Confession: I was a terrible student until Joy Tilley rocked my 14-year-old mind with her lessons and passion for the perfect, five-paragraph essay.
Awful student I was.
Never completed homework.
Never did a project (nor did my parents “for me” by the way)
Could not sit still or focus. My mind was, and still is, in constant movement.
I spent my days with messy hair, skinned and bruised from head to toe, and generally hated going to school.
I have this vivid memory of standing in front of Mrs. Staley and my fifth grade class to give a yearly book report, for a book I did not read and didn’t create the visual for, and I generally didn’t really even care.
I spent most of my days trying to think of a way to go see the front office secretary and find an excuse to call my grandmother for a ride home.
That all changed on my first day as a freshman in high school when Mrs. Tilley took chalk to the blackboard.
She was LOUD!
She was always pristinely dressed. Yet, still, chalk would fly through the air creating pillows of dust as she wrote. Her facial expressions were exceptional. Her voice, with great inflection, gave purpose and meaning to every word.
Her lessons were everything my undiagnosed ADD mind likely needed.
More than anything she had a Joy for teaching, and I am grateful to this day for the potential she saw in me and how those lessons gave me the confidence to focus on academic success moving forward.
As therapy providers you also know that teaching, training and those essential competency checks are crucial key to ensure our patients’ success on a daily basis during, and more importantly, after our care.
Teaching and training to all interdisciplinary team members, which begins day one, continues throughout their therapy course, and is inclusive of return demonstration from others as a component of skilled care.
There are three phases here: Watch me; follow me; show me.
Teaching also should include patient-level areas when compensation is a noted area of evidenced-based skill.
Medicare Benefit Policy Manual Chapter 15 Section 220 provides the examples below specific to occupational therapy scope of practice:
“The teaching of compensatory technique to improve the level of independence in the activities of daily living or adapt to an evolving deterioration in health and function, for example:
- Teaching a patient who has lost the use of an arm how to pare potatoes and chop vegetables with one hand;
- Teaching an upper extremity amputee how to functionally utilize a prosthesis;
- Teaching a stroke patient new techniques to enable the patient to perform feeding, dressing, and other activities as independently as possible; or
- Teaching a patient with a hip fracture/hip replacement techniques of standing tolerance and balance to enable the patient to perform such functional activities as dressing and homemaking tasks.”
Furthermore, examples of teaching via instruction and training are provided associated with physical therapy and speech-language pathology as relates to skilled maintenance care.
Example 1 reflects a typical outpatient scenario in which a patient has been receiving ongoing therapy under a physical therapy plan of care, and the physical therapist begins the establishment of the maintenance program prior to the patient’s anticipated discharge.
EXAMPLE 1: A patient with Parkinson’s disease is nearing the end of a rehabilitative physical therapy program and requires the services of a therapist during the last week(s) of treatment to determine what type of exercises will contribute the most to maintain function or to prevent or slow further deterioration of the patient’s present functional level following cessation of treatment. In such situations, the establishment of a maintenance program appropriate to the capacity and tolerance of the patient by the qualified therapist, the instruction of the patient or family members in carrying out the program, and such reassessments and/or reevaluations as may be required, may constitute covered therapy because of the need for the skills of a qualified therapist.
EXAMPLE 2: A patient with multiple sclerosis needs a maintenance program to slow or prevent deterioration in communication ability caused by the medical condition. Therapy services from a qualified speech-language pathologist may be covered to establish a maintenance program even though the patient’s current medical condition does not yet justify the need for individual skilled therapy sessions. Evaluation, establishment of the program, and training the family or support personnel may require the skills of a therapist and would be covered.
In closing, I challenge us all to find our Joy in teaching.
Find the simple, yet practical ways to implement teaching and training into your everyday care.
The reward of seeing the outcomes can be invaluable for keeping our patients safe, independent and functioning at their highest practicable level.
And I guarantee, seeing your impact in others will be the greatest Joy of all.
Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).