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Archive for category: Occupational Therapy At Work

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OT for Obesity

There is significant media surrounding obesity, and the general impression is that being overweight is a “choice”.  However, in many cases obesity may be caused by other factors including a medical condition or injury, genetics, mental illness or disability.   While the societal focus has been on helping people to lose excess weight (through programs, even gimmicks, and reality shows), there is another lingering problem.  Living with obesity can make routine tasks difficult, and can make daily living a struggle.  Mary Forhan, an Occupational Therapist from Edmonton, has worked with many obese individuals over the years and is now dedicating her focus to helping these and other patients struggling with obesity live their lives to the fullest. The following article from the Edmonton Journal discusses how Occupational Therapy can help.

The Edmonton Journal: Edmonton lands obesity expert in occupational therapy

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Senior Safety Week

This past week has been dedicated to National Seniors Safety awareness in Canada and this year’s focus is on drug safety for seniors. It’s no secret that our aging population relies on a great amount of over the counter and prescription drugs for many ailments and conditions. With so many pills and vitamins in the daily regimen, it’s important to ensure you or whomever you may take care of is taking these properly and as directed.  The following article from Canada’s Safety Council discusses great drug safety tips for seniors and caregivers.  

Canada Safety Council: Senior Safety Week

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How is Ordering a Wheelchair the “Cost of Doing Business”?

The new wave in insurance denials (from assessors and adjusters) is that planning and communication time is “the cost of doing business”.  Huh?  Until you spend a day with me, at my desk, in my car, on my phone, and in my client visits, how do you know my “business”?  I can tell you that it goes like this:  for every hour I spend with a client, I spend an equal hour doing the follow-up that came from the visit in the first place.  And for CAT files, make that two hours.  What am I doing in that time?  I am calling vendors to source equipment, trying to get the best price, best client service, and the most appropriate devices.  I am researching practical and inexpensive solutions on the internet.  I am calling other team members to discuss functional issues, and to ensure collaborative but not duplicated service.  I am arranging attendant care as if they need attendant care, they often need someone to coordinate it.  I am trying to obtain funding approval from the insurer, or trying to save the client’s rehabilitation dollars by hooking them up with public services.  I am receiving calls from my client to tell me the cast came off, that the new medication is helping, and that they are trying to use the cognitive strategies we discussed.  I am reminding them of the things I am waiting on, or sourcing for them, or the calls that have not been returned.

Sound like case management?  It is not, it is OT and those services are necessary for the provision of our therapy.  And believe me, calling to get quotes on devices is a lot cheaper than driving to the client each time to meet with a different vendor.  “Planning and communication time” actually saves money.

But what is concerning, and also comical, is that the people who are telling us what “is the cost of doing business” are getting paid the entire time.  The adjuster that denies planning time and spends 30 minutes on the phone arguing with us is getting paid.  We are not.  Or, the examination OT that got paid to review our plan and cut us off from a few treatment hours.  When was the last time that OT actually treated a client anyway?

I have had two epic conversations with adjusters that drive this point home.  In one case, the adjuster and I got off topic and started chatting about housing.  After 30 minutes he said “are you charging me for this phone call”?  I responded with “first of all, I don’t charge you, I charge my client, and no, I am not going to charge my client because you kept me on the phone for 30 minutes”.  I then said, “but you are getting paid to talk to me, right?”  He said “well I make less than you”.  My response was “not in the last 30 minutes”.  He laughed.  The other conversation was even more interesting.  An adjuster was going to arrange for an assessment to question our kilometer costs (which had been approved on the file for the last three years but she was covering the desk due to a vacation).  Again I spent 30 minutes on the phone explaining that this has never been challenged.  I did the math and she was disputing $4.80.  I asked her if she was seriously going to arrange for a $1500 assessment to question $4.80?  Apparently she was.  So I said “don’t worry about it then, I will eat the $4.80”.  I wonder if her employer knew that they paid her probably an hour of salary to save them $4.80.  Ridiculous.

But the biggest thing insurers and assessors need to remember is that the CLIENT has approved that time and those costs.  We are required to review our plans with those we are treating, and to get their signature and authorization.  We explain to people that often we spend significant time behind the scenes getting the job done.  They understand this and approve those expenses as “necessary” for their treatment.  Then, we demonstrate this to be the case as we remain in contact with them and are very proactive at helping them to function better – directly and indirectly.  Honestly, the nickel and diming is ultimately costing the industry more, and reducing the quality of care received by injured people.

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Occupation Is: Sexuality

Don’t worry, this post is rated G.

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So far this month we have slept, gotten out of bed, completed our morning routine, had something to eat, been productive, managed our finances and our home. That’s it, right? Well, not exactly. There is one final piece of “living” that I feel compelled to include.

Sexuality is an incredibly important part of being human. Yet, when we are injured, ill, or suffering from physical, cognitive, emotional or behavioral difficulties, this too can suffer. Many of my clients report a reduced libido, erectile dysfunction, have significant physical barriers to intimacy, or issues with body image post-surgery, amputation, or after gaining weight from inactivity. With lack of sleep, medication side-effects, low mood, and hormonal changes post-trauma, being able to achieve or enjoy intimacy is not always easy.

Believe it or not, but part of Occupational Therapy training includes the occupation of sexual activity. I remember it clearly: I was in my last year of OT school and one of the owners of Come as You Are in Toronto (http://www.comeasyouare.com/) was invited to run a lecture on adapted sexuality. When the topic and scope were announced that day, to my surprise, half of the students left before the lecture even started. I suppose not every student was willing to be as open about, and versed in, this sensitive topic. However, I personally found the session extremely helpful. The class openly discussed why sexuality is so important as an occupation, how as future therapists we could be open with clients about this topic without breaking professional boundaries, we reviewed adaptive sexual aids, and also talked about how certain diagnoses impact sexual abilities and how creative positioning can facilitate participation.

Recently, I had a client with a spinal cord injury attend a session at Lyndhurst on sexuality and intimacy. She found the session extremely helpful. The session was hosted by two OT’s and some spinal cord injury survivors. During the session, the OT’s demonstrated how they have been able to creatively adapt different sexual tools so they could be used by people with physical limitations to participation. Other topics around the psychology of intimacy and positioning were also covered, and my client found the session extremely helpful. I also am aware of the information on both sexuality and fertility for people with spinal cord injury at SCI-U (http://www.sci-u.ca/take-a-course/). Of course, this topic stretches far beyond just spinal cord injury, and every diagnosis and problem to sexual participation needs to be treated uniquely. Also, while OT’s can address barriers to sexual activity from a functional perspective, often medical and psychological intervention is also needed to help people return to their previous “normal”.

So, if you have issues with sexuality after an injury or illness, know that OT’s can help with this too. After all, we consider sexuality to be an important occupation.

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Occupation Is: Managing a Household

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

Let’s just assume that we have done all the important stuff.  We have slept, are out of bed, groomed, dressed, fed, are done being productive, and did some fun stuff in between.  Eventually, like it or not, we need to tackle the not-fun stuff.

The interesting thing about “not-fun stuff” is that everyone defines this so differently.  Each of us has our own unique interests, abilities, and standards when it comes to groceries, laundry, cleaning and managing our yard and property.  Personally, I loathe grocery shopping (and anything that is meal preparation) and would rather cut the lawn then use a vacuum.  My kids do their own laundry as of age 10 because it has a wonderful built in consequence.  No laundry = no clothes to wear and I don’t need to say a thing.  Besides, I don’t think asking them to start doing this at 16 will go as well.  With six of us in our house, and two animals, the meal responsibilities, cleaning, and shopping tasks are time consuming.  However, all off these things are another layer in my lasagna of “occupations”.

Imagine you are in a car accident and spend a few weeks in hospital.  Your spouse, friend, mother, brother, someone, has to swoop in and help with your children, pets or house.  Eventually you come home and find that things have not been done to your standards, if done at all, and it will be months before you will have the ability to get back to these tasks independently.  The look of your home and property is stressful for you, the meals are different, and you are home all day to notice.  Or maybe you weren’t in a car accident, but have a progressive illness or medical condition that renders you to be no longer able to complete heavier tasks, but you try diligently to manage the smaller tasks within your abilities but this too is now declining.   Perhaps you have sustained a brain injury and your memory is lacking for when things were last accomplished, or when you try to go to the store you end up missing half of the items on your list, if you even take one.  Or worse, the store is an overwhelming place for you considering the visual and auditory stressors from any busy shopping environment.  Maybe mood is the problem:  depression and anxiety can be significant barriers to getting things done, but yet the more things are not done, the more depressed and anxious you become. The cycle continues.

Managing a household and all the tasks included in this, is very much an occupation.  It is a separate set of demands from personal care, earning an income, or managing our productive time.  Occupational therapists routinely help clients to return to the occupation that is managing a home.  There are multiple strategies that can be used for people with brain injuries, chronic pain, or social phobias to return successfully to grocery shopping.  There are also multiple aids available that makes light and heavy cleaning easier.  We often need to help people break down tasks into smaller chunks, or educate people on pacing as a means to get things accomplished.  Education on proper body mechanics is also very useful at reducing strain on recovering shoulders, necks and backs for things like lifting, carrying, reaching, and bending.  Outdoor tasks are more difficult to resume, simply because they are heavier, but many of the same principles apply.  If behavior, mood or avoidance are the problem, we have strategies and tools to help with that also.  We believe that most functional problems have a solution.

Occupations are therefore all the things included in managing your home.  These tasks can be heavy, time consuming, and “not-fun”, but they are a necessary part of living.  If you are struggling to get these things done, or know someone else who is, occupational therapy can help.

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Occupation Is: Managing Your Finances

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

It is no secret that there are physical, mental and emotional consequences of stress.  Access to money is a basic human need as food, shelter, and emotional security are all impacted by our ability to provide for ourselves and our family.  As such, the stress created from a lack of money, or drastic and sudden loss of income, is significant.  In the economic crisis of 2008, there was mounting evidence that financial issues were causing a whole host of associated health problems including a rise in reports of headaches, backaches, ulcers, increased blood pressure, depression and anxiety (http://www.frbsf.org/community-development/files/choi.pdf).   Therefore, it is no secret that financial security is a determinant of health.

I can say that 100% of my clients suffer from financial problems after their traumatic event.  How could you not?  If you think your income is “insured” against illness or disability, check again.  If you are fortunate you have private disability or health coverage.  Or, you might have a good short or long term disability plan at work and in that case, you might get 80% of your income covered at the time of claim.  However, this usually only lasts for two years before the “test” changes and most people find their income loss benefits end.  In the world of auto insurance, without other coverage, the maximum income replacement is $400 / week, regardless of what you made before (unless you “bought up” which no one does).  And just think – three years ago the Financial Services Commission of Ontario wanted to lower this to $300 / week to put more money back in the pockets of insurers.  Could you live on $1200 / month?  I digress…

So, you are in an accident, suffer an illness or can no longer work.  How will you manage?  How will you be able to afford the medications you are now required to take (these aren’t covered 100% either folks), the equipment you need (the government might fund 75% for some items, but when a prosthetic limb is $60,000 that is still a lot out of pocket), the treatment you require (even with extended benefits, $350 in PT won’t get you very far), and your regular expenses that won’t dwindle unless you make major lifestyle changes?  The answer is stress, worry, concern, sleepless nights, borrowing, illegal activity, and brutal attempts to unsafely return to work because you “have to”.

Believe it or not, managing your finances is what we call another “occupation”.  Working with an occupational therapist, a disabled person can create a new budget around the change in income, get support to make decisions about spending, and gain access to other potential sources of financial support.  Perhaps you qualify for the Disability Tax Credit, or the Registered Disability Savings Plan?  Maybe you need to apply for the Ontario Disability Support Program, or can access funding for devices through the Assistive Devices Program?  Perhaps your home modifications qualify for the new Tax Credit, or you can apply to the March of Dimes under their Home and Vehicle Modification Program?  Maybe without other coverage the local Community Care Access Center can provide you with home care, treatment or equipment?  Can your medications be covered by Trillium?  Are you maximizing the coverage available to you under auto insurance policy or work benefits?  Is there a local food bank, or disabled transportation program? These are all things we look at.

Then of course, there is the process of returning to work.  What if you cannot manage the demands of your previous job or this is no longer available to you based on a long absence?  Perhaps the jobs you are trained for no longer match your abilities?  Occupational therapists can help with identifying previous job demands, outlining new job interests, and comparing these to the abilities you have.  We can set up structured work programs, gradual re-entry plans, and connect you with people and programs in the community that help people get back into the work force.

Occupation is managing your finances and making sure you can get by.  If this is impacted by a disability, Occupational Therapists’ treat that.

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Occupation Is: Doing Fun Stuff

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, what are your plans after work?  How do you like to spend your evenings?  What do you do for fun?  Given the choice, how do you spend free time?  While being productive is essential for the human psyche, so is being unproductive.  Well, sort of, because even a lack of productivity is productive.  Deep, I know.

Personally, I love a good funny movie, dinner with friends, time with nature, getting out with my kids, exercising, playing sports, reading, blogging, and going on vacation.  Those are my “fun”.  For others, this could be creative hobbies or outlets, museums, live theatre or music, antiquing, collecting, photography, being online, or a thousand other things that I don’t even know exist.

So what if I was injured, suffered from a mental health problem, have a medical issue, or brain injury?  Perhaps I would lack the ability to sit through a movie, or could no longer understand the nuances of humor.  Maybe my personality would change and my friends would have a hard time relating to the “new me”.  Or, I could no longer physically handle my nature walks, exercising or playing sports.  If my vision was impaired, I could not read anymore.  If I struggled with cognitive communication, or attention problems, putting together a blog article might also be off the table.  And vacations?  Those are incredibly difficult to plan and organize at the best of times.

Occupational therapists are very skilled at helping people resume the occupation of fun.  There are multiple ways we do this, as we recognize that our “fun” defines much of who we are, and why we work so hard in the first place.  For example, if I had to rehab myself from the problems above, I might start with suggesting sit-coms as these require less physical tolerances for sitting, and a shorter attention span.  I could view these with another person, and discuss the humor, sarcasm, and recall the best one liners.  Perhaps I would need education and support to understand how my personality changes are impacting my relationships, so I can try to make some changes.  If my physical abilities were limited, my OT could help me find new ways to enjoy nature (bird watching, photography as examples), and could help me discover new sports and forms of exercise within my abilities (yoga, Tai Chi, and many modified sports have become very popular for people with disabilities).  If I can’t read a standard book, maybe I could use an iPad or e-reader so I can change the font size, or switch to audio-books.  For my blogs, I could learn new ways to move from a blog idea to a full article, by breaking down the topic into paragraphs or chunks, or learning how to dictate if written communication is my challenge.  Vacations could take the form of day trips, short overnights, and eventually out of the country through the help of a travel agent that specializes in planning accessible vacations.  I would probably learn that in Canada my attendant can fly for free (with approved paperwork), and that many places (Disney included) are highly accessible.

So if a disability is stopping you from enjoying the occupation of fun, OT’s treat that.

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Occupational Therapy Works: Ask For It!

 

This October, Occupational Therapy Month, the Canadian Association of Occupational Therapists (CAOT) is kicking off a national campaign to increase exposure about the benefits of OT and asking the public to help make OT more accessible to all.  CAOT is asking you to “ask for OT” to your doctors, health insurance companies and employers.  The following link from CAOT shows how OT can help you or someone you care about.  Check it out and don’t be afraid to “Ask For It!”

CAOT: How Does OT Help?