By Rose Hoban
After Justin Richard sustained a spinal cord injury in 2003, he spent three months in a rehabilitation facility, re-learning how to do the basics.
“Learning to reuse my arms and hands to perform everyday tasks, whether it was getting dressed in the morning or cooking in the kitchen or going grocery shopping,” said Richard.
“My main concern was getting back to school, getting back to work, getting back to the community … and being a productive member of society.”
During that process, Richard said occupational therapy was perhaps the most important part of his rehabilitation process.
Now, more than a decade after his injury, Richard plays quadriplegic rugby and uses a hand bicycle for exercise.
And he works as an occupational therapist.
Richard knows the value of having someone who understands his needs working as an occupational therapist. So he came with other therapists to the General Assembly last week to ask lawmakers to greenlight HB 683, which would give patients their choice of therapists.
The therapists were also asking lawmakers to give OT more consideration as they reform Medicaid.
Too few
If physical therapy is the process of teaching someone how to use their muscles, occupational therapy is the process of teaching someone with an injury what to do with those muscles: cooking, typing, dressing, toileting.
“It’s great that you can walk, it’s great that you can balance, and physical therapists work on those muscles,” said Amber Ward, the immediate past president of the North Carolina Occupational Therapy Association. “But are you going to walk around dirty and naked? You need to have those functional things to be able to help yourself.”
North Carolina’s Medicaid program limits the number of therapy visits a patient can receive once they leave the hospital: Someone like Richard, who has a spinal cord injury, only gets 24 visits combined from physical and occupational therapists. The occupational therapists said that’s not nearly enough.
“If a client needs a wheelchair or an assistive device, a lot of times OT clinics and referral sources won’t even do the evaluation,” because of the Medicaid restrictions, said Tony Leo, who was also visiting with lawmakers. Leo works with patients who have complex needs.
“We have to send the clients out of their home, we have to send them long distances to get the evaluations that they need – that are mandated by Medicaid – to provide the equipment, which is an access problem.”
And for people like Richard, Medicaid only provides a new wheelchair every five years. Waiting that long might mean a chair no longer fits right, creating pressure sores. Those pressure sores can quickly become serious, leading to hospitalization. An infected pressure sore can kill a patient, as happened to film star Christopher Reeve.
And Leo said doctors are not trained to do the assessments to fit a chair correctly.
“Doctors hate completing wheelchair evaluations; it’s hard, it’s confusing, it’s time consuming,” he said. “I do a lot of education for the physicians, how to navigate what’s needed documentation-wise … to actually qualify and get the equipment for the clients. That’s half the battle.”
Choices
The other thing the occupational therapists talked to legislators about is a bill that would allow patients to choose their occupational therapists.
Currently, patients can choose their doctors, physical therapists and other therapists within their insurance networks; HB 683 would add occupational therapists to that list. An analysis by the legislative Fiscal Research Division found the bill would have no cost to the state.
The bill made it through the House in 2015, but has been in the Committee on Rules and Operations of the Senate, a committee where many bills are sent to languish or die.
UNC-Chapel Hill OT student Anna George explained that many occupational therapists specialize, say, in working with brain-injury patients or patients who have orthopedic injuries or with kids with cerebral palsy.
“There’s different specialties,” Leo added. “You don’t want a pediatric OT treating an adult neurology patient.”
“The client should have the right to go to whoever they want and is most appropriate.”
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