AOTA’s Virtual Hill Day

If you’ve been looking for an opportunity to join forces with OT practitioners and students from around the country and advocate for occupational therapy while wearing your pajamas and bunny slippers, this blog post is for you!

June 12, 2009 is AOTA’s Second Annual Virtual Hill Day (you know, as in Capitol Hill)!

This year, efforts expended during Virtual Hill Day will be geared toward the passage of a Home Health bill developed by AOTA: The Medicare Home Health Flexibility Act (HR 1094). This bill enables home health agencies to determine the most appropriate skilled service to make the initial assessment visit for a Medicare client who qualifies for home health rehabilitation therapy. In order to make the initial assessment visit, the skilled service has to be one that is included in the client’s physician referred home health plan. The bill permits occupational therapists to conduct the initial home health assessment visit when OT is listed on the physician’s order, along with a qualifying service such as PT or Speech. In short, passage of the Medicare Flexibility Act will make occupational therapy an initiating service for Medicare home health services.

Because current Medicare law limits client access to occupational therapy in home health, there is the potential for agencies to provide care based on Medicare restrictions, as opposed to providing care based on individualized client needs. AOTA has been fighting the inequality of Medicare’s initiating service policy since the Reagan administration. Passage of HR 1094 will allow home health agencies the flexibility to better utilize the skills of OTs to open cases and meet client needs. Because the proposal is does not expand Medicare eligibility or services, it is budget neutral.

Now that you have an overview of the Medicare Home Health Flexibility Act, I can only assume that you are ready and rearin’ to help. There are two ways to do this (both of which can be done in the aforementioned pajamas and bunny slippers):

**Send an email to your legislators using this form. Note: it’s a good idea to alter and personalize the form letter at least a little.

**Call your state’s legislators and ask them to support the Medicare Home Health Flexibility Act. Make sure your legislator knows how important this bill is to you, your profession, and your clients.

Good Numbers; Bad Numbers

Today is the 6 month anniversary of this blog!!!

In the last six months, OT Advocacy has been honored by 1,781 blog visitors from 32 different countries. Visitors from the US have come from 47 states. 915 visitors have accessed the blog from 51 cities in WA state. Thanks readers!

In less uplifting news, below is a list of health-related budget cuts that are being applied in Washington:

$255.2 Million: Basic Health Plan (eliminating 40,000 enrollments)
$84.1 Million: Pharmacy payments
$75 Million: Hospital rate cuts
$55 Million: Vaccine program cuts
$37.7 Million: Nursing home rates (state only dollars)
$33.1 Million: Mental health/Regional Support Network allotments
$32.6 Million: Value of in-home hours for disabled, long-term care
$32.6 Million: Healthy Options vendor premium
$30.7 Million: Restructured hospital payments
$25 Million: Reduced payment to federally qualified health centers
$19.3 Million: Adult day health centers
$18.4 Million: Residential rates for disabled, long-term care

(Data obtained from The Olympian)

Oh THAT’S Why!

A few quarters ago I took a class called “Health Care Issues”, which included information about using political advocacy to preserve and support occupational therapy. At the time, I thought the course content was determined by the professor, who I knew to have a personal interest in advocacy. Later, I happened to be reading a document in my AOTA Official Documents book and got sucked into the list of topics that all accredited OT programs must address in their curriculum (time to get a life, Alece?). Well, it turns that out my professor wasn’t just teaching material she found interesting, she was teaching info mandated by AOTA.

By adding an understanding of advocacy to the standards that OT academic programs must meet in order to achieve accreditation, the Accreditation Council for Occupational Therapy Education (ACOTE) ensures that OT and OTA students graduate with an awareness of the impact that political advocacy has on their profession. There are a variety of ways academic programs provide students with educational experiences related to public policy and political advocacy. I discovered that many OT and OTA programs offer courses that incorporate a hands-on approach to advocacy. Assignments can include writing emails to members of Congress to provide a constituent view point, meeting with legislators to discuss issues that affect occupational therapy, or researching a current bill related to occupational therapy and writing testimony for a public hearing.

I’ve read numerous times that students who become involved with political advocacy through class assignments often express a prolonged interest in politics and public policy. The opportunity to get involved provides students with an insight into the crucial efforts being undertaken at a state and federal level, and imparts the necessity of becoming politically active to defend and advance the profession of occupational therapy. Practitioners who were involved in political advocacy efforts as students often continue to participate in their state association after graduation, serving on the state legislative committee and taking on leadership roles to advocate for occupational therapy.

I began this blog as part of a Capstone Project for my MOT degree and have really enjoyed learning about advocacy and obtaining hands-on experience with my state OT organization. Anyone have any good stories of participating in advocacy efforts as a student? Leave your comments below!

Promote a Name Change or Promote the Profession?

By guest contributor Vicki Bergstrom, OTAS

When I first heard of the debate revolving around a name change for COTAs, I was ready to jump on the wagon and join those strongly impassioned for the change.  What COTAs do should be validated by the title given them; our field requires professional qualifications and skills.  Many feel that the title of “assistant” does not lend enough recognition and acclaim to all that COTAs are qualified to do.  While I would not turn down a title change, am I am willing to put my desire to sound more prestigious above the need to promote the field of OT to the public at large? The bigger picture tells me, “no.”  My priority is to the profession as a whole.

OT is an essential service that is underutilized, in large part, due to public misunderstanding of the field’s purpose and role in improving quality of life. Expanding public knowledge of the profession and increasing understanding of the benefits occupational therapy offers will directly impact utilization of OT services. I feel confident saying that anyone who goes into health care is largely motivated by a desire to touch lives in a way that makes a positive difference.  As we increase awareness of the profession and promote the value of the services provided, we in turn increase the value of our personal contributions to that profession, regardless of our title. If we, as COTAs, perceive ourselves as valuable contributors to the field of occupational therapy, this will be reflected in our presentation to, and image perceived by, the larger public.

I do not mean to make light of the desires of so many, including myself, to obtain a title that carries a more significant representation of the work COTAs do, but I think that we need to heed our own advice.  In order to be true to our profession, we must practice what we preach; as a professional we must conserve our energy and be as functional as possible.  We must pace our efforts and not let our emotions send us into a whirl-wind frenzy. We must plan in a way that benefits the profession as a whole, and prioritize our goals to ensure that they are accomplished in an order that makes sense.  Let us spend our energy on promoting occupational therapy, which has the power to help so many positively embrace a life lived fully.

(Read previous OT Advocacy posts about the COTA name change debate here and here)

Vicki Bergstrom a first year student in the OTA program at Green River Community College in Auburn, WA.

Who Has Access to Ride on an Airplane?

You would think this would be an easy question to answer: EVERYONE has access to ride on an airplane, right? Think again.

Have you ridden on an airplane lately? Take a moment to picture the interior of an airplane. The aisles are narrow and the seats are certainly more narrow than in a car. Why? Because the airline industry makes money by cramming as many people as possible onto their airplanes! Duh!

But what about all the people who want to fly but can’t because they either can’t fit into an airline seat or can’t fit down the aisle? How many people can you think of who can’t sit in a standard airplane seat? Who do you know that can’t even get on an airplane and down the aisle? And the airplane restroom?  You can forget about it; airplane restrooms are completely inaccessible by persons with disabilities. I know several people who can’t access transportation via airplane. And I am not talking ONLY about people who use wheelchairs.

Of course people with wheelchairs have a terrible time with airplanes. Wheelchairs don’t fit on the airplane, so individuals who use them have to be either carried down the aisle or transferred onto a different chair and then transferred from that chair to their seat. Talk about the potential for injury, not only to the passenger but the flight attendants too. And of course the consumer’s chair usually gets damaged in the process as well.

How about the person with obesity that can’t fit into the seat, or walk down the aisle? They have every right to fly just like everyone else. Is it fair to make these people purchase two seats? Is it fair for them to purchase one seat but squeeze over onto the seats  of the people sitting next to them?

What about people who aren’t considered obese but just simply don’t fit comfortably in an airplane seat? What about other people with different physical disabilities? What about people with spasticity and high extensor tone? What about people with limbs that don’t bend or contort into those tiny seats, like people with a muscle contractures, a fused joint, or a cast/splint?

What if your shoulder and axilla was splinted so that your shoulder was held out in 90 degrees abduction and you were flying to meet a specialty surgeon? Where would you sit on the plane? What if your knee didn’t bend? What if the only way you could physically sit in a chair is with your leg sticking straight out in front of you? Where are you supposed to sit on a plane? You certainly don’t fit in a regular seat. You can’t sit in the aisle seat because your leg sticks out and poses a safety hazard, not to mention getting whacked by the snack cart. Maybe the emergency exit row you might think. Nope, you have to be physically able to sit in those seats. What about the first bulk head row? I suppose…. if it hasn’t already been given to another passenger, that is.

And if you had a disability, how successful do you think you would be in convincing the ticket counter or the flight attendant that you only fit in one select seat on the airplane, or have other special needs? I believe the odds are very low, unless you show up in a wheelchair! It is amazing how difficult it is for some people to receive accommodations when flying. I personally have witnessed people being denied access to seating accommodations on several occasions. I have also witnessed airline employees suggesting to a person with a disability that if they were wheeled up to the counter in a wheelchair, they would have a better chance of getting the seat they need than if they walk up to the counter. Talk about discrimination!

These discrepancies and  discrimination are outrageous and need to be changed. But how? By YOU! The voice for better accommodations on airplanes is too soft. New airplanes are being designed and created without disability access in mind. It is time the nation raises up in arms about this issue!

How is the Economic Crisis Affecting AOTA?

The good news:
AOTA membership continues to increase. The organization currently boasts over 39,000 members, representing a 15% increase since 2005. (There are approximately 140,000 certified practitioners in the US).

AOTA’s continuing education revenue is also increasing.

AOTA held a spring Representative Assembly meeting online rather than in person, saving up to $75,000 in travel expenses. The virtual meeting was considered a success.

The 2009 budget has retained funding for key Vision projects.

AOTA’s long standing alliance with General Motors, which has funded research regarding occupational therapy’s involvement in driver re-education, is still intact despite GM’s pending bankruptcy.

The bad news:
As of January 2009, AOTA lost $540,000 in investment income.

Revenue for FY 2008 showed a loss of almost $785,000 in net assets. (In FY 2007 AOTA saw an increase of almost $200,000 in net assets).

Losses result in large part from higher taxes, a $345,000 payment to the defined-benefit pension plan to adjust the required minimum liability, and empty rental units in the AOTA national office building in Bethesda, MD. The pension fund has been frozen since 1998 and will be discontinued next year, and new tenants may soon move into the national headquarters building.

5,665 people attended the 2008 conference in Long Beach, but only 5,100 attended the 2009 conference in Houston.

Last fall, association leaders began to reduce the FY 2009 budget by $537,000. Significant cuts were made to training and travel expenses.

In December 2008, the national office laid off employees and reduced its senior staff salaries.

Efforts to ensure that the National Association building complies with ADA regulations have experienced a set-back. The building is currently about one-third of the way to ADA compliance.

All information obtained from ADVANCE Outlook: OT

New Law: Establishing Intensive Behavior Support Services.

On February 25th I wrote about three bills that were being tracked and monitored by the WOTA Legislative Committee. Today I decided to check up on the bills and found that only one, SB 5117, passed. SB 5117 addresses the increasing number of children with developmental disabilities and intense behaviors. The new law will create services and develop supports for these children and their family members, with a goal of avoiding disruption to families and eliminating the need for out-of-home placement. Funding will be available to serve 100 children, age 8 through 20. Services include family training, consultation, respite, and behavior support, and the potential provision of therapeutic and medical supplies and equipment, nutrition, clothing, and vehicle adaptation.

The hope is that with these services, the families of children with developmental disabilities will be better equipped to care for their child at home, rather than being forced to rely on an Intermediate Care Facility for the Mentally Retarded (ICF/MR), a Medicaid entitlement program. As reported in this article, since 2006 the number of children placed into an ICF/MR has increased from 2 or less children per year to five to eight children per year. Challenging behavior is a common reason that children are placed in an ICF/MR .

SB 5117 directs the Department of Social and Health Services (DSHS) to recruit providers who address each child’s unique needs, and to establish effective supports for each child in multiple settings by collaborating with service providers, family members, schools and health practitioners. Occupational therapy has a lot to offer children with developmental disabilities and challenging behaviors; I can only hope that we will be included in the efforts to provide these children and their families with the support and skilled services they need.

The bill will go into effect on July 27th.

Branching Out: OT in Community Practice

Earlier this week I visited Gilda’s Club of Seattle with my “OT in Community Practice” class. One of 30 Gilda’s Clubhouses in the United States, Gilda’s Club Seattle is a non-profit cancer support community offering a wide variety of free services for individuals touched by cancer. People of all ages with all different forms of cancer, cancer survivors, and their family and friends can come to Gilda’s Club to participate in support groups, lectures, classes, workshops, and social events. The Club is located in a large building (ironically an old funeral home) and contains numerous sunlit rooms for small groups and classes, a lounge, a communal kitchen, a spacious “dancehall”, staff offices, an exercise room, a kid’s playroom referred to as “Noogieland”, and an art therapy room.

One thing that makes Gilda’s Club unique is the focus on providing a socially and emotionally supportive environment for families. A comprehensive Children and Teen Program offers children the opportunity to talk about their experiences with cancer, participate in exercise, crafts, and other fun activities. There are also programs that bring families together to discuss cancer and the ensuing emotional issues. While Sally Benson, Program Director of Gilda’s Club Seattle, reports that teen club members are difficult to engage as the primary audience of a program, there are other ways to facilitate teen involvement in Gilda’s Club. For example, teenagers like volunteering at Gilda’s Club, helping entertain and care for younger children, and also enjoy an annual writing contest.

It is impossible to visit and learn about Gilda’s Club without noticing the glaring similarities between the mission and values of the organization and the philosophy driving the field of occupational therapy. The holistic, person and family centered approach to wellness championed by Gilda’s Club mirrors the top-down approach of OT. The parallel approached an eerie level when, sitting in the Gilda Club Fireplace Room, I noticed the last line written on the back of the Club’s brochure: “Gilda’s Club Seattle – facing cancer together and living life to the fullest”. So THAT’S where AOTA got our new brand!

Despite the strong theoretical link between Gilda’s Club Seattle and occupational therapy, there is currently no actual connection. An online search for “Gilda’s Club + occupational therapy” returned minimal results: the Chief Executive Officer of Gilda’s Club of Madison, WI worked as an occupational therapy at Children’s Hospital for years before moving on to explore other careers, and occupational therapy practitioners have led courses at a Gilda’s Club in New Jersey and one in Toronto. This dearth of query results leads me to ask the important question: WHY aren’t there occupational therapists working at Gilda’s Clubs around the nation? It would be easy to reply, “Well Gilda’s Club has never had an OT position available”; placing the onus of an affiliation entirely on Gilda’s Club. However, as hard as Gilda’s Club works to provide the highest quality services for their members, it may be that they are simply unfamiliar with all that occupational therapy has to offer.

I think that Gilda’s Club would be an excellent place for an occupational therapist to make a significant impact on the lives of others. With the proper education, I am sure that Gilda’s Club staff and club members would agree with this assessment. The logistical concerns, (primarily that of a salary) would be difficult to surmount, but not impossible. The staff members of Gilda’s Club are required to be quite adept at procuring grant money, and with perseverance, an OT practitioner may just find that they are able to work with the Club to obtain a grant that funds an OT position.

Visiting Gilda’s Club was a fun field trip, and I appreciate the opportunity to reflect on the often-untapped potential for OT services within the community, whether in a pre-established position, or a new, self-created position. While the incredible versatility of occupational therapy ensures the POTENTIAL for far reaching presence and influence, it is up to occupational therapy practitioners to take the road less traveled.

Occupational Therapy in the News

As many of your know, AOTA’s Centennial Vision strives to ensure that occupational therapy is (among other things) a WIDELY RECOGNIZED profession. One way to further this crucial goal is to get OT in the public eye as much and as accurately as humanely possible! Here are three very recent news articles that feature occupational therapy:

“Therapists help burn victims recover” / April, 4, 2009/ The Progress, Clearfield, PA
Details the story of occupational therapist Kate Peno, certified occupational therapy assistant Karen Swalligan, and patient Dave Clark. In 2008, Clark received second and third degree burns to his chest, hands, arms, neck, and face when the car engine that he was working on exploded. Clark was treated at a local burn center and underwent numerous graft surgeries. As the grafts began to heal, Clark found that the new skin covering his upper extremities was very tight and significantly limited his range of motion. Clark was referred to Clearfield Hospital’s Rehabilitation Department and began receiving occupational therapy from Peno and Swalligan. Although Peno admitted that she had no prior experience treating burn patients, she researched articles about occupational therapy for burn victims and got right down to business, working her OT magic. For three months Clark participated in five OT sessions a week with Peno and Swalligan. After “graduating” from occupational therapy, Clark returned to work and daily life with no functional limitations.

Reasons this article rocks:
****It stars an OT and a COTA ****It provides an excellent definition of occupational therapy, including an explanation of the roles of OTRs and COTAs ****The article cites specific examples of OT interventions (non-underwater-basket-weaving-esque activities! ****It points out that the interventions implemented were researched and evidence base ****There is  a very happy ending

“Occupational Therapy Keeps Angler Fishing” / April 28, 2009 / NBC Newswatch TV- 12 in Rhinelaner, WI
The story of  fishing guide Russ Smith, who received occupational therapy services after he was bit on the thumb by a fish and contracted a nasty infection. After undergoing surgery and beating the infection, Smith was left with a left hand that was virtually unusable. Enter Patience Lamers, an OTR at Howard Young Medical Center. While the article fails to describe the interventions implemented, the end result is a happy fisherman. Smith’s involved thumb is reported to be 90% as strong as his uninvolved thumb, and most importantly, he is able to participate in his greatest passion.

Reasons this article rocks:
****The title includes the words “Occupational Therapy” **** The article provides an example of the type of medical condition and activity limitation that can be treated by an OT practitioner **** Multiple statements made by Smith emphasize the importance of being able to engage in personally meaningful occupations

“Wiggle Room helps special needs students” / May 3, 2009 / Indianapolis Star, Indianapolis, IN
The creation of a sensory-integration room affectionately called “A Little Wiggle Room” at Center Grove Elementary School provides a safe place for children with autism and other SI problems to relax and release energy. The room is brightly painted and contains a platform swing, tubes to crawl through, a trampoline, and bins full of sensory items such as pebbles, sand, and fabric scraps. There is also a quiet area where children can regroup in peace. Cindy Webb, OTR, is quoted in the article stating that the room provides a proactive way to intervene with children before they exhibit the behavioral problems that often result from Autism and sensory integration disorders.

Reason this article rocks:
**** Both Autism and Sensory Integration Disorder are hot topics these days, and we want everyone to know that OT can help!

Occupational Therapy on Wikipedia: Part II of II (Wherein Alece Complains A Lot)

This blog entry is the second part of an examination of the Wikipedia article for “Occupational Therapy”. First, I would like to start by addressing the strengths of the OT Wikipedia article. The article presents a fascinating history of occupational therapy. Specially, the inclusion of information about the use of occupation in ancient times is very interesting, and not something I learned about in school. The article does a good job showing the breadth of OT- the evolution of the field, current trends, and emerging areas. I also really like the section of the article that discusses OT in reference to the International Classification of Functioning, Disability, and Health (ICF). This is a great way to show the international importance and relevance of a field that hardly anyone is familiar with.

And now, the weaknesses. One thing I noticed while reading the Wikipedia article is the high incidence of poorly worded sentences. The actual content of a poorly written sentence is diminished by grammatical errors, and the frequent occurrence of errors in the Wikipedia article detracts from the overall quality and reliability of the information being presented. An example of a sentence in dire need of editing: “Occupational Therapy draws from the field of occupational science to provide an evidence base to practice and develop academic and practice links to other related disciplines such as social science and anthropology, and also utilizes a range of generic models to guide the practice of OT”. Yikes.

A second weakness is the tendency to make generalizations that do not further public understanding of “the bigger picture”. I suppose it is difficult to explain without an example: “Home Health: Occupational therapists who work in this area of practice generally work with clients in the geriatric population who have one or more of the following diagnoses: Alzheimer’s disease, arthritis, depression, CVA, generalized weakness, COPD, or Parkinson’s disease”. While I agree that many home health clients have these conditions, merely listing a few of the conditions does little to further the public’s general comprehension of the principles behind home health services. A better explanation would be something along the lines of, “Clients who have been determined “home bound” by a physician are eligible for home health services. Many of these individuals are geriatric clients with conditions such as dementia, depression, CVA, total joint replacement, congestive heart failure, or Parkinson’s Disease. Often home health clients possess complicated medical histories and are experiencing co-morbidity. Services include, but are not limited to, home safety evaluations and modifications to prevent falls and increase independence, medical equipment and assistive technology need evaluation and training, provision of and training in home exercise programs, and ADL/IADL retraining“. This explanation gives specific examples while also providing information about the broader situation.

Another weakness is the organization of the “Areas of Practice in Occupational Therapy” section of the article. For reasons beyond my comprehension, the areas of practice are broken into three categories: Physical Health, Mental Health, and Community. The fact that these three categories are not in parallel form (two types of health and then a physical locale) leads to significant overlap. So, for example, many items in the “Community” section deal directly with “Physical Health” or “Mental Health”, and vice versa. Additionally, within these categories there are subcategories that also do not align in parallel form. For example, under “Physical Health”, there is a subcategory entitled “Pediatrics” (a population), and then the next subcategory is “Acute Care Hospitals” (a physical locale). This is an organizational train wreck. A better way to organize the areas of practice would be to group the areas by population: Geriatrics; Pediatrics; Mental Health; and Physical Disabilities, and then have all subcategories represent locations of service delivery. For example under the Pediatric area of practice, the subcategories could be: Schools, Inpatient Rehab, Outpatient Clinics, Birth-to-Three Centers, etc etc.

A final weakness is the omission of much important information. A few topics that I would love to see addressed in the OT Wikipedia article:

- The major OT organizations (AOTA, WFOT, CAOT, BAOT, etc)
- Some information about health care issues that impact OT (e.g. how is OT covered by insurance?)
- Information about the ethics in OT
- A more comprehensive list/explanation of the FORs
- Info about OT political advocacy
- Explanation of the NBCOT exam, certification, and licensure requirements
- A thorough description of OTAs- roles, responsibilities, relationship to OTs, educational requirements, job outlook, etc.

There is no doubt that creating a comprehensive article for the career field of occupational therapy is a difficult undertaking. One of the primary challenges is the fact that, while espousing the same philosophy and values, occupational therapy is slightly different in every country. Differences, such as educational, licensure, and certification requirements, typical practice settings, job outlook, terminology, governing organizations, assessments used, etc, make it tricky to write an all-encompassing article that accurately sums up the entire field on a global level. One possible solution to this dilemma is the creation of separate Wikipedia pages for OT in different countries. In this scenario, if an individual visits Wikipedia and types “occupational therapy” into the search bar, they will be taken to a “disambiguation page” with options such as “Occupational Therapy in the United States”, “Occupational Therapy in the United Kingdom”, “Occupational Therapy in Canada”, etc. The user can then make a selection, resulting in automatic redirection to a new page with information corresponding to the specific selection.

Now, I fully realize that after reading all of my criticisms you may be thinking, “Why don’t you stop complaining and put your money where your mouth is, Alece?“. Well, I intend to. So there But I could use your help: let me know what you think about the OT Wikipedia article, and how we can make it better!