Re: IRF-Recreational Therapy

[Guest guest]

We have a 38-bed IRF but our average census is 24. We have one full-time CTRS

and 3 contingent ones who help during time off and unusually high census.

Referrals are physician order driven and we receive them on approx 95% of the

patients. During the initial interview/assessment, the CTRS will determine if

RT services are appropriate and/or if the patient wants to particpate. Approx

40% opt out or do not have the endurance/ability to participate so the RT

discontinues them.

Currently, the RT program consists of a interdisc out-trip (1x week), an OT/RT

group (upper body strength/endurance), pet therapy (1x week), and the other time

is spent in groups or 1:1 doing table top activities (cognitive, perceptual).

We have experimented with many different schedules but the current schedule is

Mon -Friday. We have tried evenings and weekends and are about to try a new

schedule again. I would prefer to shift some hours to the weekend but it's

tough to have one person work every weekend. On occasion, one of our contingent

CTRS's will work a weekend to help with assessments that spilled over from

Friday.

I too would appreciate hearing from others what the role of the CTRS is on the

rehab unit. With our shorter LOS (ave 10 days) I question the role/need for RT

services in this setting. Seems like everyone is fighting for the patient's

time (OT, PT, SLP, NP, RT) and with the outcomes for an IRF being so narrow

anymore (very functional and self-care related) is there a need for RT? We

don't count RT for the 3 hour rule.

Even PT and OT have to be very careful that everything they do is " justified "

for this setting. When LOS was 2-3 weeks and some of the goals were more

advanced, it made more sense to have RT.

We are CARF accredited and have been told by the surveyors that they see a lot

of rehab units downsizing and/or eliminating RT services. Even though there is

a CARF std that list CTRS as a service to be made available it's very general

and vague. One of the surveyors said that another discipline (usually OT) can

fulfill the role. It's not so much about it being a CTRS as long as someone is

addressing the patients leisure/recreational interests. Of course, CMS is not

so concerned with such a comprehensive approach and would probably view RT as

" fluff " in the care plan! Don't get me wrong, I definitely see value in RT

services but as a manager I need to ask these critical questions.

Lori

Lori

>>> rwharper@... 02/06/06 4:55 PM >>>

I would like to hear form other Inpatient Rehab Facilities to see how

you are using Recreational Therapists in your facilities.

1. What is the size of your facility and how many RTs do you

employ?

2. What is the RT to patient ratio?

3. What is the RT's primary job duties?

4. What is the RT's work schedule?

5. Are there criteria that have to be met for a RT referral?

Thanks for your help.

Randy Harper, P.T.

Rehab Manager

Whitaker Rehabilitation Center

Office:

Pager:

Email: rwharper@...

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