My perspective on mandates encompasses more than legislation or rules that are written to support or ''clarify'' (as if!) legislation. I think of mandates as being decrees made by powerful systems trying to bring some semblance of order to chaos. As a case manager, I'm often involved in the efforts to keep chaos at bay. As an Occupational ...

As a case manager, I draw on resources wherever I can find them. The trouble is, many resources lie with people who have been too conditioned by the constraints of mandates to see new opportunities. Here's an example in which Medicare ''habituation'' created problems. ''Martha'', one of the injured workers for whom I was the disability case ...

Despite some good experiences, I believe there are significant flaws in mandates. The concept has merit, but the applications are a different story. Mandates can have unintended negative consequences. Efforts to comply with mandates can lead to cookie-cutter, one-size-fits-all approaches. Such approaches can create attitudes of entitlement for ...

The specialty OT practice of case management has different constraints than ''traditional'' OT practices. Those differences can free up thinking about how and where OT services belong. The case example I introduced in the previous blog entry occurred several years ago. But just last month, an article1about new considerations for OT practice in ...

One of the most interesting cases of my practice as a disability case manager (DCM) provides an example of how a mandate for OT services proved valuable. My client was an 18-year old I'll call MB. MB survived a traumatic brain injury (TBI) at the hands of a rival gang member. I was asked to help MB with his goal of getting a job. MB was living ...

  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. ...

  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. ...

  Changes in Medicare funding for skilled nursing facilities happened just a few days ago on October 1st. 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 ...

           News from some of the town hall meetings that have been happening around the country reminds me of the Vietnam War protests of the late 60's. Large organized groups of people protesting issues with proposed government actions. There were protesters carrying signs with defaced pictures of ...

         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 ...