Conversation with a future OT student

From: A future OT student
Sent: Sunday, December 13, 2009 7:07 PM
Subject: from a future OT student: wanted to say thanks

Dear Dr. Alterio,
I just wanted to thank you for all of the great stories you posted on your blog... I am writing to you because I have been searching for stories by occupational therapists where they actually help people, where they make a real difference. After going through prerequisites, applications and finally being accepted into two of my top choice schools- I have found terrible posts on [a website] posted by ex occupational therapists and some physical therapists which all revolve around how occupational therapy is an ineffective, terrible profession to go into. They warn people to stay away from the profession. Many people have written in response to those posts saying that because of them, they have changed their mind. You helped me to not change my mind.

I started looking into occupational therapy after having worked with special needs children as an aide for several years. I particularly remember enjoying work with an occupational therapist as she treated a girl with cerebral palsy. I also enjoyed working with children with autism and Downs Syndrome. I have a back ground in the arts (thought I haven't been able to earn an income from it).

I'm just glad to hear your real stories that reveal that you really do help people, and that its not all about getting reimbursed (for something patients don't need) and [providing personal care].

I wanted to ask you what you thought of skilled nursing facilities (if you don't mind).

I also wanted to ask you if you think it would benefit my future to go to a better school like [University A] versus [University B] (which is good, but not as good in some areas). Do you think people who go to more reputable schools have a better shot at a job they want?

I hope you don't mind my questions. Initially, I just wanted this to be a note of appreciation for the work you do, and for documenting it.

Thanks a million,
A future OT student


Dear Future OT Student,

Thanks for your very kind note.

The Internet is a challenging place to get information because there is no guarantee that you are getting a balanced opinion and whatever you read may not always represent the true spectrum of opinion on any given topic. This even holds true for my own online writing. This does not invalidate anyone's opinions, but it is still important to remember!

As for skilled nursing facilities, I personally find them to be challenging places to work - but there is very important work to be done in those environments. I spent many hours in nursing homes early in my career, but this was before the so-called 'nursing home boom' of the 90s when the environment changed and became even more focused on reimbursement. My experience in nursing homes is that people in these facilities have incredible needs and that it is very challenging to meet those needs in that environment. The context is 'foreign' to most of the people placed there and in fact very few people choose to live in those facilities. In itself, this reality makes nursing home care tend toward tragic - at least when measured against the ruler of typical expectations of where people want to be in their lives.

There are exceptions, of course. Some skilled nursing facilities have re-engineered themselves into rehab facilities and people who reside there are only there on a short term basis for post-surgical or post-trauma recovery. Many skilled nursing facilities have sizable populations of people in this category. The problem happens when people who are elderly and experiencing declining health are determined to be 'eligible' for rehab beds or positions based upon someone else's formula. This causes unfortunate activity like rehab for someone who under other situations might not even choose it or might not even want it.

An exceptional skilled nursing facility situation I experienced was where the patients quite literally co-opted the occupational therapy room and created a 'culture' of work for themselves - they even went so far as to hang a sign on the door that said something to the effect of 'Let no one call another person's work inconsequential.' People who were long-term residents of that nursing facility came in and worked on things that they wanted to work on - some were functional activities and others were not! As a new graduate (at the time) I thought that it was my job to make sure all of their activity choices were respective of their occupational roles - any my naiveté almost prevented me from understanding that for many of these people the therapy was the environment and the culture - and not the activities! The people in this particular nursing home who created and participated in their occupational therapy routines were among the happiest residents of any skilled nursing facility I have ever seen in the twenty plus years since that time. These people, all with very broken physical bodies, represented a triumph of the human spirit that I have not again seen demonstrated - it was a rare and compelling experience.

My point is that even in desperate conditions there is hope, and hope is good when we can learn how to harness it for people who we are charged to care for.

Maybe the people who posted on those forums you refer to have lost some hope? I hope they can find it, somewhere - because spending your life doing something or being somewhere you don't want to be is not a way to spend a life.

Finally, regarding your question about schools - go to a place that feels like a match to you. Of course you should ask the school about their accreditation, graduation rate, and percentage passing the certification examination - but other than that your choice of a college has to match so many other factors in your life. Your future career as an occupational therapist will not be determined by the college that you go as much as what you choose to do with the college that you go to!

And I am very hopeful that you make all the best choices, for you!

Warm regards,



Claire Louise said…
Just writing to say that your blog is so so fascinating and interesting for me to read as I plan to study OT at university soon.
Thanks for all the great posts!
Also, how do you view the role of an occupational therapist in 5/10 years? I only hope they are still as important then as they are now.
Hi Claire!

Thanks for reading...

5-10 years is not far into the future - I don't see that there will be groundbreaking changes in what occupational therapists do in this particular time frame. The primary reason for this is because of the slow pace of change in federal mandates.

That being said, there are reasons to believe that OTs and other health professionals will continue to increase their roles in wellness care and health promotion, as well as in working in community/private practice settings. There will be continuing need to provide services for our aging population base as well as to provide other traditional occupational therapy interventions. So, the profession will likely continue to grow and evolve into new practice settings but traditional practice opportunities should still be strong, at least in this near term.


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