they complain or indicate soreness. If we make exercise something that promotes health instead aches and pains, we all benefit.

Until next time, hope all your thoughts are good,

Tim