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Hello fellow OT practitioners. I am located in the great state of Texas in the southern US. We are required to assess our Medicare patients using a post acute standard scoring system we call the GG codes. GG is the section of the assessment tool therapy is usually responsible for scoring on admission and discharge. These scores are captured in home health, skilled nursing and acute inpatient rehab facilities. The scores help to determine payment and length of stay. They are very important and can be the difference in a patient discharging home versus another level of care. OT in the IRF usually assesses the following on admission and discharge: eating, oral hygiene, toilet hygiene, upper and lower body dressing, footwear, showering/bathing, and toilet transfers. We as OT services have been pushed to only focus on these money makers. It seems that we are missing other areas important to our client's.
I am curious and hope to gain insight to how other inpatient rehab facilities utilize OT services. I struggle with being seen as the discipline that bathes and toilets the patients so we can document the GG code accurately for billing. I realize most of this comes from people in administration who do not understand the value of OT and OT staff fearful of advocating. We are seeing a decline in Nursing assistants that are trained to handle the rehab patient and not held accountable. I am wondering if this is normal for this setting or is it an anomaly? It seems more of the day to day hygiene care is an OT role leaving no time for task practice or motor learning or even IADLS. Any suggestions or empathy would be appreciated. Research on outcomes from IRF programs would be great. I want this to be positive as I truly love the people I work with.
I understand where you're coming from. It’s a common struggle in inpatient rehab settings, where Occupational Therapy (OT) can sometimes be reduced to basic tasks like hygiene or documenting GG codes. But OT is far more than that. It's about giving people the tools to regain independence, and our role is to tap into what truly matters to each person we work with.
First, consider how you frame your sessions. Sometimes, hygiene tasks can be turned into moments of functional practice. For example, instead of just assisting with bathing, use it as an opportunity to work on balance, reaching, or fine motor skills—turning the mundane into meaningful, client-centered interventions. This approach subtly shifts the perspective from "just hygiene" to something much more holistic.
Incorporating ADLs (Activities of Daily Living) into more complex activities helps clients connect what they’re doing now with what they hope to achieve later. Don’t be afraid to push for IADLs (Instrumental Activities of Daily Living) in your treatment plans. Even in an inpatient setting, small adaptations can make a difference—setting up a simple cooking task or practicing money management can be integrated, even if just for a few minutes.
For evidence, check out recent studies focusing on OT's impact on rehab outcomes, like improved functional independence measures (FIM) scores. Research shows that the more we emphasize meaningful activities, the more significant the gains in motor recovery and overall engagement become.
Stay confident in advocating for your role. We aren’t just there to check off boxes—we're there to inspire, challenge, and enable. And that's something the GG code could never capture.
Hi Anita. Thanks for reaching out to the community. This is a really insightful post - and a situation that, unfortunately, likely reflects that of many other therapists out there... We'll bring it to the attention of fellow Members shortly. Could you just clarify where you are based in the world - and what 'GG codes' stands for, as added context for others? (You can edit your text to include these details). Thanks!