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I must disagree with this premise

  •  11-16-2007, 4:15 PM

    I must disagree with this premise

    I have been an OTR 12 years now, and I have had some real problems with the use of COTA's, as currently seen in most adult and geriatric facilities. The problems include: 1. The lack of sound education in cognitive, neuro-rehab,  and mental health components of Occupational Therapy 2. The desire by facilities for extensive billable minutes of treatment, which often precludes the cota from doing extensive one-on-one treatment.

    1. It has been my experience that about 75% of the cota's that I have worked with over the years have not been able  to follow through on some of the non-adl type goals that were written. For example, in my current facility, I recently had a patient who is having a hard time coping because of some personal and health issues, I provided a 'coping survey' handout to the cota and wanted him to do some quiet treatment with this resident.  The cota  just didn't 'get it', and this was never done. On another occassion, I wanted a different cota to have a resident use the computer for fine motor, eye-hand coordination, and self-esteem, as he is a young man who was fully employed until the cva, and he used the computer a lot. She inferred that she would not want to do this, and so it was never attempted. With some cotas, there is no comfort level in cognitive tasks, neuro treatment, mental health issues like self-esteem/ coping, etc.

    2. Due to the need for 'billable minutes' many cotas are content to do table-top activites that seem silly or irrelevant to the person. They do theraband or 'rep' type of treatment, that is really PT,  because these activites can be done with several at a time and the patients are dovetailed into therapy. The PT works on the legs and the OT works on the arms...which is how most people view therapy. This is less of a cota issue than it is a facility issue, but the use of cotas has diminished the real aspect of OT regarding treatment provided.

    There is a need to better educate cotas regarding the 'holistic' aspect of OTand I would like to see the use of cotas limited to no more than 75% of any resident's total weekly treatment. But, this will never happen. ST does not have this issue as they do not use assistants. If the person who posted this wants to get the education and become an OTR, that is great. We need more therapists who can promote the profession and think 'out of the box'.

    Tim Mancino, OTR/L 

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