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I am currently licensed in Florida and California, as an Occupational Therapist. To provide an Evaluation, a physician referral is required. For insurance to pay for the therapy, the therapy has to be ordered by a physician. Case Management services are available, for people that require assistance with managing their overall medical care and their ability to function in the home. Care Management services are private pay.
Occupational Therapists specialize in helping a person become as functionally independent as possible. This means retraining a person to have the ability to be as independent as possible in the following areas: Feeding themselves, bathing themselves, managing personal hygiene, handling their home environment, and problem solving whatever may be restricting their ability to lead a full and more active life. This may involve equipment for added safety, but each person is different and each situation usually requires a different approach.
ACTIVITIES OF DAILY LIVING RE-TRAINING
Assess what someone can do; related to taking care of themselves, and then define what the person’s goals are. The intervention would be to determine what kind of equipment would allow the person to meet their needs, and train them to use the equipment. There are times that some physical problems exist in the home (narrow doorways is a common one), that need to be modified as well. Anything you can do to help a person be more independent helps the person and caregiver. Being independent in caring for yourself brings back a sense of self-esteem and confidence, that influences a person’s goals and motivation to do more.
This can encompass a number of different services:
Medical Management - This type of care would include a review of the person’s current medical condition and their medical history. Suggestions are made related to additional evaluations to consider, with the goal being to maximize the person’s general health and determine what limitations there are related to care access. If transportation is an issue, or management of the person’s condition in their living situation, those concerns are addressed in the assessment and suggestions are made. An evaluation related to a person’s need for medical management can be completed, without a commitment to have case management.
Accepting a case for medical management or case management is considered on an individual basis, and is private pay.
Additional Services – When Case Management is initiated, any or all of the services identified under “Services Available” could be incorporated into the Care Plan that is generated.
HOME EXERCISE PROGRAMS
It is always important to know what a person’s goals are, when developing a home exercise program. I actually prefer to call it a home activity program, because no one in their right mind actually likes to exercise. There is a lot to be said for being active. You can choose to do certain tasks, and those tasks can be modified at times, so you can actually be exercising when you are doing them. For example; making a meal or making a bed can be considered exercise if it is done in a way that you use maximal energy when doing the task. For example; if a person has weakness on one side of their body, but they use the weak arm to help them make the bed, rather than do the job one handed, that could be part of a home exercise program. The purpose of activity and exercise is to improve motion and develop strength and endurance. You are only limited by your creativity.
HOME SAFETY TRAINING
This type of training is important for most people that have had a change in their ability to function independently. Whether it is a mental or physical change, it is important for people to be safe where they live. This would include each position a person needs to assume when dressing, bathing or doing their self-care. Whether a person is sitting or standing, it is important to evaluate a person’s ability to do a task before they are left to do it independently. In other words, what a person may say (and think) they can do, they may not be able to do when left on their own. Many times when people have had a stroke or are dealing with memory loss, they may actually think they can do something like; stand and walk to the bathroom, but they cannot safely do the task. In fact I have known patients in the hospital to tell a nurse that they can get on the toilet without help, then the nurse leaves the room, and the patient stands up and falls on the floor. You can’t take anything for granted.
This type of training is important for people who have physical challenges that limit their endurance. Some common ones are Arthritis, COPD (Congestive-Obstructive-Pulmonary-Disease), and Multiple Sclerosis. All of these conditions limit movement to varying degrees. They require that a person spend a lot of energy and effort to be able to do a limited amount of activity. Whether you are limited by arms and legs that don’t move well, or if your ability to breathe while moving is challenged, it is important to learn techniques to manage those limitations. It is all about how you approach a task and how you perform the task. Spend less energy but get the job done! That is the goal.
HOME SAFETY ASSESSMENT
This is an evaluation only. It includes a review of the home; indoors and/or outdoors. It includes a review of all doorways, kitchen and bathroom access, as well as entry and exit from the shower, management of steps, and kitchen use. Safety is the primary objective and recommendations are made, keeping a person’s goals in mind.
ERGONOMIC WORK SITE ASSESSMENT
Employers are usually the primary people that request this type of evaluation, but some attorneys do as well. If it is difficult for a person to do their job, due to an injury or condition that is interfering with their capability to work, we look at the actual job setting and make suggestions to enable a person to re-enter their previous job or assist in developing a modified job.