Healthcare reform, the economic depression, reduced insurance reimbursements, Medicare and Medicaid cutbacks, how will this affect the future of the COTA?

            Some people are quite nervous right now, thinking that Obama's healthcare reform will eliminate the COTA position. Others are worried that the reduced reimbursement rates will decrease salaries. Some have indicated that continued layoffs and company closings would reduce caseloads, thereby reducing the number of hours available to work. And several prospective students have written me recently asking if they should still consider enrolling in an OTA program, will there be a need in the future?

            Well, just as I told one person, job security does not seem to be a part of American language anymore. I can't predict the future but I do have a few thoughts from the trends I've seen.

           Today, companies close and relocate for economic gain leaving hundreds of people unemployed. Most are also left with no healthcare, placing further strain on an already tight public system. With fewer people able to afford medical benefits, including therapy, this does indicate fewer jobs.

            This is where healthcare reform would change the future. With healthcare for all, medical treatments would probably increase as more people are able to utilize the system. More people using the system mean more jobs. That's good, however as I see it, to maintain financial control rates will be set for every treatment much the same as we have now with CPT codes. But I also expect to see these rates reduced to a figure lower than current levels, significantly decreasing payment for therapy. Less reimbursement indicates reduced salaries.

           Next we have cutbacks on Medicare funding looming in the near future. Stricter policies on treatment minute calculation, effectively forcing one-on-one treatments. This will make productivity fall, and require more therapists to see the same caseload. More staff with the same reimbursement sounds like there has to be a cut somewhere. I predict salaries will take another hit when this takes effect, or possibly sooner.

          So no, I don't see healthcare reform or reimbursement cuts eliminating the COTA position.  I believe that there will be an increase in the number of COTA jobs in the future, but again more than likely at a reduced salary from today's level. This could be the determining factor of the COTA future though. If salaries are cut to a point that it no longer is economically feasible to obtain a two year degree to earn just a bit more than your local hamburger flipper, no one will enter the field and it will slowly die.

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

Tim

Well, I must admit that talking to others with different experiences and listening to the other side of the story is one good way to learn. This past weekend my thoughts were changed on the health care reform issues, and simply by listening to another opinion from someone who sees another side of the story.

            Medicare as we know it is failing. Government is blamed for it, and people don't want their healthcare operated by big brother thinking the same results will happen. A new thought was presented to me concerning Medicare versus private insurance though, and it makes sense.

            Medicare recipients are almost all elderly, and most are already in failing or poor health. In other words, they are what are known as high risk clients in the private sector.  So yes, if every person you insured used more medical dollars than the premiums you are bound to operate in the red.     

Private insurance companies have the luxury of selecting clients to insure, hoping to pick the ones that use fewer medical services. This will keep their overhead lower, and leave more profit. Of course that's what they want. The average overhead operating costs of private companies typically run 28% or more. The overhead operating costs of Medicare average 3% of total revenue.

A private insurer can also place people in high risk categories, forcing them to pay higher premiums. For some this is impossible. Consider this scenario; you have just been diagnosed with cancer. Treatments and medicine run well over $2,000 per month but the company healthcare plan covers that. Until you get so sick that you can no longer work. COBRA coverage is so expensive due to pre-existing conditions that it is unaffordable, especially when you are unemployed. So where do you go for coverage? Many run up huge hospital bills and eventually are forced to file bankruptcy or lose their home and savings. One such person sought help by moving to a foreign country for treatment where her medicine costs decreased from $120 per dose to 5¢. I'm sure the additional $119.95 difference in price per dose here in America goes towards advertising and research costs. Oh, and probably a few big bonus checks too.

So am I now in support of healthcare reform? Not completely, but it makes sense that if all Americans were in the same plan the cost of insurance would be shared between the healthy as well as the ill. With everyone under one umbrella, costs could be more fairly shared. This larger insurer would also have more leverage when purchasing services, setting rates and reimbursements. Maybe if congress can conjure up a good piece of legislation for once, healthcare reform could be an affordable possibility.

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

Tim

Changes in Medicare funding for skilled nursing facilities happened just a few days ago on October 1^st. These changes will cut deeper into the budgets of all Skilled Nursing Facilities (SNF's), but the impact will be felt more in smaller SNF's.  With strained budgets, it will more than likely affect the quality of care our senior citizens receive. The current changes are significant, but changes set to take effect in October 2010 may bring a devastating blow to long term care, even more so than PPS.

            Current changes in funding appear to have actually increased. The daily rate for a skilled ultra high patient went up, slightly.  With this increase though, came assigned cost directives that place all costs for all care on the SNF. For instance, if a patient needs a new wheelchair it's up to the SNF to provide it. Yes, this has always been true but now this also includes specialized chairs. Do you see a small 70 bed rural SNF being able to afford a wheelchair that costs several thousand dollars for one resident?

            I don't know how your facility is equipped presently, but in my SNF we are always looking for bargains on rehab needs. Ask for a $150 pressure reducing cushion for one of our long term residents who has had problems with pressure areas for months, but the budget says no you have to make do with this less efficient $90 one. We are constantly being asked if we have something in the department or storage that would work rather than buying (99% of the time the answer is NO, but they continue to ask). My OTR goes to Goodwill at least once a month, and will buy any DME she thinks will benefit the residents. Well, this helps in our job too because now we don't have to go begging for a piece of equipment. Over the years my favorite saying has become; "We have done so much with so little for so long, we are now qualified to do anything with nothing".

            But as I mentioned, the changes that are set to take effect on October 01, 2010 could prove to be more destructive to LTC than PPS itself. This new change makes multiple patient treatments a thing of the past. Concurrent therapy will still be allowed, but the time must be evenly split between the patients. Essentially this means one on one therapy again, like in the pre-PPS days. The difference is back then we were paid for every hour we were on the premises. Now we are only paid for each treatment minute we deliver. With treatment minutes reduced per therapist to the minimal 80% standards, companies will need to hire more therapists to complete the same amount of work being done by the current and smaller staff now. Smells like a pay cut to me.

            Even delivering the minimal minutes per day having to do one on one treatments will be difficult in some facilities. Scheduling patients is something I have always found to be more effort than reward. Any time the doctor comes in they get preferential access to the patient. Then there are meals, activities, med passes, specialists, and of course the most important is how the patient is feeling and moving today. If any of these things occur or go wrong, then your schedule is out the window for the rest of the day.

            The only good thing that will come out of this will be the end (hopefully) of stories about some therapists being given 800 minutes of treatment a day. Companies will run the risk of being fined for over production of therapy minutes, and a simple check of the employee hours versus therapy minutes delivered will suffice for enough proof.

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

Tim

Sometimes family members of some of my patients are so clueless it really makes me wonder what they are thinking. Some seem to think therapy is a magic bullet, and we can cure any problem. In the past, there have been a couple of real backward thinking people I've dealt with, but just recently there has been a couple people that have really made me scratch my head.

            Case one: the person is near comatose, follows no verbal directions, totally dependent for transfers, dressing, feeding, and personal hygiene. On eval, this person resisted even the simplest tasks. Yet the daughter wants to take this person home. She even asked the doctor to write orders for a second therapy eval about two weeks after the first which ended up with the same results. My thought is if she does take this person home that within a week she'll either be exhausted or have them back in the hospital.

            Case two: the person is late stage dementia, a recent fall at home ended with a hospitalization and a possible patella fracture. On eval this person resisted everything, scratched and swung at the therapists, and screamed out with just being touched. This person is totally dependent for hygiene, dressing, bathing and transfers. Again, the daughter thinks she can take this person home and take care of them even though she works a full time job and has her own medical issues. Do you have the same thought as I do? It will be just a matter of days before there is another incident.

            Why do families want to do this? Sometimes it almost seems like abuse, and I feel terrible that these people are going home to an environment that is probably unsafe and the needed equipment to properly care for the person is most likely unavailable. I cringe at stories heard on the news, like the one a few years ago of the lady who's son used to leave her on a mattress on the garage floor while he went to work for the day. She was left no food or water, was incontinent and had to lie in soiled briefs all day. Of course the days he decided to hang out with buddies after work she was left to wait longer for care. I'm so glad he got caught. Want to know what reason he gave for doing this? He needed the extra money from his mother's Social Security check to pay off his bills and child support so he couldn't afford someone to watch mom during the day. Did I mention that this was mom's house he was living in rent free?

            It's sad that money is the main motivation for trying to keep these people at home. I have run into several situations where I assume that is the case, the family was living with the parent or grandparent and didn't want to sign the house over to the state to enroll the person on Medicaid. Unfortunately that is the situation in both of the fore mentioned cases. These families are making poor medical decisions just to benefit themselves. I am sorry for some that this means losing a place to live and losing income, but the bottom line is proper care for the elderly. I know this is not what always happens, but situations like this sure seem to be coming up more frequently. The worst part is there seems to be no way of educating these families of the risk they put their relative in.

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

Tim

Probably one of the hardest things to learn as a therapist is writing progress notes. If you're involved in long term care, then you know these are a requirement from Medicare and insurance companies. Documentation of their patient's progress is normally required at specific time schedules.

            SOAP notes were the first type of documentation mentioned in school. Soap notes, I thought? Do we need to document on how well the patient can wash? All kidding aside, we soon learned what SOAP stands for, which is Subjective, Objective, Assessment, and Plan. This has always helped me organize thoughts when I write notes, even when writing a narrative note. Currently my documentation is all VIA computer where I work. We use a program that prompts you for all the basic patient information, and then has a small area for writing a narrative note underneath. This is a big help to stay current on notes.

            So we all know that notes are due weekly on your Part A Medicare patient, daily (or with each visit) on the Part B Medicare patient, and at various times by insurance companies for their patients. Sometimes notes can seem to come due quickly, and many times when I see a patient with a note due that day think "Didn't I just write their note?" And, after a long day of treating patients it's really hard to sit and write several notes. Since these notes are needed to justify the continuation of therapy, keeping current on them is important though.

            The notes themselves must show progress towards goals. The progress may be slight, but if the patient is making gains towards their stated goals then therapy is justified to continue. With my Fieldwork students I try to explain that each note must not only show progress, but their words must "paint a picture" of the patient so that a person who has never seen this patient can "see" what this patient is capable of by reading your note only.

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

Tim

            Actually there are lots of reasons. The people you meet and work with. Those unforgettable moments when a patient is able to complete a task for the first time. Those funny moments. And so many more.

            Working in OT you get to meet some of the nicest people. Sure, some of the people aren't so nice, and yes some can be pretty downright grumpy. But there's always the few who really have an impact on everyone. They are the one who is always motivated despite their handicap or illness. They are the ones who cheer on the rest of the patients. And they always have a smile on their face. Day after day.

            Some of the nicest people I've met have been during my years in OT. From travelling to seminars to the people I've worked side by side with, you can't ask for a better group of people to be associated with. I still remember my first supervisor as being one of the friendliest persons I've ever met who wasn't related to me.

            The patients you work with sometimes seem to be just going through the motions, some are trying but only partially, and then there are the ones who give 110%. Although they are far and few between, these memorable people make the day worthwhile. They are the ones who are in the gym first thing, and hang around even after the session is done. You might see them working in their room later, giving a few words of encouragement to one of the other patients, or alerting the nursing staff that another patient needs assistance. These are also the patients that you applaud as they reach every goal, small or large.

            Some of the times I remember most though are the funny happenings. There are the funny hysterical moments, and there are the "you had to be there" funny moments. Either brightens up a person's day. Funnier yet is it is usually the same people who are your super achievers that come up with some of the funniest things.

            Every day in OT is a bit different. Some can be boring, some can be hectic. Some days you'll remember more than others. One thing is for sure, the more days you spend in the field, the more memorable days you'll have.

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

Tim

            From the few polls I've seen, only 30-35% of all respondents support government healthcare reform. The majority of respondents oppose any form of government run healthcare insurance. The small numbers of supporters are very vocal, however, and if you do not support the changes this reform will bring then it's time to speak out.

            One major change of the proposed reform will be additional financial cuts to long term care facilities. At a time when every item in the nursing home is already selected for price instead of quality, what will our seniors be forced to give up next? The American Health Care Association/National Center for Assisted Living has initiated a Save Our Seniors (S.O.S.) campaign to fight these cuts. On their site you can send your congressional leaders an e-mail stating your opposition, find all sorts of information, find town hall meetings, and even invite your local representatives to tour your facility.

            DirectSupply also has its Washington Wire news post. On here they have an entire Health Care Reform Toolkit with so much information it took me a couple of days to scan it all.

            The proposed cuts will affect jobs in long term care. If anyone remembers the 1998 cuts imposed by PPS, there were some therapists who were forced to take up to a 50% salary reduction. Therapy basically shut down for two years until companies could figure out the new system.

             Unfortunately, some companies have figured out the new system too well and continue to financially drain Medicare.

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

Tim

            Well, here is Part Two of the typical day of mine. Sorry there were a few blogs between since I promised this as the next one when I wrote Part One. Issues that I thought were more important than one of my boring days got blogged about first though.

            The alarm rings and its back to the clinic after getting showered, dressed, breakfast and put together a lunch, then the short (thankfully) fifteen minute drive. Some days the elevator is quite slow and it might take another ten minutes to get from the bottom floor to the top floor. Walking the hall to the clinic usually gets one or two comments, updates or requests from staff, patients, or both.

            Once in the clinic, the day begins with logging in on the computer to check e-mails and minutes. Writing up my daily log sheet as I check minutes lets me know who to go see first if possible. By the time the log is done, minutes noted, e-mails answered, the patients begin to show up for Physical Therapy. Some days it's down the hall to complete some dressing, bathing or toileting tasks to get those people to therapy. Some days there are three or four in the gym right away, and more than the P.T. department can handle at once. I'll hang around the gym those days and begin treatment there with some exercise, transfer training, or other activity. On days that people have been seen in their room for ADL's, they will now be ready to come to the gym. I'll be in the gym soon after to begin therapy with the first group, who are now done with P.T. The morning usually consists of six to eight treatments, depending on the minutes each person needs.

            As the lunch hour nears, the people from downstairs begin to leave since their floor is served first. Patients from the rehab floor will hang around another half hour or so until their trays arrive. That makes it easy to get those few extra minutes in, but sure makes it hard to work on feeding at lunch time. By the time all the trays are out, I'm starving. It sure is hard to work on feeding when you're tummy is growling. Lunch sometimes consists of a sandwich in one hand, and the keyboard under the other. Some days it's one of the nearby fast food places, then back to the keyboard.

            After lunch, there are usually a few room visits to do and finish up a treatment with at least one or two of the morning people. When all the treatments are complete there are usually one or two issues to be dealt with, one of the needier residents always seems to be wanting something. Then its log the minutes, write the notes, and answer the new e-mails that have come since lunch. Using the computer makes these tasks a lot easier, unless there are server problems.

            So that is really not such a bad day. I find that most days are pretty similar; it's only the patient's that change.

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

Tim

           No I'm not thinking about the kind you might find at a restaurant covered with barbeque sauce. What I'm referring to today is a method that many people use to transfer patients. I have always detested the transferring people this way, and swear that some day I will take any person guilty of using it to the gym and hang them in the parallel bars.

            This transfer is completed with two people, one on either side of the patient. Each places an arm under the patients arm, up near the shoulder. Both people lift the patient using the arms as handles, basically supporting all their weight by the shoulder joint.

            If you study the anatomy of the shoulder joint, you'll find there is a large bundle of nerves located under the arm. Impingement of these nerves on a consistent basis can cause irreparable damage. If the joint itself is weak, perhaps from arthritis or history of CVA, the shoulder joint can become separated with this much force applied. With the shoulder joint being only as strong as the muscles surrounding it, the joint becomes unstable with weakness.

            Years ago I worked with a gentleman who had suffered from a stroke. His shoulder was already painful and subluxed. Transfers were his worst fear, as he had fallen several times. The staff at this facility was notorious for their chicken wing lifts, and I had already become a royal pain to them regarding his transfers. This is the facility where I originally deemed the punishment for using this type of transfer to be hung on the parallel bars by your armpits for five minutes. Every time I caught staff using this transfer method I got on my soapbox. Returning to the facility on Monday after the weekend I found his name on the list of residents sent out to the hospital. When I inquired why he was out, I wanted to scream when told that his shoulder had been dislocated during a transfer.

            Just the other day I came across a resident who is a bilateral AKA. Transferring this person has been occurring via the chicken wing lift. Thank goodness they have a strong upper body with no shoulder problems. However as they are capable of a sliding board transfer with just set up, this will be the new method. Period.

            I've always stayed with what my teachers taught me; before you apply anything to a patient try it out on your self. Having two co-workers lift you by the armpits hurts, believe me. No, actually I want you to try it for yourself and see.

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

Tim

         I know, kind of a sick topic for a blog, huh? However were you aware that Congress is currently discussing this topic as a part of the Health Care Reform bill? Yes it's true, now the government wants to tell us when we need to end our life and stop being a burden to Medicare funding.

            Here's an excerpt from a recent interview;

JANE STURM: Hazel Homer is over 105 now. But at 100 the doctor had said to her, I can't do anything more unless you have a pacemaker. I said, go for it. She said, go for it. But the arrhythmia specialist said, no, it's too old.

Her doctor said, I'm going to make an appointment, because a picture is worth a thousand words. And when the other arrhythmia specialist saw her, saw her joy of life and so on, he said, I'm going for it. So that was over five years ago. My question to you is, outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cutoff at a certain age?

OBAMA: Well, first of all, I want to meet your mom. And I want to find out what's she's eating.

OBAMA: But, look, the first thing for all of us to understand is  that we actually have some - some choices to make about how we want to deal with our own end-of-life care. And that's one of the things I think that we can all promote, and this is not a big government program. This is something that each of us individually can do, is to draft and sign a living will so that we're very clear with our doctors about how we want to approach the end of life.

I don't think that we can make judgments based on peoples' spirit. That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.

CHARLIE GIBSON: But the money may not have been there for her pacemaker or for your grandmother's hip replacement.

OBAMA: Well, and - and that's absolutely true. And end-of-life care is one of the most difficult sets of decisions that we're going to have to make.

Here's the full interview:

http://www.coloradohealthinsurancebrokers.com/politics/obama-health-reform-prime-time/

            To me it seems what President Obama is saying is "dealing with end of life issues will be the toughest thing we (Congress) will need to decide". As part of the new Health Care Reform bill being drafted, wording has been included with regulations that every person over the age of 65 must have a "counseling" session every five years to discuss ways to end your life sooner. This rule also applies to anyone who has cancer of any type, regardless of age.

            My thought on this is the fact that I know that the people making these rules are not subject to following them when they retire. They have a nice medical plan that pays 97% of all costs for the rest of their life. They'll be able to retire into a nice fancy facility, with the best of care for any medical problems they may suffer. Meanwhile our hardworking American seniors must sign their home and life savings over when they end up in long term care.                 

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

Tim

Well, I see that Congress has cut another $40 Billion out of Medicare funding. That is for 2010, and over the next ten years the cuts will total $556 Billion! It sure sounds to me like PPS II is here, and it's hitting just as the baby boomer generation just hitting the age of Medicare. Ouch!

            The worst impact this might cause, according to one report, is less funds available for home health. Why does this not make sense? Cut funding and reduce services that keep people in their own home, or force them to choose long term care where costs will be significantly higher.

            When people run out of Medicare funding and need to stay in long term care, they usually apply for Medicaid. With many states running tight budgets, there are going to be cuts in Medicaid. What happens when the states cut Medicaid? I know some medical practitioners who refuse to see certain insurance carriers because their reimbursement rate is so low the practitioner can't make a profit. If the Medicaid rate is cut to the point that a long term facility can't make a profit, they will be closing. Again just as more LTC rooms will be needed with the boomers coming.

            My final thought is that while Congress is trying to manage the budget while cutting costs on Medicare, education, and state funding, are they voting themselves another fat raise like they did after the budget cuts in 1997?

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

Tim

The alarm goes off so you roll over and get out of bed; it's time to head to work. This process, repeated five times per week or more, is the typical American employees' life. We work to earn the money we need to pay the bills we create when we are not working.

Our daily occupational roles vary as much as there are job titles, and I often think what would it be like to be a  doctor, truck driver, actor, or whatever else my mind wanders into. However, even within the same job title the role could be very different, such as a COTA working in a school versus a COTA working in a long term care facility. Anyway, I thought I would relate the story of a day in the life of a COTA in a long term care facility.

The story is one of my most horrendous days ever. A day when no one is ready, schedules fall apart, and anything that could go wrong does. On my next blog, I'll post a more typical day.

 In the door and straight to the paperwork drawer, fill in a daily log with my patient list for the day. Find the master minute log and figure out how many minutes each person needs. Log on the computer and check the e-mail in case there are any meetings, care conferences, incident reports or other changes on patient status. Then head up to the gym. On my list today I have fourteen patients to see for a total of 465 minutes, plus a care conference at lunch time.

My first scheduled person for an ADL is sick and refuses therapy today. I head to the next person to find out they are currently having an IV infusion for the next hour. My third and fourth person are now being served breakfast, so I head to my fifth person as they have a self feeding goal.

I find this person reclined in bed with their nose about touching the bedside table, trying to reach up for the food. It takes me five minutes until I finally find someone to assist me to reposition this person so they can eat. Three bites later, with two bites dripping down this person's gown, they announce they are full. Hands, face, chest and gown are sticky with jelly and syrup. This turns out to be a complete bed bath and dress. The person falls asleep several times, and I end up being in there for about twenty minutes more than I need to be but the job had to be finished.

I head back to the gym to find three of my patients there, so I begin with one then another, bouncing back and forth as I address their goals and set them up with activities. The third is still in PT, so I can catch them after that. Finishing with the first two I find that the other person has headed off to the beauty shop, but another has arrived in the gym so I begin with that person. I send our transporter to find another person, but no one else is available.

The morning is already half way over and I still have ten people to see. Both the transporter and I roam the halls for fifteen minutes without success. There are two of my afternoon people in the gym now though, so I head back to see if they are agreeable to seeing me when they are done with PT. One agrees, but the other is so short of breath they need to rest. Ten minutes later the one is done with PT and I begin their session. My hairdresser person returns, things are going better until the other person asks to use the restroom. Setting my hairdresser up on an activity we head off to the restroom to find that this person needs a total change. I spend about twenty five minutes with toileting, cleaning, and changing clothes with this person. Back at the gym, the hairdresser person has tired of waiting and went back to their room but another has arrived. I finish with one as I start the next. It's getting close to lunch time and there are still seven people to see and more time to get in with the hairdresser person.

One more arrives at the gym and begins their treatment, and by lunch I am down to having five people to see. Three of these are room treats, meaning the person is in isolation and will need to be seen one on one. One more is scheduled for shortly after lunch time, one of my regulars.

Now it's time to head to the care conference though, finishing up late with the last morning person means waiting until afterwards to eat lunch. The conference lasts forty minutes, way longer than most, as the family is split on a decision and asks many questions. With just twenty minutes left to eat lunch until my scheduled appointment, I head back to the gym to pick up my paperwork.

On the way, one of the nurses stops me asking how one of my patients transfers. This was an opportunity to get in a couple of minutes of therapy, as this was one who refused earlier. So I head to the room to find two nurse aides struggling to get this big guy into a wheelchair. I set things up and instruct the aides on how to assist. In the middle of the transfer one of the aides releases her grip. The guy plops into his chair bending forward enough to pop his colostomy bag all down my leg.

It takes me thirty minutes to get cleaned up and into new clothes, and I've lost my appetite but manage to choke down a banana on my way back to the gym. My appointment is there waiting "You're fifteen minutes late" he says "and I have a doctor appointment in thirty minutes." Twenty minutes into the session the driver comes to pick him up.

I spend the next three hours doing room treats, trying to find the hairdresser person between each room so I can complete those minutes. I also look for my other missing person. They are a social butterfly, spending time visiting in several rooms and attending all activities. Two of the room treats are in rooms so hot I am sweating profusely after each visit. One of the treats is actually easy, Oh No! It's almost four in the afternoon before I find both the hairdresser person and the social butterfly. In the gym we complete their sessions, then I head to the office.

Logging all the visits takes 10-15 minutes, adding the minutes to the book another ten. Then there are four progress notes to be written. Finishing those I open the e-mail again to see that there are three that need a response. After about an hour total in the office the day is finally done.

Then tomorrow's alarm goes off...........

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

Tim

           I've been sitting here on the side of my bed for ten minutes now. I really got to go. It must have taken me five minutes just to sit up. I've been so weak since my hip surgery and catching pneumonia. I really have to go, bad. I wonder what's taking the help so long to answer the light. Well, the portable commode is right here, I bet I could make it........

            I've been sitting here in my room for three hours now. I am bored. There's nothing decent to watch on TV. Is it lunch time soon? Or is it almost dinner time? Maybe I should get up and go look down the hallway and see if anyone is there, or will that darn noise start again when I do.......

            Lack of help, boredom, confusion. No, these aren't the only way falls happen. In any long term care facility you can probably find a thousand reasons why the residents fall. The sad part is when a fall results in injury or death. According to the Centers for Disease Control and Prevention (CDC) statistics, nationwide about 1,800 deaths occur yearly from a fall or injuries related to the fall. A typical nursing home with 100 beds reports 100 to 200 falls per year, but then some falls are go unreported. Serious injuries occur in 10-20% of these falls, with 2-6% of the falls causing fractures.

            Preventing falls seems like an impossible task. With the current restraint reduction guidelines, reduced staffing, and tight budgets, most homes are limited in what they can do. As much as restraints, when used appropriately, can benefit a specific population I never see the day when all homes are restraint free. In one facility (MR/DD) I worked, following the yearly survey twenty five residents were identified as possible restraint reduction candidates. Beginning with the best eight residents the restraints were removed and within the month all but one had fallen. Two of the falls involved serious injury, with one occurring because the resident got up to help the aide who was catching another of the residents that was falling. The aides ended up having to sit these eight together and constantly run from one person to the next to keep them safe. This job needed two or three aides alone, but was delegated to one aide, in addition to care of the remaining seven or eight other residents on the hall. The one who didn't fall, by the way, was sick all month.

            Making environmental changes can help reduce falls, however since major changes can be a big financial investment most homes must schedule these into a future budget. That won't help the resident now, as I found out during an assessment once. The resident was reported with a decreased ability to brush their teeth, now requiring set up daily. I found out that this resident had been recently "alarmed" (pressure sensitive seat alarm placed) due to numerous falls. Their only mode of transportation was a power scooter that barely fit in the bathroom door, and would not fit next to the sink due to the design of the counter. The only answer was a total remodel of the bathroom.

            As much as I joke about tying fifty helium balloons onto a person's belt to keep them from falling, falls are not a laughing matter. The only constant factor here is the population. We will always have the confused residents that can't remember they are unsafe to stand up and walk. Keeping these people safe will probably remain an unsolved problem for many years.

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

Tim

           Have you been at your job for a long time? Or have you been job hopping? No matter which one you are, do you feel that your position is secure?

            In today's market, jobs seem plentiful for therapists. Some of these jobs might be a position you don't want to take, but they are still out there. But then some of these jobs entail working for contractors, and their only security is usually a year to year contract with the facility. From experience I can tell you that I've started several different positions only to be let go three to six months later because the facility decided to switch to a new contractor. The funny side to this is when I was living in a small Indiana town I covered one facility for three different companies.

            Job security in the medical field in this day of economic failures seems to be holding its own. At least I haven't heard of any hospitals or nursing homes asking the government for a bailout. People don't plan to get sick or injured, we just happen to work with the unfortunate ones who need our help. When most of us need medical care, we seek it and worry about the cost later. The average American spends 5-10% of their annual income on medical care, but some people need to spend up to 25% of their income to cover health care costs.

            If the security of job availability was left up to me to decide, then at this time I think things seem fairly good out there. From the number of phone calls, cards, letters and e-mails I get there must be plenty of jobs around. And as much as it's always comforting to the mind to know if your current position ends there are more jobs out there, you just hope you won't have to resort to finding out how many really exist. I do, however, shy away from any offers where sign on bonuses and high salaries get mentioned right away. It makes me wonder if the facility is that bad or if the caseload is too difficult, that this is the only way they can lure a therapist in.

            So how's your job security today? Feel pretty useful and needed in your current position? Or is your company so big that anytime they feel like changing staff new people show up? Is the contract about to run out? With the many different factors that can affect a person's job security in today's world, it makes you wonder who's next.

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

Tim

           Do you ever have those patients that have an excuse for everything? Why they can't do this, why they can't do that. The ones who have more excuses than Fred Sammons has reachers?

            You probably know the type of person I'm talking about. They are usually the one who will say (the first week anyway) they are going to do everything therapy tells them so they can get better and go home. They might say that they are a hard worker and will do therapy all night in their room. Lots of them have stories about their high school or college athletic days, or their employment and how strong they were.

            And then when it comes to actually doing the therapy, you hear one excuse after another. My shoulder was injured in a car wreck years ago and it aches, I can't do that. My arthritis makes my joints stiff, I can't exercise them. My family doesn't want me to get home, why should I do that? I don't feel good today, can't we skip that? Alright, that's enough because you have probably heard these and many more in your days.

            Yes, these are usually the ones who need therapy the most. Many are so deconditioned that they don't have half the strength or endurance to dress, bathe or prepare meals. But they think they can go home.

            And I'm sure the ones like this who do return home then have an accident, have an excuse for that too.

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

Tim