COTA Concern

[a0pitre]

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Hello,

At one facility in which I work as an OT, there is a program called restorative nursing program (RNP) This facility is SNF setting. An RNP takes place USUALLY when a pt's progress has ceased, the pt is d/c from skilled services, and qualified individuals are trained at administering exercises to maintain strength, endurance, balance, etc. or prevent rapid decline in these areas. Training, which can be completed by the OTR/L or COTA, usually takes one week.Prior to the training a new goal for caregiver education is made.

I usually make this goal, which becomes part of the POC; however, it was brought to my attention that the COTA can make this goal as long as the supervising OT signs off on it. I guess my issue is: is this within a COTA's scope to write goals for pt/caregiver education? Is it within their scope to make goals, in general

Any takes on this matter? Would appreciate both a COTA and OTR's perspective.


Andrew, PT, DPT, OTR/L, MOT

 

[PTA2OT]

It is not within a COTA's scope of practice to write/make goals.

 

[a0pitre]

I was leaning toward that notion. Wasn't 100% sure.

 

[CurlyHairedGirl]

I'm applying to OT programs, so am not a student or practitioner at this point. I have shadowed at a facility that had both COTAs and OTs, and I went to an info session at an OTA school.

My impression was that the maximum duties of a COTA varied from state to state. Also, it very much depended on how much trust/authority the OT was willing to place in the COTA. If the COTA had been informally trained by the facility to establish goals in limited areas with patients who had a specific set of diagnoses, wouldn't OTs be able to sign off on them? To me, that sounds like it would be less difficult than doing an eval from scratch on a new patient about which little was known. I know that evals can be delegated to a COTA, so setting continuing goals on someone who has already had some sounds easier.

Incidentally, I noticed that Andrew was both a DPT and MOT. Did you go to the dual program at St. Augustine, and what were your reasons for doing both?

 

[a0pitre]

I'm applying to OT programs, so am not a student or practitioner at this point. I have shadowed at a facility that had both COTAs and OTs, and I went to an info session at an OTA school.

My impression was that the maximum duties of a COTA varied from state to state. Also, it very much depended on how much trust/authority the OT was willing to place in the COTA. If the COTA had been informally trained by the facility to establish goals in limited areas with patients who had a specific set of diagnoses, wouldn't OTs be able to sign off on them? To me, that sounds like it would be less difficult than doing an eval from scratch on a new patient about which little was known. I know that evals can be delegated to a COTA, so setting continuing goals on someone who has already had some sounds easier.

Incidentally, I noticed that Andrew was both a DPT and MOT. Did you go to the dual program at St. Augustine, and what were your reasons for doing both?

The COTA can participate in the eval process; however, the interpretation, plan of care design, etc. is all on the OTR. COTAs in no instance can perform or be assigned evals. Consequently it makes total sense that only the OTR make new goals, upgrade goals, downgrade goals, and d/c goals based on observation of pt and communication with the COTA.

To answer your question, I did attend USA specifically for dual. I started out strictly PT and had no idea of OT however after observing an OT I fell in love with the discipline. I chose the dual because Ifigured I would be more marketable (I would have found work regardless if I would have chosen one field), I wanted to eventually go into private practice ( I've only been out 2years so still working toward that goal), an overall wanted to be well rounded (Majority of my work is OUTpt ortho and I'm able to think out of the box with my OT pts because I've learned so much from my PT curriculum that I had not been introduced to in OT curriculum.). Being an OT has made me a better PT. Although marketability didn't make a difference, my starting salary was significantly higher than most of my classmates whom I graduated with. I will never burnout. My schedule is flexible and I can be as busy as I want to be. .

 

[CurlyHairedGirl]

I have multiple chronic health conditions that could flare up and limit my ability to do heavy physical work at times. I was diagnosed with the first major health condition while in physical therapy for plantar fascitis. My PT told me that my condition meant the plantar fascitis may not ever heal and that one of the PTs with my condition found the work almost too physically demanding, and perhaps had hand overuse issues.

For those reasons, I ruled out the idea of becoming a Physical Therapist. Over the past 15 years, I've had PT 7 different times. I asked a lot of questions and/or asked for alternate ways of doing things which meant that I butted heads with a couple of PT assistants that were treating me.

The last two times I was treated (including one right now) I was treated by a DPT. I found that a lot of issues I had with the perspectives of PT seem to have changed. I had been griping that my hip and knee problems were treated separately, when they were very connected. When I talked about that with the current PT, she said that knee issues often were rooted in the hip.

I am a science geek at heart, so some of the PT coursework sounds very interesting.

 

[a0pitre]

Those are definitely the most rewarding cases. PTs definitely moving toward a holistic approach of treating pts. I myself almost never treat the knee at the knee. It's a puzzle. Good PTs look at the kinetic chain, identify the impairments, and treat accordingly. It's, at times, sometimes a simple fix. If a muscles tight, you stretch, if weak you strengthen, if a joint is tight you manipulate, if joint is hypermobile, you brace an strengthen muscles around, If there is a nerve issue, you treat accordingly. There are others fields of PT that is a lot less demanding and manual based as many ortho type clinics. home health and SNFs aren't. Acute setting probably. Ugghhhh work hardening. School setting, I'm sure there are many other settings. Me...myself...I prefer manual based clinics