A Day in the Life | Skilled Nursing Facility

Today I am so excited to have Bill Wong here to share a day in his life as an occupational therapist. You might already be familiar with Bill from his strong social media presence. Today, Bill is sharing what a typical day in his life as a per diem occupational therapist working in a skilled nursing facility looks like. Oh, and he shares his experience of being an occupational therapist with autism. Please read on to learn more!

I had many of my current co-workers ask me, “Bill, you are a young person. You are capable in working full time hours now. But, why are you choosing to work per diem?” My professional reply has been, “I just want some time to do the extracurricular stuff that I want to do.” While this is 50% true, the other 50% is that I want to avoid burning out, like I had in my first job in OT in pediatrics.

Start of the Day

I wake up at about 7:00 a.m. every day that I am working. My goal is to leave my house between 8:00 a.m. to 8:30 a.m. to get to my work place for the day between 9:00 a.m. and 9:30 a.m. Depending on the day, I will spend 35-75 minutes on the road to get to my work. To keep my times relatively consistent, I often don’t go on freeways unless there is a stretch where I can go with little traffic.

Usually I will know where I go for the day from the Friday (or sometimes earlier) of the previous week. However, I will keep my cell phone to my side in the event that I have a call from my staffer at my SNF company. After all, it is possible that I may need to go to another building for the day instead, or have a schedule change due to something emergency come up.

Once I come to work, I clock in and receive my schedule for the day. I looked over my patient’s list to see if there are patients that I am unfamiliar with. I will also check on assignment board to see if these patients also have physical therapy for the day. This is important because there maybe some patients where co-treating is the only option. After that, I will prioritize who I should see for the day. For me, I will do evaluations first, and then complete them right after. I choose this option to work around my working memory deficits. After that, I will try to look at the rehab gym to see if there are patients already there. If so, I will try to work with these patients also. If not, I will go with whoever I can find that are available.

Throughout the Day

How much time I spend with the patient will be the suggested intervention time minus 15 minutes. If the building is bigger, I will subtract another 5 minutes. The reason are because- a) I spend an average of 8-10 minutes per daily note. b) since I am an OTR, I might be expected to write some recertifications, progress reports, and discharge summaries, which can take anywhere from 8-12 minutes per report. c) the patient might want to be seen for a later time than I planned. d) the elevators at these buildings are slow. After all, as a per diem SNF occupational therapist, I am expected to get the daily notes done at the very minimum. If I can get any other reports done, that is a bonus.

If I were to have at least one evaluation, I will go through the patient’s medical chart in about 10 minutes so that I can know important details about the patient- for determining possible appropriate goals, appropriate billing codes for physician orders, and any other vital details for the rest of the occupational therapy team to know. After all,

As for my documentations, to compensate for my short term memory issues, I will do my documentation once for the patients I have seen before lunch, and once after lunch. This compensation strategy has worked well because I know I am minimizing my chances of messing up patients’ daily progress documentations.

Meanwhile, I have to be on my toes until after 2 pm, especially on days where I anticipate there will be many hours of needs in facilities that I can reasonably drive to. After all, I will not be surprised to receive calls regarding working overtime on these days.

If it were a Friday, I will be proactive in calling my staffer to know the buildings I will work at for the following week. By being reliable (yet knowing my limits at the same time), I am able to build a great relationship with my staffer. In turn, I get more preferable places to go for work, especially due to me being proactive. This is important because per diem practitioners are lower down on the packing order for available hours, though they are higher than the practitioners on registry. I am thankful that I don’t work on registry because I would have gotten working hours at facilities that I might not desire as much.

End of the Day

On a good day, I get to start going home by 6 p.m. However, on a long day, I might not start going home until 8:30 or 9 p.m. This will depend on whether I work overtime or not, as well as the number of reports I am expected to finish. In some facilities, it can be a lonely feeling when I am the last person to leave on the rehab team. In other facilities, I might be accompanied by some other rehab team members who stay late. After my work is done, I will drive anywhere from 30 minutes to 2 hours home, depending on the distance and traffic.

Back to Home

I will go home for a home cooked meal. After that, I might either crash straight to bed, or spend an hour or two on social media. The latter is important because I know it is important to continue to grow my social media presence in occupational therapy globally.

What I Have Learned

As an occupational therapist who is autistic, I have learned early on in my career that I might need more mental breaks than my neurotypical counterparts. Yes, I am to a point where I am more than capable to work full time hours. In fact, there are days I am capable to work overtime, which I did not have this ability previously. However, having known what burnout feels like, that is why I choose per diem instead of full time or part time for my career.

I also have gotten past the point of worrying how people might perceive me- as someone with strong knowledge in autism, but choosing to work at SNF. After all, I realize that I need to work with my strengths and weaknesses, as there is no such thing as a perfect occupational therapy job. The fact that I can work in occupational therapy successfully and competently after some initial struggles is a testament of my work ethic and desire to succeed.

About Bill:

Bill Wong was born in Hong Kong and came to the United States with his family as an 11 year old in 1996. Bill received his bachelor’s degree in statistics from University of California, Riverside in 2007, master’s degree in occupational therapy from University of Southern California in 2011, and clinical doctorate degree in occupational therapy from University of Southern California in 2013.

Bill was diagnosed with Asperger’s Syndrome in August 2010. After a year in trying to find his identity in occupational therapy, he decided to establish his specialty in autism. Since receiving his diagnosis, Bill has presented at occupational therapy conferences at state, national, and international levels. Bill has also guest lectured at 8 different occupational therapy masters programs on autism.

Bill’s passion for his occupational therapy career is to be able to deliver occupational therapy presentations to Chinese speaking countries in Chinese and to continue to establish himself as a leader in occupational therapy and autism communities.

Connect with Bill:

Twitter: @BillWongOT
Facebook: www.facebook.com/redshirtpilgrim
Pinterest: www.pinterest.com/bw1628/
TEDx Grand Forks: youtube.com

A Few Things

A few things I've come across that I think are worth sharing:

 

The importance of play. 

This article had me at the headline: Meaningful Activities Protect the Brain from Depression. OTs know all about meaningful activities (aka: "occupations").

I love the Squiggle Wiggle Pen and here's a great way to use it!

Do you struggle to limit your child's screen time? I cannot even express how much I LOVE this system Shasta is using to limit the screen time in her household.

Speaking of screen time, AOTA's Checking the Pulse has a list of 10 apps that will help you save time.

And in honor of Autism Awareness Month, here are a few things autism-style:

 

Sesame Street is doing their part to raise autism awareness.

Some books to help kids understand autism.

And lastly, please don't forget that wandering is a serious problem among children with autism.

A Parent's Perspective - Sailing Autistic Seas

A Parent's Perspective is back and today I'd like to welcome Miz Kp of Sailing Autistic Seas. Miz Kp is mom to 5 year old Angel who is on the autism spectrum. Miz Kp's passion is learning everything she can about autism and sharing it with others. In addition to her blog on autism, Miz Kp also maintains a list of Angel's Top Five Autism Apps, a support and special education resource list, and a list of events and seminars that may be helpful to parents of children with special needs. I'm so happy Miz Kp is taking the time to stop by and share some of her knowledge with my readers today. Read on for Miz Kp's perspective!

 

Our life in five words:

Determined, Motivated, Hectic, and Blessed

 

Four qualities I look for in a therapist:

• Patient: Angel needs a therapist who is patient and who can take the time to understand his unique needs.
• Communicates: I am a communicator by nature, so I really appreciate it when therapists keep the lines of communication open with me as I try to do with them. I am open to e-mailing, phone calls and writing in Angel’s communication book.  
• Innovative: I like therapists who are full of ideas. These ideas can include activities to do with Angel at home and even tips to encourage speech. An example of this is his new OT just gave us a list of sensory-based activities to do with Angel at home. 
• Invested: A therapist who is enthusiastic about Angel’s progress is a blessing. This means that this therapist understands his autism diagnosis and how it can manifest itself in various situations. This therapist is committed to Angel’s success and is willing to embrace what will work for him and discard what is not working. This therapist will accept the fact that Angel has sensory needs and he/she will incorporate this knowledge into his sessions.

 

Three resources I can’t live without:

1. Wrightslaw.com: This is my go-to web site when I am preparing for an IEP meeting. Their book FromEmotions to Advocacy has been a great resource. They have a wealth of information available to parents and advocates as we try to advocate the special education system.
2. Support System: My support system has helped me cope with a rollercoaster of emotions since Angel was diagnosed with autism a little over a year ago.  I have gotten support from family members, friends, support groups, professionals, and even people on social media. Web sites like Facebook, Twitter, and Pinterest have been very resourceful for me and have allowed me to connect with other parents in a way I could not before. One of my favorite Pinterest pages that every parent of a child with autism should check out is Autism Parents on Pinterest.
3. iPad: Angel got his iPad as a gift from his Grandnana. It has been a great addition to our household. He has learned a lot exploring the apps and children’s videos on YouTube. There are so many apps for children with autism and we are continuing to explore as many as we can.  

Two words (or more!) of advice for therapists working with children with autism:

• Our children may have the same autism diagnosis but there are still things that make each one unique. Please try to get to know my son.
• I like detailed progress reports and well -developed IEP goals. It shows that you really took the time to get to know my son and have a vested interest in his progress and development. 

A word of advice for the parents of a child newly diagnosed with autism:

Crying is okay. You are mourning the loss of a dream you had for your child. However as you cry, remember that your child is still the wonderful person that you knew before his or her diagnosis. Some days will be easy and some days will be hard. Keep in mind that everything you do for your child will benefit them now and in the long run. Also reach out to your support network. If you do not have one then build one. For example: Join a support group or you can even reach out to others via social media. It is priceless to find another parent who totally gets it. 

One dream for my child: 

I dream that Angel will develop the cognitive, academic, and daily living skills to live as independently as possible when he grows up.  I know this is a second dream but I have to get it in. I dream that my son will grow up in a world that understand and accept him as he is. 

What I do to rest and recharge: 

I love to read. There is a nothing like a good book to take my mind off things when needed. On the rare occasion that I can take a nap, I enjoy those also. I enjoy socializing with friends and family when I can. I also love to travel and try to squeeze a trip in at least once a year. 

  

Thanks so much for stopping by Miz Kp! Readers be sure to check out her blog and website, Sailing Autistic Seas at www.sailingautisticseas.com. You can also follow Miz Kp and Angel on Facebook, Twitter, and Pinterest. 

 

A Parent's Perspective - JJ's Journey

Lori and Jeremy being interviewed on NBC. Scroll to the bottom for the full interview.

Today I am pleased to share Lori Ciccarelli's perspective with you. Lori is mother to Jeremy Brooks, a 23 year old young man with Autism Spectrum Disorder, who will be graduating college this year with a bachelor’s degree in Graphic Design with a concentration in Illustration and a minor in Writing.

Jeremy was inducted into an international honor society for college students with special needs.

Lori is a regular contributor to Special-Ism, a website dedicated to addressing the varied challenges within the "invisible" special needs community. Lori also created a documentary, JJ's Journey: A Journey About Autism, to share the struggles she and Jeremy have faced, as well as how they overcame many challenges. Lori is currently earning a master’s degree in Leadership and a certification in Spiritual Leadership. She would like to pursue a doctorate in Hospital Chaplaincy. Lori holds an appointed seat on the Board of Directors for the California State Council on Developmental Disabilities.

Our life in four words:

Determined. Thrive. Hopeful. Advocacy.

Four qualities I look for in a therapist:

1. Compassion: The number one quality I look for in therapists is that they can put themselves in my son’s shoes and try to understand his perspective.
2. Creative: It’s important that therapists go outside the box setting up their clients for success which may include non-traditional learning techniques as not everyone learns traditionally.
3. Experience: Because my son was diagnosed with autism a couple of decades ago, there was not much information or experienced professionals in this field. We have been the pioneers for so many situations. It’s wonderful when we can connect with therapists that already have experience with Social Cognitive Deficit Disorders.
4. Passion / drive: When a therapist is burned out or doesn’t want to work with special needs children, it is obvious and it leaks all over the place. Our kids must sense that the professionals working with them really do care and want what is best for them to thrive.

Three resources I can’t live without:

• Michelle Garcia Winner’s Social Behavior Map – a tool to help my son take the perspective of others. Typically those on the spectrum are challenged with going outside of themselves to understand the perspective of others. This tool makes it more concrete and not only helped my son connect with others, but also helped with reading comprehension placing him in the character’s shoes. I have derived Winner’s tool to use in leadership workshops when I teach on elevating Emotional Intelligence as it is all about social competence.
• The Incredible 5-point Scale by Buron and Curtis. This tool is like magic!! For those on the spectrum with low impulse control, to self regulate can be a challenge. This tool helped to make self regulating very concrete with a plan in place to help when emotions start to flare up. I also use this tool when teaching leaders on how to enhance Emotional Intelligence.
• God: I am a very spiritual person. There are so many challenges that come with raising a child with special needs. God gives me strengthen. Over the years, I prayed for patience, perseverance, compassion, and unconditional love. God wasn’t going to just hand over those qualities instead He provided opportunities for me to grow by blessing me with a special needs’ child. I am not the same person I was 25 years ago.

Jeremy participating in therapeutic horseback riding.

A few words of advice for parents raising a child on the autism spectrum:

• Remember, you are your child’s best advocate. You need to stay involved with the educational team. Remember, you have rights and so does your child. Your child has the right to a Free Appropriate Public Education (FAPE). Make sure the school is meeting the goals and objectives on the IEP. I had to call the State’s Department of Education, Special Ed a couple of times due to frustration and they reminded me that my IEP was a legal document should I need to take action.
• Be resourceful. It is unfortunate that the school districts will not inform you of all the resources available to your child because of budgets. Connect with parents that have gone this route for resources available.

Two words of advice for parents of a child newly diagnosed with an autism spectrum disorder:

Persevere. Don’t give up. There is hope. I was in denial for many years. Once I accepted my son’s diagnosis, doors started opening because I started opening those doors. When I finally realized my son didn’t need a cure and focused on tools for success, he then started to soar!! I was the obstacle in the way because I spent time looking for a cure. We are proud of who he is and how far he has come.

Jeremy, age 4.

One dream for my child:

Happiness and acceptance. The hardest part of this journey has been the bullying and the intolerance of others. I would like for my son to find his “peeps.” Everyone wants to belong and fit. I pray that he stays strong and proud of his uniqueness while finding a network of true sincere friends.

Jeremy didn't enjoy Disneyland until he was 17 years old because of experiencing sensory overload.

What I do to rest and recharge:

I love to be outside in nature walking, hiking, meditating and praying. Letting the cares of the world go!

Lori, thank you so much for stopping by and sharing your journey today! Readers, please be sure to visit Lori's website at www.autismjourney.net and to follow her posts on the Special-Ism blog. You can also follow Lori on Facebook and Twitter. Don't forget to check out this article featuring Jeremy at college.

Jeremy and Lori's television interview: