We did a Q&A on Stories a few days ago, and I’m recapping the answers to all the clinical questions here as an easy reference.
Tips for Advocating for Recliners for Independent Long-Term Care Residents (when the facility “doesn’t allow” recliners)?
I would first dig into why the facility doesn’t allow them. Is it a space thing? Is the facility concerned about safety? Are there unnecessary things in the room that could be removed to make more space for a recliner?
Once those questions are answered, hopefully your ability to advocate will be a bit more specified to the situation.
It’s important to remember that just because the individual is physically independent with mobility and transfers doesn’t mean they don’t have other qualifiers for recliner use. Are they at risk for skin breakdown? Do they have pain? Do they have edema? These are all conditions that can be addressed with the use of a recliner.
I hope that the facility understands that this is now the Resident’s home, and that Resident has a right to a comfortable living space (that is of course still safe).
Sometimes getting families involved or collaborating with the Medical Director (either for further advocacy or even to write an order for medical necessity) can get administrators more on board.
Is PRN better than Full-Time?
There are certainly pros and cons.
Among the Pros: you can make your own schedule, you can experience multiple buildings and settings more easily, you’re not as exposed to any staff drama that may be present in the building, and you typically work at a higher rate of pay.
Among the Cons: the hours you’re looking for may not be available, full and parttime staff take scheduling priority over you, usually PRN positions do not come with benefits (like PTO, health insurance, etc.), it can be more challenging to build rapport with patients and Residents and you’re not always as involved in the overall continuum of care.
Ultimately, it’s whatever you’re looking for and whatever works best for you and your family. There’s no wrong decision 🙂
Ever use the placemat as the second part of the ACL-S?
While I don’t use this as much as the leather lacing tool, I have and do use it! The Allen’s Cognitive Level Screen is one of my favorites for so many reasons.
More on why I love it here!
How can I get family members on board with my recommendations?
My biggest tip: give them tangible evidence.
Invite them to observe sessions. Take before & after photo/video (with permission of course!). Share the objective data you’ve collected from any assessments you’ve done.
It also helps to get the entire care plan team involved in the discussion. Having reinforcement from the doctor, nurses, and social work can make a huge impact on a family’s overall understanding of why these recommendations are necessary and meaningful.
Intervention ideas for incontinence (educating staff, etc.)?
I always start with data collection and go from there. And I find that including staff in the entire process from the very start can make all the difference.
I have an entire breakdown of my process for addressing continence here!
Tips for making CNAs more on-board with recommendations we make (walking programs, etc)?
There are three major things that have helped me so much:
1. Keep in communication with staff from the very beginning. Don’t wait until the end to provide a summary of everything you’ve covered since the start of care.
2. Treat the staff like an active and valuable member of the care team. Ask them what they’re noticing. Get their input on what they think is working and what could be improved. Create a Restorative Program with the staff.
3. Don’t wait until the last day of treatment to provide training. Invite the staff into your sessions, demonstrating and educating on recommendations as you’re actively treating the Patient or Resident.
What do your treatments look like for contracture management patients?
I start with moist heat for 15 or so minutes. Then I apply low load prolonged stretch for at least 30 minutes, focusing on the planes of motion that are the most limited. Then I’ll apply whatever splint or positioning device we’re using or trialing. I also make sure to document how long the Patient can tolerate these devices, any pain relief or exacerbation that occurs, and the effectiveness of positioning during the trial period to ensure that this is the right strategy.
How do you balance quality treatments and documentation in the SNF setting?
It’s honestly a real challenge sometimes.
I try to leave the last 5 minutes of each treatment session to write the daily note. This is obviously easier said than done. If I have an evaluation, recertification, or discharge summary, most if not all of the session is spent working on that with the Patient’s active involvement (as much as possible).
I have several blog posts all about efficient and effective documentation; just little tips and tricks that have worked for me along the way.
How to Document Daily Notes Effectively and Efficiently
The Memory Unit OT 
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