This is a very true statement.  I don't know if there is a clear solution to this problem.  I did what I needed to do to keep my license and to keep myself ethically sound in this profession.  I no longer work in nursing homes where this fraud occurs.  It happens alot in many, many different types of facillities.  I work ...

Is the limited flexion in one arm or both arms?  

I am a COTA and work home health in the state of Ohio.  My OTR'S do not do supervised visits but I am in contact with them by phone several times a week to keep them updated on pts. and to discuss d/c plans.  I have over 12 yrs. experience as well so my OTR's are comfortable with my daily treatments.  Not all states allow assistants ...

I have also worked in facilities where this very same situation has occurred.  After too many of these incidents,  I decided to change my response to this action.  I would double-check my orders from my OTR and see where or not toileting tasks/tf's were apart of my POC.  If they were, then I would take advantage of this ...