The patient that I had this past Thursday at fieldwork is completing her 21-day stint of OT this coming Tuesday. She has been very independent in all ADLs since I met her 2 weeks ago, having completed the STGs and LTGs set by the OTR. The OT staff is "working" on IADLs including simple meal prep and this was the subject of the tx session that I did with her. She prepared a blueberry cobbler. As she worked, I couldn't help but think "she doesn't need any help from me." She washed the blueberries, mixed the ingredients and poured them over the prepared blueberries. I pre-heated the oven and put the cobbler in the oven for her, because her leg is fixated in the extended position it is impossible for her to do these things safely. Everything, that did not require her to stand (she is NWB) or reach above her extended reach height, she did.
This lady is a great, strong-willed, capable lady and I enjoyed talking to her and was inspired by her determination to stay healthy and go home. Saying that, though, I think for the last week, at least, she has been getting OT, when really there are many who need it so much more. She is capable of doing UE exercises on her own and has done them at home for many months. It seems like a wasted expense for OT to see her every day. She would do just as well to be seen every other day or 2 times each week, letting her exercise independently on the "off" days. There are so many people who need more minutes, more days than medicare allows. Wouldn't it go far to take days from patients that don't really need them and transfer them to the patients who need them most?
I know this is a difficult issue on many levels, and I'm sure her family would say she should get all the time that is allowed by Medicare, but it does make me think that there need to be some changes in the way that some think about insurance, Medicare and the need to be flexible. Not everyone needs 21 days of OT. Some need much more, some need less.
This seems to be an ethical delimma that has been observed by many. This is a good article on such issues.
http://www.aota.org/Practitioners/Ethics/Advisory/Social-Justice.aspx
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