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

           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

          You've just got to love the residents of any long term facility. From their easy going pace to their outlook on life, most of them are just making the best of each and every day. Of course, there are always the few people who are more memorable. These are the few residents that you'll always remember long after their time. These are the ones who always had a funny joke, asked those off the wall questions, or had a certain skill that made them stand out.

            Then there are the ones who think they are spending a vacation in the finest hotel. With all the services available anyone might think they are on vacation. Let's see, there's meals brought to your room, someone to make your bed, help dress, bathe and toilet you, a nurse to bring your medicine, activities to attend, and even an exercise class.

            With all of this service, a person might wonder what more can one ask for. There are a few things that I often hear of residents asking for, but some residents have requested a strange item or two at times. Yes, there is always the tissue issue. The tissues often distributed for the residents are usually not very pleasing to the nose. Of course the other bathroom tissue item is often referred to as feeling like sandpaper on your derriere.  But one resident stopped me the other day and asked if I was going past the kitchen. "Yes" I responded. "Good" he says, "Tell the chef I want a pork chop, no gravy, fried potatoes, and some fruit for dinner."

            I don't think I was wearing my suit and bow tie that day!

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

Tim

          When so many tasks pile up that require more time than a person has, setting a goal to complete them takes dedication and determination. I guess this would be the same thing for someone recovering from an illness; recovery is the goal, which takes determination and hard work to complete. Completing such goals bring about a sense of accomplishment for a person, knowing they succeeded in whatever they set out to do. This is good for one's ego too.

            I really can't say that my tasks have prevailed over my time lately, just that my time has been split into too many projects at once. Sometimes I feel like I've bitten off more than I can chew, if you know the old saying. I'm sure just like many of you, between work, children, home, family stuff, and any other volunteering or community meetings life can really get busy. Take on a few more projects and soon you can't find time to get done all the things that need to be done, and there's no time for you. A simple solution is to quit some of the things you are involved with, but that's the easy way out. Reorganizing your time schedule might help get more done. Recruiting help for some tasks you don't need to handle personally is another way to maintain a schedule.

            I really got thinking about my personal projects lately, and all the things that needed to get completed, wondering when and how it was going to get done. There was the homework from class, the project report, the home visits, work, home, car repairs and more. A couple of scheduled trips that cut further into my time available didn't help either. And it made me think about a person recovering from an illness. Maybe one of your typical OT patients. They have goals to accomplish, and one by one they get things done. Through determination, hard work, and time things get done.

Yes, a person can take the easy way out and just give up on some goals, never accomplishing what it was they set out to conquer. But then, the human ego doesn't accept disappointment very well does it?

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

Tim

            The consultant team consists of nurses who have been trained in MDS applications and projections. There are no therapists on this team, and to my knowledge not one member has been a therapist in the past. Their primary job is to review progress and rehab team meeting notes, including e-mails between the MDS team and therapy staff, then recommend therapy goals to increase company profits. Or in my words "grab as many dollars from Medicare as they can figure out how to".  Now I realize that making a profit is a necessity of business or else the business will close. A profit I can agree with, but ethically I can not agree with the use of the therapy team as a money making machine. As a therapy team, we strive to deliver services that are appropriate for each patient and discuss as a team the best plan for each patient when that person has reached their potential.

            The real concern here is the consultants' recommendations have included continuing therapy with some people who have reached their maximum potential. They have also recommended initiating therapy with some people who are not appropriate. It seems like they are reading between the lines on the evals, progress notes, screens, and other correspondence, and then recommend therapy goals in an effort to gain additional minutes. One such instance is the person who has severe dementia but can dress and bathe independently and safely with just verbal cues to initiate. This person was evaluated for their cognitive retention skills, which is documented to prove that information presented is forgotten in less than one minute. With this short of a memory span it is very unlikely that any new information will be retained, such as initiating self dressing and bathing on a daily basis. Additionally, as dementia is a progressive disease, the retention of any new information will only decrease even further in the future. The consultants' suggestion was to provide this person with therapy in order to have them initiate ADL's on a daily basis. HUH??!!?? As I said, their reading of evals and notes seem to be quite patchy, only finding information they want to in order to "suggest" therapy goals.

            This leads to another ethical issue I struggle with. Who is appropriate to recommend therapy goals? Well, when it's my license on the line the only answer I'll give you is my supervising OTR. Risking the loss of my therapy license jeopardizes my career and livelihood, and there is no way I'm allowing that to happen. Nurses, consultants and/or family members do not have the education required to establish therapy goals.

            One other issue with the consultants' presence is that we have spent so much time answering their questions that we have lost minutes with a few patients. Why does this seem like an oxymoron? They are there to maximize minutes yet deter us from doing our jobs.

            My final thought on this is my definition of the word consultant - A person who is designated to find someone else more work, despite the fact that they lack the knowledge base to do so, and while ignoring all ethical principles increase company profits so they can validate their hefty salary.

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

Tim

            As a therapist, one of the most rewarding parts of my job is when I see a patient overcome their deficits and is able to return home. Unfortunately, some people don't succeed and end up remaining in long term care. Worse yet are the people who are only able to re-gain some of their abilities, then return home in a less than safe environment.

            There are some patients that you just know are going to be alright after they return home following rehab. They are motivated, able to complete necessary tasks safely, and understand precautions. These are the patients that make therapy fun, easy, and rewarding.

            It's always sad to see some people who really try, but are unable to complete certain tasks. Whether physical or mental limitations hold them back, you can just tell they are giving it their all but it's not enough. Along the same thought are the ones who would be safe at home with a little family support, but it's not available. These people make up our long term population.

            One of my worst fears though, are the people who you know will be a safety risk if they return home. At times it's a family decision, sometimes it's a financial situation, but then there are the ones who you just know will not be safe to go home. Despite all the warnings, advice and recommendations they go home anyway. In the past few weeks, we have had a couple of these discharges from the facility where I work. I expect that they will return before long, or end up at another facility soon. Hopefully not for the reason that they have an accident, but realize that life at home is tougher than they thought. Yes, being in a facility where you have your food brought to you, your bed made, and someone to help dress and bathe you makes life easy. Doing all of these things by yourself though is tough, in addition to the many other things that need to be done around a home. There are too many stories in the news these days about these kinds of events, and less is better in this case.

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

Tim

            Well, I hate to say this but it looks like the COTA title is going to hang around for a bit longer. I believe that Motion 3, as presented by the AOTA Representative Assembly, is going to die before it gets started due to lack of interest. Further issues stated that will help defeat this motion include the financial expense of the change and general opposition of many OTR's.

            On the OT Connections page where people were allowed to leave a written post on their feelings about this issue and others, only three entries were posted regarding the COTA title change. The worst part is that all three entries were left by OTR's, not one COTA spoke up with their thoughts on this issue.

            From all the responses left on my two blogs regarding the title name change I was sure that many COTA's would head to the OT Connections page and leave a thought. Unfortunately I'm just as guilty. No excuses given, but just like all of us just too busy trying to make a living and balance family matters.

            Anyway, the Representative Assembly is now in meetings discussing all the Motions presented. March 25 was the last day any posts left on the OT Connections page would be read and considered.

            My only other thought here is this: Why did our state organizations not inform their members of the upcoming actions of the RA? My inbox is always getting e-mails regarding job offers, seminar dates and the like from the state board. These are things I never signed up to receive, and really don't want. However, knowing they have my e-mail address (again, which I never supplied to them) why oh why don't they forward some of this important info? I hope your dues money isn't buying someone nice trips or cars instead of addressing issues that are important. Further, I wonder if the state organizations are receiving compensation for supplying our e-mail addresses to prospective employers and/or seminar educators.

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

Tim

            One of the best things about working with so many different people is that you occasionally hear some good stories. Working with the senior population you may hear stories about the Great Depression, WWII, the first telephones, and more. Of course there are the personal stories too, but my ear is always open for a funny joke or saying. Sometimes it's not just a straight joke either; things done or said in the proper context can be just as funny.

            Over the years I've heard almost all of the stories, from the war stories to the personal tragedies to the family histories. All the stories are interesting, but I still like a good laugh best. I've had quite a few jokesters through the years, but here are a few memorable ones.

            Just recently there was a gentleman who came through our department.  He loved to tell jokes, or should I say joke. He could really deliver a punch line but the only problem is he told the same joke every time. Some days it was 5-10 times during the session, repeating the same joke over and over like he's never told it to me before. One day I told him one of my corny jokes, and that became his joke for the next few days.  He told it over and over to whoever would listen. Sorry to all my co-workers for that, but at least it was a new joke!

            One of the best was the 101 year old female who played possum on me one day. I had just passed her room and glanced in to see her sitting up in her favorite chair reading the morning paper, as usual. She must have noticed me too, because it was her scheduled time for therapy. Returning to her room just a minute or so later I entered to see her slumped over in her chair, the newspaper falling off her lap to the floor. After my initial shock I spun around to go for help and heard a snicker. Turning back around there she was sitting up with the biggest grin on her face. When she was sure I had seen her she busted out into a good laugh, saying "I got you, I got you!!"

            Then there was the 94 year old female that arrived in the department for her first Physical Therapy session. She walked in slowly pushing her walker, and was asked to have a seat on the chair next to the bed. She stopped and glanced back and forth at both the bed and the chair several times then stated "Oh, I thought I'd get laid for this." No one in the room could stop from snickering, including a few of the patients.

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

Tim

This topic has received numerous responses in my last two blog posts. Many of you have expressed a desire to have the COTA name changed for one reason or another. Well, have I got some big news for you today.

I just attended a seminar yesterday (3-13-09) and learned that AOTA's Representative Assembly is currently in discussion about the COTA title name change. If you care to offer any input on this subject, you'll need to do so by March 25, 2009. At that time, the RA plans to prepare a document to present to the entire assembly in order to determine if this matter should receive further discussion by the board.

To give your input on this, you should contact your state representative to the AOTA. Or, IF you are an AOTA member you can head to the AOTA website (http://www.aota.org/) and view the Representative Assembly motions currently being discussed. If you are not an AOTA member, then you can head to the OTConnections blog page where you can leave a post on any of the motions currently in discussion.

So, all of you who have expressed a desire to have the COTA title changed, here's your opportunity. As of today there are only three posts, and it looks like all three are opposed to the change. Time to speak up COTA's!

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

Tim

When you look over the first paperwork on a new patient, do you automatically focus on their deficits? After all, isn't that what we're supposed to do? Find a problem and then fix it, right?

Well, I guess that is true, but after you note all the deficits and consider them, are there any abilities to focus on? I'll admit, these abilities can be difficult to see on a bunch of admit paperwork, but hopefully easier to find once you meet the person.

We recently had a new admit at our LTC, and the hospital paperwork arrived one day prior. We all grimaced as we read the list of diagnoses. The list was long, ranging from cardiac problems, dementia, hypertension, old fractures, 95 years old, and a recent fall sustaining a hip fracture with a total replacement. We all began to think one thing, long term care resident coming up! Of course, our deduction was just from reading paperwork.

That is, until this patient arrived. Beginning treatments the next day we all wondered how far we could push this person. But despite the long list of problems, this is just one happy and determined person. During therapy in the gym, this person loves to sing to us and chats with all the other patients. To our surprise, they have progressed very well through therapy.

I definitely learned from this patient that having the attitude and determination to "get better" will overcome all the challenges anyone is faced with. I read the paperwork and thought deficits; I met the person and found abilities.

Until next time, hope all your thoughts are good-

                                                                           Tim

Here's a quick question that came up this past week. Maybe this is something that few ever think about, but it was one that really made me think. I'm not sure if there are any specific regulations covering this issue, but maybe there should be.

 Anyway, a new Part B person was evaluated by therapy on a Wednesday.  The orders were written for treatments three times per week. In order to capture a RUG score, MDS wanted this person treated Wednesday, Thursday and Friday of that week. This was fine, as the order allowed for three treatments for that week. However, they also wanted this person seen for treatments the following week on Monday and Tuesday. This is where the question comes up.

For this person, when does a week start and end? Is there a designation of a Sunday to Saturday week? Or would you establish their week as normally done with a Part A person, day one is always the day of eval and the days begin counting from there. In other words, for a Part A person if the eval occurred on a Wednesday, then day 7 (or the completion of week 1) would be the next week Tuesday, correct? If this same "formula" is applied to the Part B person, then seeing them on the following Monday and Tuesday would be five treatments in the same week by my deduction. But is there a difference in how the weeks are established for Part A and Part B patients?

Yes, I have run into this problem before. It is solved by simply discussing the treatment plan with the MDS office prior to writing the treatment orders. If a RUG level can be captured by obtaining five consecutive treatments then the order can be written for five times the first week, then decrease to three times the following week(s). 

My real problem with this is that the evaluating therapist didn't think this person could tolerate therapy five days a week, therefore the order for three times a week. And even though the weekend was in there to allow this person to rest for two days between these five consecutive treatments, that left a gap of at least five days where they would only receive one more treatment. Makes me wonder if any gains the person made in week one would be lost during the scheduling gap in week two.

Until next time, hope all your thoughts are good-

Tim

Technology has really made it so easy to find what we want, when we want. Having the ability to log on, do a bit of reading/study, take a test, and then print out a certificate is the only way to go when you find yourself in a pinch for a few credit hours.

I've also found that a few of the on-line providers have required courses at a very good price. For instance, here in Ohio we need to complete an Ethics course every two years. On-line it's less than ten bucks, locally (when it's offered) has run from twenty five and up. Just for the savings alone doing this course on-line is only way to go.

Since money is tight these days, the savings of doing courses on-line can be one of the best benefits. Even if a live course is fairly inexpensive, consider how much you could spend on food, fuel and hotel costs. These costs can outweigh the savings of a cheap course.

Now I don't intend for you to do all your required CEU's on-line, because just the ability to mingle with your peers at a live course is one of the best ways to hear and learn what others are doing out there in the OT world. But, when you're just three days away from renewal and are short CEU's.........

Until next time, hope all your thoughts are good-

Tim

The main question I keep hearing about is PPS and RUG minutes. Every student I've talked to is concerned as to why they have not received some education about these topics in school. Which is a good question, but here are my thoughts on this.

First, PPS and RUG's are specific things used mainly in Long Term Care facilities only. If an OTA is planning a career in the school system, why would they need this information? By the same token, in schools there are IEP's (student reports) that need to be completed by the therapists on a routine basis. Again, for a therapist planning to work LTC this education would be wasted time. Does this start to make sense? Not every subject can be covered in school in the length of time given, especially items specific to one area only.

Secondly, remember that school is just the groundwork for the rest of your career. If we had to learn everything in school that we would need to deal with our entire career, we might have to go to school for 10 or more years. This is why there are continuing education requirements. We learn by doing, observing experienced therapists, and by further education specific to our choice of career paths.

Third and last, this is the reason why we do Fieldwork before we just head out to work. Not only to explore all that OT has to offer, but to see where we fit in and the population we will enjoy working with. For some this may be a natural, if you enjoy working with children you might try to secure a position in a pediatric facility. For those who love to work with senior citizens we would naturally head to a LTC facility. Each career choice will have specific "extras" that we will need to learn. When I left LTC to work in Hands for a while, there were lots of new things I had to learn even though I had been a COTA for 15+ years. Again, I knew the basics (from schooling), but had to learn specifics.

Since we are all human and have different knowledge and strengths, we all have different things to offer to our patients. Finding the correct path can be difficult for some, but if you keep your mind open, give what you can, and continue learning, the world of OT will only get better for all.

Until next time, hope all your thoughts are good

Tim

The key wording in this report is that "the employees" were meeting the new standards. They were working harder to make a bigger profit for the company. However, nowhere in this report did it mention that the employees were receiving any kind of raise or bonus. Just the one person sitting at the top of the ladder is going to profit. Of course, I'm sure the stockholders of this company will also see an increase on the value of their shareholdings. The employees? Well, they get to keep their job.

Again, I have to say I'm sick of hearing how much many CEO's make. Anyone could sit in a big office and demand better productivity out of their workers, show an increase in yearly profit, and then have the nerve to say it was all their doing. Back in 1980, the average CEO was making 40 times what the average worker in the company was earning. Today, a typical CEO makes 500 times what the average worker of the company makes! 500 times! That means that a CEO can make more in one year than the average employee, their children, their grandchildren and their great grandchildren will make in their entire lifetime.

Figuring our U.S. rate of inflation, which since 2000 has risen a whopping 26.08%, even the average employee is almost losing ground. The average workers raise during the same years has only increased 27.01%. A CEO's increase during the same years skyrocketed 535%.  In real money terms, if you were employed in 1980 making an average hourly wage of $15.87 per hour and your wage had been adjusted at the same rate as a CEO, today you would be earning more than $200,000. Do you think you could live on that?

If you're interested in what CEO's of top companies earn, follow this link to the AFL-CIO's Executive Paywatch Database.

Until next time, hope all your thoughts are good-

Tim