A Bee in My Bonnet

A Bee in My Bonnet

I know that what I have to say here will probably be controversial and possibly misconstrued by some, but I am just too nettled to keep quiet any longer. I love our profession of occupational therapy as much as anyone, I have been a dues-paying member of AOTA for 38+ years, and I just have to say this.

I’m getting tired of our continual self-promotion, especially when it’s not balanced with advocacy and political action on behalf of those we serve.

AOTA cheers us on to promote occupational therapy and the laws that increase our access to payment, but says nothing about the huge elephant in the room- the attempts being made by our current administration in Washington to take us back to small or no public funding for health care. For sure it’s AOTA’s mission to promote OT, but I think that being totally OT-centric is out of line at this time.

I just opened up the August SIS Quarterly Practice Connections from AOTA, and saw an article on “What Can I Do To Highlight Occupational Therapy?” to members of Congress. I’ve received many of these articles over the years, and even participated in meeting with political aides on Capitol Hill to inform them about our issues. I love to talk up my beloved profession (and often do- just ask my poor family), but right now evangelizing only for OT seems self-serving when the entire system of shared funding for health care is under siege.

I also continue to receive pleas to contact my representatives to end the therapy cap for Medicare funded rehabilitation services. Again, this is a worthy cause, but it bothers me that AOTA seems so preoccupied with only those issues that involve OT job stability and income. Of course I support these things, but it feels like we’re trying to water the garden as the house is burning.

The recent Republican effort to abruptly kill off the Affordable Care Act has failed, but there remain ongoing efforts to systematically cut essential funds for key features of the ACA, thereby “proving” its unsustainability. Medicaid is likewise at risk of active starvation. The danger will be present and continuous until we have a very different philosophy in the White House and Congress.

Please let’s speak out, write about, and in every way possible advocate quality health care for all. Health care that includes occupational therapy services, as well as all of the other health and social services that people must have to be well. Our voices are effective, as has been shown in the past six months, but they must be activated in order to work.

There, I feel better now. The bee in my bonnet has ceased buzzing for just a moment. Thanks for reading.

2 thoughts on “A Bee in My Bonnet”

  • Dear Authentic OT and the occupational therapy community:

    As I sit here into the evening at the AOTA office I feel I must express how lucky I am for having worked for your profession and for the people you serve—among them my family members—for almost 24 years but I also want to express dismay about some concerns that come up about AOTA’s advocacy activities.
    I must respond to your “Bee” post.
    Every once in a while, the Public Affairs Division will get some communication indicating concern that AOTA promotes OT too much and that we are are simply self-serving. The second half of the comment is usually that AOTA must advocate not just for payment and coverage but for our clients.
    This accusation makes me mad and confused.
    I can assure you, AuthenticOT, and every member, every non-member, every client and every potential client that AOTA’s advocacy is a daily march for clients to get the occupational therapy that can enable them to “live life to its fullest.” It is not a narrow mission. It is not greedy. It is not egocentric.
    Not a day goes by that consumer and client needs are not the center of my discussions. Just today my various internal meetings have focused on issues that are inextricably linked to consumers and their needs. Today staff and volunteers discussed our concerns about urging CMS to create protections to assure Medicare beneficiaries get authentic and appropriate therapy in skilled nursing facilities, the importance of the use of the cognitive code to provide access for patients to the distinct services that occupational therapy can provide to make their lives better, and the harm that will come to consumers if essential health benefits in insurance are not covered or not subsidized properly.
    Over the past weeks and months our advocacy on health care reform has centered on the targeted attacks on Medicaid which will affect children in schools, people with disabilities in independent living and individuals with mental health concerns. AOTA has sent messages to members to urge their Congressional representatives and Senators to protect and save Medicaid because of what it provides to many, many people. Our talking points included:
    Additionally, under a block grant system, states will be able to waive current, robust mandatory benefits such as the Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services required for children under Medicaid. As written, the only requirement for pediatric coverage under a block grant is that states cover “health care for children under the age of 18.”
    AOTA sent out particular messages to pediatric practitioners to support protections for services for children in schools.
    This is not just self-interest.
    In the therapy cap, one of the first advocacy pieces I wrote—low these 20 years ago—provided descriptions of the people who could be denied therapy services, showing Congress the real and personal impact of the cap. The therapy cap is not only a policy that affects therapists. The therapy cap is inherently a limitation on clients and consumers. If the cap is lifted, consumers benefit. Of course the profession does too but the benefit is only through making OT available to those who need it. Advocating on the therapy cap does more for consumers than any individual practitioner. It assures that people can become their optimal selves through quality services.
    All our other issues have consumer concerns woven into their fabric. At this time we are arguing on Capitol Hill for more funding for training occupational therapy practitioners in mental health, for allowing occupational therapy to open cases for Medicare beneficiaries who need occupational therapy, for more research on effectiveness of rehabilitation including occupational therapy. Won’t these bring benefit to our clients and society?
    The coalitions we participate in include the Mental Health Liaison Group and the Consortium for Citizens with Disabilities. Actually, AOTA was a founding member of the CCD back in the 1980’s. Doesn’t this work enhance recognition of the consumers who are at the heart of service provision?
    Are these self-serving goals and activities? Are these approaches to protect important programs and important investments, to change policies, to protect access to care just for the benefit of occupational therapy practitioners? I must say a resounding “NO.”
    These accusations that AOTA is only “in it for the glory” hurt me. Personally and professionally. I came to AOTA from the disability consumer advocacy community. I had spent the previous 15 years trying to change policy in education, to reduce dependence on inappropriate and restrictive institutional settings, to redirect policy toward human fulfillment in independence, productivity, and integration. AOTA hired me specifically because of my experience in consumer advocacy. Furthermore, AOTA is guided in our actions by the priorities of the AOTA Board which are undergirded by the belief that the profession and its Association is in place for the betterment of society. I can tell you that because I have listened to the Board debates. They never forget what is really at stake.
    And if we promote fair payment for OT, appropriate guidelines for coverage, licensure laws that respect the full scope of the profession, health care that serves the needs of all Americans, it is ok. It is right and just. Consumers and clients can’t get occupational therapy if we don’t work for protections and recognition. We do not serve consumers and clients by NOT advocating for the interests of the profession. We serve them and ourselves by advocating for good health care, for good Medicare policy, for a robust Medicaid program, for increased research and training money—all including attention to occupational therapy. I believe what is good for OT IS good for consumers and clients.
    Rest assured that advocating for consumers is endemic to AOTA’s efforts. It is our reason for advocating. It is the rationale for our calls to action.
    We may ask members to “promote the profession” or “advocate for OT” or “educate about the benefits of OT” but don’t think that is a narrow message. Think of it as the expansive, encompassing message to assure that all people get what they need through policies that promote health and well being at the same time we promote what occupational therapy can do. For individuals and society.
    Don’t mistake raising the banner of occupational therapy for self-promotion. Your advocacy and the advocacy AOTA encourages is inextricably linked to consumer needs and possibilities. It is always about quality for all whether it is in the context of the repeal and replace debate or the therapy cap or funding for good school services. It is always about the end goal of meeting the needs of individuals and our national community. It is always about doing the best we can to make life and living better.
    If that is inappropriate, then I have wasted many a year. But I don’t believe it. And I will get up tomorrow and do it again. I will urge members and others to promote occupational therapy as a call to excellence and equal access to the benefits of American life. I will press the profession to stand up for itself because that is standing up for every client served by OT. I will plead for each and every member of Congress, for every state legislator, for every school board member, for every citizen to value occupational therapy. And by doing so promote consumers and clients and their rights to the best possible services.
    Christina Metzler
    Chief Public Affairs Officer

    • Dear Christina,

      Thank you so much for your informed and informative response to this editorial. I can imagine how frustrating it must have been to read my opinion, given how hard you work to promote our profession as a means to improve health care for all. Your passion for and dedication to the monumental task of connecting with those in political power on behalf of our profession are exemplary; all occupational therapists in the U.S. have benefitted from your hard work, whether we belong to AOTA or not. I want to thank you, and I would never want to offend or to seem unappreciative of all that you have done and continue to do for us all.

      Perhaps my emotional reaction lies more with the sense that we (speaking as a member of AOTA) could and should explicitly state that we as an association believe that all people should have access to health care. I understand that this would imply support of a universal or single-payer health system, an issue with political implications. As a member I would very much like to see my association take this stand alongside many other national health care groups. I recognize that I am but once voice out of many.

      As a leader in our national association, you walk a fine line to represent us to legislators who fall on all points of the political spectrum, and that requires great diplomacy and care. You must measure every word and nuance with care. I hope that you will continue to fight for our profession and our clients’ best interests, and I will continue to be an active and enthusiastic member and supporter of AOTA. I will also use my voice as an independent practitioner to respectfully request an explicit statement of support for the right of all Americans to good health care, because I think that position is congruent with our ethics and standards as a profession.

      Debora Davidson, PhD. OTR/L
      Owner, Authentic Occupational Therapy, Inc.

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