Sue Paul COO,OTR/L has been the Chief Operating Officer of Baker Rehab Group since 2002. Ms. Paul has held certifications in geriatrics through the American Occupational Therapy Association and served as AOTA representative for the End of Life Practice Recommendations for the National Alzheimer’s Association in Washington D.C. She is the author of the Head, Hands, Heart Dementia Assessment System, which is a healthcare provider tool for assessing and treating persons with dementia.
Well here we are at the end of OT Month 2015 and we’ve had some great insights and lessons shared by some of our colleagues. But not everybody got the chance to share. Not only was April #OTTakeover Month, it was also annual compliance month, and let’s-install-a-new-electronic-medical-record-month, and spring break month… and a month filled with a ton of work and growth and “stepping up” at BRG. Our therapists have been pushed to the max this month so we’ve decided to spread the love out over the rest of the year. So watch your inbox and the Baker Beacon for additional nuggets of OT wisdom. It’s good stuff.
But since it is still technically OT Month, allow me to share with you my own recent “a-ha” lessons. I’ve been an OT for almost 25 years, which means I pretty much know what I know, and I know what I don’t know. But it turns out, what I thought I knew is really something I used to know, or maybe I still know, but I lump in with other things I know into a fuller body of knowledge. Such are the fruits of maturity and experience. However, it seems I’ve been neglecting to put into practice some key principles that are really important in the delivery of quality occupational therapy services. Even more eye-opening is that I learned these valuable lessons from a new grad.
I have been covering patient treatments for one of our younger, newer therapists while she is on vacation. I have been pleasantly assured by all of her patients that her skills and aptitude for home health OT is top notch… they all love her. The one thing that they each have mentioned to me, and that they really appreciate, is how she has been able to break down the parts of task into smaller components. By reviewing each step of a task, they are able to hone in on each weak link and work on corrective actions. I keep hearing the same feedback over and over, “She really breaks it down for me.”
In occupational therapy lingo, this is called task analysis. We spend a lot of time in OT school breaking down functional tasks into components that consider movement patterns, cognitive processes, and environmental and psychosocial elements. It’s OT 101.
When you’ve seen the same task performed hundreds of different ways over the course of 25 years, you tend to take a more macroscopic view of issues. Or you tend to assume that the problem is obvious to everyone, because you’ve seen it so many times before. I have been reminded lately how crucial it is to explain task analysis to our patients. I had forgotten how much they appreciate understanding our reasoning behind treatment approaches, even the most obvious detail, and how important it is to show them the weak link in a sequence. I may know what the problem is and how to fix it, but may not bother to break it down into smaller steps for the sake of better compliance and participation. I tell them to trust me. When did I become such a know-it-all?
So I’d like to thank Rachel Hensberger for her stellar contribution to the OT community and for reminding me how valuable our basic guiding principles are. She has done her patients, her profession, and her “boss” a great service. I am humbled and grateful.
Some of our occupational therapists are BRG employees. Some are independent contractors who run their own businesses. Regardless of their relationship to BRG, we need to celebrate their amazing contributions to the Occupational Therapy profession.
In years past, we’ve celebrated OT month with cupcakes or pins, but giving the therapists a little appreciation isn’t quite the same as giving them recognition. And what better way is there to recognize their skills, talents, and passions than giving them a platform on which to share them?
All through the month of April, we will be recognizing the occupational therapists affiliated with BRG by letting them tell you their views, opinions, strategies, and tips through our blog, The Baker Beacon. They will be the authors of topics from home modifications to dementia to stroke to driving. Tune into The Baker Beacon throughout the month of April for the latest installments, and don’t forget to follow us on Facebook for up to date postings.
“Excellence in Clinical Care” is one of those phrases we use all the time. It is Baker Rehab Group’s mantra. When John and I say “excellence”, we attach genuine passion to it, being careful not casually toss the word around like a meaningless ball of fluff.
But sometimes I think about the origin of rhetoric in organizations. Dilution of the mission statement and core values happens over time, especially when the owners repeatedly say the same popular buzz-phrase over and over again.
I recently read an article so profound I swooned, which isn’t normally the case from an organizational leadership publication. But the author tied together several themes of interest to me- philosophy, human behavior, and abstract concepts that are difficult to describe.
In his article Excellence: What is it? How to recognize it? How to Measure It?, Jim Sniechowski, PhD considers the value of excellence using three timeless metrics: truth, beauty, and goodness. He shares, “What I learned is that these three, along with the idea of unity, were called the Transcendentals because they transcend the limitations of place and time, and are rooted in being. They do not depend upon culture, religion, personal ideology and preference.”
Boom! I was hooked. Thanks to Plato and other deep thinkers, we have a way to describe that universal feeling of appreciation for something or someone regardless of societal influences. We have the collective definition of excellence.
But excellence is hard to measure. Sniechowski describes the external and internal forces of excellence. The external ones are easy to measure- they are the standards we use to measure someone against someone else. If you are faster, bigger, stronger, or smarter than someone else, that is easily measured. It is easy to prove claims that you “excel” compared to others. He writes, “The measure of excellence resides in surpassing someone and that makes excellence a social experience.”
But surely excellence is more than a shallow victory.
The internal driver of excellence comes from within. It is a self-generated desire to overcome a problem. It has nothing to do with how performance stacks against a competitor. This kind of motivation can lead to great discoveries and advancements.
But for something to be considered excellent, it really needs the balance of both external and internal measures. Do you know the empty feeling of achieving something that has little meaning to you? Do you also know the disappointing feeling of achieving something that has little value to others? The true measure of excellence lies somewhere in between.
The true measure of excellence is found in determining both the qualitative and the quantitative values in what we do as rehabilitation providers. The number-crunches and outcome-measures, “the qualitative”, are easy enough. The truth, beauty, and goodness of what we do are harder to put on paper.
I think Sniechowski defines them nicely:
“Truth (the intellectual dimension) is manifested as the rightness or exact coherence between intention and execution of the event;
Beauty (the aesthetic dimension) is the quality present in an event that gives intense pleasure or deep satisfaction to the mind from its meaningful design or pattern;
Goodness (the moral dimension) is the impact felt when witnessing mastery, i.e. conformance to a set of rules and obligations executed brilliantly.
Any moment of excellence will contain each of these dimensions as they interplay and weave together supporting and strengthening each other fusing into a unity of excellence regardless of the area of expression.”
As a therapist, you know when you’ve hit the mark on these things. You know when you’ve taught your patient well, when you’ve instructed a technique that enables him to put on his own shirt and the technique actually worked (truth). You also know the value in that smile that crosses your patient’s face the first time they walk across the room (beauty). You have helped your patients achieve goals they once thought impossible, and they got there by following the plan that you laid out and that you both executed together (goodness).
Just as putting excellence out into the world requires the balance of both internal and external drivers, the measure of excellence requires the awareness of both the measurer and the measuree. It is not for me to say exactly how driven you are to provide excellent care and whether you are motivated by a tugged heartstring or a hefty paycheck, but I will see the results in the truth, beauty, and goodness that comes out of everything you do.
We have the opportunity to be the Van Gogh’s and Einstein’s of our field. By aligning our passions and talents with the mechanical responsibilities of being occupational, physical, and speech therapists, we create a beautiful paradox…. we achieve excellence by helping others achieve theirs.
“We just can’t make your glasses any stronger.” To many individuals with low vision, this is a frequently heard statement from eye care professionals. It is estimated than one in four people over the age of 80 are affected by low vision. As the population ages and life expectancy increases, low vision has become the third leading cause of disability in older Americans. Most of us know someone whose life has been altered by severe vision loss. But few people know that there is something that can be done about it.
Low vision is defined as a visual impairment that cannot be corrected by eye glasses, medicine, or surgery that interferes with the ability to perform everyday activities. The most common conditions are macular degeneration, diabetic retinopathy, glaucoma, and vision loss from stroke.
People with severe vision loss have difficulty performing simple daily tasks that many of us take for granted. Reading medication bottles, writing checks, or setting the dials on the stove can be nearly impossible for someone with low vision, even with the use of corrective glasses.
While many of these conditions are irreversible, this does not have to mean a loss of independence or quality of life. If you are experiencing vision loss, the first step is to contact your eye care professional. An ophthalmologist can diagnose and treat eye disease and may prescribe medications or surgery to address vision related conditions. An optometrist can diagnose eye disorders and prescribe glasses, low vision devices, or vision therapy. It is important to find an eye care professional that specializes in low vision. Your doctor may then recommend that you receive additional low vision training through a vision rehabilitation teacher or an occupational therapist.
Why Occupational Therapy?
Occupational therapists are rehabilitation professionals who are uniquely trained to help clients achieve the highest level of independence despite disability or impairment. Many occupational therapists now have specialized training in low vision. A low vision occupational therapist (OT) can evaluate the home environment, provide treatment, and teach compensatory strategies so that the client can use their available vision. Recommendations may be made for assistive devices that can enable the person to remain in the home and perform daily activities independently. Low Vision OTs can also provide information on the many services and organizations available in the community. Because occupational therapy is a skilled rehabilitation service, these services are typically covered through Medicare and other third party payers.
Most seniors have a strong desire to remain independent in their own homes, even with declining vision. With the appropriate modifications, this is a viable option for many. Increasing lighting, contrast, and improving organizational strategies are a few simple things that may enable someone to remain independent at home. Training in orientation and mobility can allow individuals to remain active in the community as well.
When standard glasses are no longer an option, optical devices can provide the needed magnification so that an individual can continue reading. High powered magnifiers and electronic readers now are able to magnify print up to 20x the original size. Additional devices such as talking glucometers, color identifiers, and large button cell phones are also available to those with low vision. If vision loss has impacted you, remember that you are not alone and there are many options available to improve your quality of life.
“Obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.” - Michael Jordan
10 Simple Low Vision Tips:
Use full spectrum or natural daylight bulbs to reduce glare and imitate daylight
Remember to light up stairs, pathways, and walkways
Consider goose neck style lamps which are best for reading
Use a black felt tip pen on white paper when writing
Avoid too much pattern on placemats and tablecloths
Label buttons on appliances with bright stickers/raised dots
Label medication bottles with large bold letters on top
Color code household documents and papers
Ask you bank about large print checks
Consider audio books when reading is no longer an option
Mary Schwartz, OTR/L is a low vision occupational therapist with Baker Rehab Group in Frederick, Maryland and sees clients both in the home and within many local assisted living facilities.
One of the hardest things about being an Occupational Therapist (OT) is getting our patients to follow through with our recommendations. This includes home exercise programs, adaptive equipment recommendations, adaptive equipment recommendations, and anything else we ask our patients to do. It doesn’t matter how awesome our interventions are or how well we know how to improve a person’s function. If your client won’t follow through when you’re not around, then their progress will be limited. So take a look at the following recommendations and try them out next time you have trouble getting a patient to follow through with your recommended plan of care.
Don’t assume that your patient understands what you said/wrote. As health care practitioners, we are educated and knowledgeable. We know how to use fancy medical terminology to sound smart, and we know what happens when people don’t take care of themselves. We understand why exactly high blood pressure is bad. We know why holding onto towel bars for stability is a recipe for disaster. But just because we know doesn’t mean our patients do. Hopefully we’ve all heard the term “health literacy”. Health literacy is “the ability to read, understand, and act on health information” (Eaton, 2004). According to the American Occupational Therapy Association, as OTs, we should “provide health education that is understandable, accessible, and usable by consumers” (Barnekow-Pizur & Darragh, 2011). In fact, nearly half of all adults have inadequate health literacy, meaning that they cannot appropriately interpret health care information (Vanderhoff, 2003). What should we do? Provide home exercises in both written and picture form. Use plain language: instead of saying “shoulder flexion”, say “raise your arms up overhead”. Even better, use their wording. If your client knows what “arm raises” or “toe touches” are, then write that. When using the teachback method to check your patient’s comprehension, avoid asking “do you understand”?, as this can elicit embarrassment or anger if the patient is confused. Instead, say something like “I’m really bad at explaining things. Why don’t you show it to me so that I can see if I did okay?” This way, if your patient doesn’t understand your instructions, you’ve placed the blame on yourself, inviting them to request further explanation.
Make sure your goals are their goals. We’ve all done it. You spend a few therapy visits working to improve a person’s independence in dressing (bathing, meal prep, etc) without much progress or follow through, only to find out that your patient doesn’t really care if they can dress themselves. It seems important to us. Why would anyone not want to dress themselves? Maybe because they live with an adult child who dresses their aging parent as an act of love and respect. And maybe that adult caregiver would prefer you focus your therapeutic efforts on improving their parent’s bed mobility in order to give the caregiver’s aching back a rest. Whatever the reason, we have to be sure we’re all on the same page. Our clients and caregivers are much more likely to do their exercises or purchase the recommended adaptive equipment if it helps them achieve their goals.
Give it meaning. Your clients need to understand how your specific interventions will help them reach their goals. For example, when I see someone who is having difficulty with upper body dressing I always look at their shoulder internal rotation, which is frequently limited. Home exercise program time! But telling a person to lean forward in their chair and try to touch the back of their belt, then repeat 10 times, twice a day, may seem silly to them. So be sure you explain that it will help make putting on jackets and button down shirts easier for them. Our clients will be more willing to complete their home exercises if they understand that those exercises were chosen specifically to meet their needs, rather than just “busy work”.
Barnekow-Pizur, K., & Darragh, A. (2011). AOTA’s societal statement on health literacy. The American Journal of Occupational Therapy,65(6), S78-S79. doi: 10.5014/ajot.2011.65S78
Eaton, J. A. (2004). Low health literacy seen impacting costs, compliance, outcomes. Physicians Financial News, 22(1), 1.
Vanderhoff, M. (2003). Patient education and health literacy. PT: Magazine of physical therapy, 13(9), 42-46.