February 27, 2019

OT's Value As Therapy Minutes Disappear

Reimbursement is changing from therapy minutes to client outcomes.  Some hospitals have tried to improve outcomes by sending clients home with iPads so nurses can establish rapport during Skype sessions.  This does not provide the long-lasting motivation created when OTs link specific health promoting behaviors to specific meaningful activities.  Here are two examples of how OTs can help every level of client turn "I should" into "I want to."

Unfortunately an OT cannot justify the expense of going to a lake to show a client with repaired finger flexor tendons why he needs to do boring, uncomfortable scar massage so he can go fishing.  However, an OT can show a client a photo of someone fishing and talk about scar tissue that keeps the thumb bent so it has little contact with the handle.  Having a straight thumb that provides the control needed to precisely cast in a desired direction can be the motivation to do scar massage.  Fishing can help a client avoid a costly 2nd surgery to get rid of scar tissue.

Meaningful activities can also be unsafe.  For example, a family cannot bring a client's dog to a rehab hospital after the client says he cannot wait to cuddle with his beloved pet.  It is not safe to bring pets that have not been trained to act appropriately in a hospital situation and whose health has not been certified by a vet.  However, the OT can point to a picture of pants and a picture of a person holding a dog and say "pants - dog".  Pet owners know dogs have sharp claws that can scratch bare thighs.  The animal is the motivation to get thighs covered with pants.  homeafterstroke.blogspot.com

February 14, 2019

Yeah this time instead of Arg

Before I went out in the 1st snow storm I was frustrated because I had forgotten the tricks for donning snow boots. I have donned these boots for years so I began with confidence.  It turned into a wrestling match when I tried to get my toe in the 1st boot.  After getting angry I stopped to catch my breath and looked down at the boot.  I noticed something that might make it easier.  Next winter I hope I remember to read additions I made to my Snow Shoes for a Stroke Survivor post.

The 2nd time it snowed all of my strategies were in place.  A windshield scraper and mitten for my sound hand were on the passenger's seat so I was able to clean the snow off my windshields before I backed out of my parking place at the grocery store.  When I saw snow accumulating on the road I worried briefly about snow on the walkway leading from the street to my covered patio.  Fortunately the snow had melted so I did not need the child-size shovel in my back seat to push snow to the side to clear a path.

Of course, my first snow strategy is to stay inside until the snow melts.  I am retired so sometimes I can use this option.  I also pay two teenagers to dig my car out and clear a path to my car.  Paying $30 to 40 is still cheaper than paying a long-term facility $5,000 a month to get someone to shovel snow for me.  homeafterstroke.blogspot.com

February 3, 2019

Preventing Volunteer Burnout

I live alone so I am both a stroke survivor and a caregiver.   I use 7 strategies to keep my volunteers from burning out (16 years) so I can stay in my home longer.

1. Prioritize.  I cut down the number of requests by identifying what I need versus what I want.  I need someone to get on a ladder to change the batteries in my smoke detectors.

2. Build trust.  People do not need special training to know they are being taken advantage of.  When I ask for help I let my volunteers know I do everything I can before I contact them.  People feel good about helping when they know they are really needed.  This strategy builds trust.

3. My husband would groan rule.  I cannot ask people to do things that would make a husband groan.  I cannot ask someone to buy a live tree, transport it, drag it into my house, use an ax to trim the base so the tree fits in the stand, and tighten and loosen the tree stand to reposition the tree until it is straight.  So I bought an artificial tree.  John takes it out of the box and snaps the four pieces together.

4. Let them choose WHAT to volunteer for.  I e-mail a request and let people choose things they want to do.  Peggy who loves to sews repaired the sleeve on my raincoat.  Barbara who is a computer technician volunteered to help me set up the router for my internet service.  Letting people choose what to do means I do not risk rejection because I have asked the wrong person.

5. Let them choose WHEN to volunteer.  After they volunteer I ask them when would be a good time for them.  Everyone has busy lives so it is less of a burden when I fit into their schedule.

6. Make a list and stick to it.  Before someone comes I make a list of the things I need done so my volunteer knows when he or she is done.  I stick to the list instead of looking around and saying "there is one more thing I need you to do."  This list also reminds me to get materials my volunteers need.  Before John comes to replace the batteries in my smoke detectors I buy 9-volt batteries.

7. 80% rule.  The 80% rule means some things can be mostly correct rather than perfect.  After my stroke I gave myself permission to not make everything perfect.  For example, the seam of my bedspread is supposed to be where the edge of the mattress is (see the black line).
It is only fair to extend the 80% rule to my volunteers.  Nobody wants to hear that they did not do it the way I used to do it.