HELP. Am I missing something? I work in a SNF with several locked dementia units and regular SNF unit. Since covid, I feel, I've been having to act as a rec therapist making activity folders for people who no longer know their name and also provide mental health tx for both advanced dementia and the regular SNF unit. Pre covid our awesome activity dept. was on these units daily with many group activities with several staff. Some of these things OT could do but there wasn't a need as it was already being done. Now somehow I'm supposed to re create all that, even though the activity dept has had to severely change and limit its operations. I can't fix this, I can't fix dementia and so I struggle when someone needs constant 1 to 1 assist for participation in a leisure activity (that they can't even identify). I'm at a loss. I often feel like an asshole taking these communication forms, with activity suggestions and directions for set-up, to the CNAs and nurses. Patients need to be fed, provided with hygiene and have PROM HEPs completed. With all these things, 1 of 2 CNAs for 25 residents, is not able to complete a leisure activity, 1 to 1, for 30 minutes everyday. I feel like no one is recognizing limited staffing and environmental limitations. HAVE I GONE MAD OR MISSING SOMETHING MAJOR? And when I express these concerns I'm simply told I'm not giving these patient's a "chance." The list of crazy reasons for therapy and expectations for OT to fix them goes on and on. Improving participation and IND in self feeding is very difficult when pt's with advanced dementia can't leave their rooms and be in feeding dining rooms.
I also feel like my company wants me to be a full on counselor, but this is another profession entirely and so I'm struggling with where the line for OT mental health and a counselor or psychologist is? Especially with dementia pts. I address through ther act, some staff training, making sure meds for anxiety /depression are part of tx and educate on coping strategies as cognitively appropriate.
Lastly, it is always expected that natural aging declines are instant therapy referral. There are times I think this is cruel and highly in-appropriate and nursing staff agrees (at times disgusted), but again my company does not. To them, end of life is not a reason to not provide therapy. I cover comfort measures. And this has become more and more of an issue since covid began. I would love any suggestions, thoughts or constructive feedback. I have no OTRs to discuss these issues with as all my superiors are DPTs