Showing posts from March, 2009

Monday morning spaghetti

In 11th grade I took a computer programming class - computers were brand new technology at the time and the teacher knew little more than the students so it was definitely a wide open frontier. The computer was an excellent tool in that programming forced my adolescent brain into a type of linear and logical thinking pattern that I still find useful today. The teacher often had us work in pairs on larger projects and I had an excellent programming partner. We regularly challenged ourselves with writing complex programs and we were sometimes over-ambitious. One particularly complex program we attempted was to write a 'Blackjack" program. I remember how excited we were when we got the cards to print correctly on the screen. This was high-end stuff for a couple of high school kids hacking away on a TRS-80 Model III computer! Our Blackjack program became increasingly complex, and as we attempted to make accommodation for ever increasing complexities the programming code becam

NY Governor Paterson plans to re-institutionalize people who have developmental disabilities?

Is this about saving money on facilities with empty beds? Or is it the confused problem solving coming from politicians who have empty heads? In a Rochester, NY Town Hall Meeting on March 11th, Governor Paterson was asked about his plans for adults who have developmental disabilities who are on long waiting lists for residential programs. Currently, many are living with their families because NY State lacks housing options for this population. Politicians should know that this is not a new problem - New York has a long and storied history of problems in providing residential services to people who have developmental disabilities. I blogged about the history of the Willowbrook State School several years ago; I encourage you to click this link for a background study of the situation Certainly options are different since Willowbrook was closed. Residential treatment programs in the years following 1987

An occupational therapist's perspective on patient elopement from nursing homes

Mrs. Kim was one of my first patients when I was a young occupational therapist. She was an 89 year old resident of the nursing home and lived there for the previous seven years. Prior to her admission she was living at home with the support of her only son. She had diagnoses including hypertension, chronic obstructive pulmonary disease, and Alzheimer's disease. She had a history of depression and severe anxiety. Mrs. Kim was a known 'flight risk' and tried to leave the nursing home facility on several occasions. The nursing home responded appropriately by installing window limiters and door alarms. Out of an abundance of caution they also made sure that Mrs. Kim always had her identification bracelet and she had an alarm that would sound whenever she wandered outside of a designated perimeter around the nursing station. Despite all of these precautions she still managed to find her way out of the facility on at least three occasions in the preceding seven years - w

Stepping into politics: Obama comments on Special Olympics

I very rarely step into politics in blog format because of the inherent landmines that one encounters. People hold tremendously polarized worldviews that make coherent debate difficult - but sometimes an issue stands out in a way that makes NOT commenting wrong. President Obama went on Jay Leno's show last night. I am not a huge fan of television so I rarely watch these shows. Still, I knew that I wanted to see 'what he said' when I checked the news this morning. Apparently, in reference to his own poor bowling skills he made what is now being spun as a 'self deprecating comment.' Obama's comment about his bowling skills was "It's like -- it was like Special Olympics, or something." In presumably light hearted banter he also allowed himself to be drawn into comments about "water-heads." This is an unbelievable lack of dignity from a President. The political spinmeisters who think that deflecting the comment as a statement about Obama

Health insurance administration: From pragmatic haggling to preposterous hilarity

There was a time when people paid their MD with chickens or apple pie. It was a bartering economy that made sense between the participants. For many years doctors resisted governmental efforts for universal health care and insurance companies did not want any part of trying to develop risk models that would make health insurance a money-making product. Houses were easy to make insurance models for - but no one wanted to deal with the vast complication of risk assessment for human health. Lots of things happened throughout the 1920s and 1930s that pushed insurance companies into the health insurance market: the Flexner report called for and prompted improved standards in medical education, small union groups began negotiating fixed-cost hospital coverage plans, and demand for medical services increased as medical technology improved and large populations of people moved from rural to urban centers. Health insurance grew through the 1960s and then government entitlement programs were e

Nixzmary Brown was murdered over three years ago. Do you remember?

Three years ago Nixzmary Brown's murder had everyone talking about child abuse and how 'the system' fails. There was no shortage of commentary about how broken the child protective system was - after all, child protection workers were already involved in the case and stated that claims of abuse were 'unfounded.' Tragically, it took a child's death to provide enough substantiated evidence - and even then the so-called parents were only found guilty of manslaughter. Suspected abuse that is reported to child protection workers is often 'unfounded' - you can find a few such cases that I have ranted about in these blog pages. Once I reported cigarette burns on a child's legs that were determined to be 'unfounded.' Another time cigarette burns on a different child's arms were 'unfounded.' In another case I had, a caretaker was cramming food down a child's throat who could only eat via g-tube but that wasn't a problem .

The mass of moms lead lives of (not so) quiet desperation

I need to turn Thoreau on his head a little here - I made mention of 'desperate parents' in a blog note last week and on cue I had a discussion with a mom recently and she looked me squarely in the eye and said You do realize that you are talking to a desperate parent, don't you? Of course I knew that. It is the time of year for reviewing Individualized Education Plans. This particular mom's story was not so different from the hundreds who have preceded her. She wanted to know if she was crazy, or if she had odd expectations of her school system, and why she was having such a difficult time interacting with her child's educational team. I began my private practice with the naive notion that I would function as a private therapist for approximately 2-3 years, work with families and school districts to help them bridge gaps of misunderstanding, and likely put myself out of business after engaging in several years worth of advocacy and educational efforts. That wa

Sensory Integration: How occupational therapists are stuck in the long tail

I am working with a student who is completing a literature review on the concept of fidelity in sensory integration. At the same time I am completing a book chapter on entrepreneurship and today came to an interesting perspective on the state of sensory integration theory and practice models. Reality dictates that people purchase goods and products and will pay for them based on some value formula. Occupational therapists have famously made references to the value of their services - from Mary Reilly's belief that OT could be one of the great ideas of 20th century medicine to the more recent AOTA branding campaign on how OT helps people live life to its fullest. If both of these statements were true people would be flocking to seek out and pay for our services. Is this the case? Certainly people are receiving occupational therapy services. Certainly insurance companies and others are paying for occupational therapy services. Despite these facts, it is true that the