For some therapists it's their niche. For others, it's a place they'd never consider working.

I'm talking about SNF's, aka long term care facilities, aka nursing homes.

By happenstance I've just been working in one for six weeks; it was the place I was assigned for my temporary, summer job.

I'm still getting my feet wet, but it doesn't feel as though SNF's are my niche. I found this area of practice to be extremely challenging, particularly psychologically. On the other hand, there was also something about my experience at "Greenwood" (not its real name) that hooked me.

Even if it's well run, there's an inherent sadness about the typical/traditional nursing home--one that's large and institutional. Namely, the artificial separating out of the frail, infirm elderly, with little or no contact with the span of generations, the ongoing stream of life, as well as the outside world. It's hard to shake the image of nursing homes as warehouses where old people await death. (Maybe that's why we've come up with an alternate language, where we speak of "long term care" and "skilled nursing.")

Essentially, I don't believe in nursing homes. That doesn't mean that I think family care is the answer; that's not always practical, possible, or even safe. But there are other alternatives.

Several years ago I became aware of "Eden Alternative," a small, not for profit organization dedicated to "improving quality of life and quality of care for those living in nursing homes," and "eliminating the plagues of loneliness, helplessness, and boredom that make life intolerable in most of today's long-term care facilities" by providing nursing home residents with personal "companionship, the opportunity to give meaningful care to other living things, and the variety and spontaneity that mark an enlivened environment." (edenalt.org) Some day I may use this blog to explore this concept--this vision--in more detail, but suffice to say that I'd be thrilled to have the opportunity to work in an Eden-oriented facility. I sincerely hope "Eden" is the wave of the future.

In the meantime, less enlightened nursing home facilities are the norm in the USA, and a large percent of our institutionalized elderly live in them. [Does anyone reading this know of any specific statistics?] How much longer can they wait for better quality of life, better quality of care?

There's a shortage of occupational therapists in my community (as there is nation-wide). My supervisor at Greenwood, a COTA, has never had a full time OT on staff. She hoped I would stay on permanently--there's no one standing in life for the job-- but I was already committed elsewhere.

And so I've left Greenwood. As I walked out the door, I was looking ahead to my new opportunity in the public schools. But I did look back. I'm not sure I'm done with "SNF's"... or that they are done with me!

(to be continued???)

[If you work in a nursing home, aka SNF, aka long term care facility, please COMMENT on your experience and your motivation for this work.]

In hindsight, my last posting-- "Adventure in Cyberspace"-- strikes me as naïve in its tunnel vision.

In her COMMENT, Kelly Alward spoke of her "mixed emotions" in regard to her own webinar experience, adding, "I wonder where all this is leading." And Bob Stott's article on current trends in continuing ed. (http://www.therapytimes.com/030209Conferences) raises the specter of "distance learning" replacing live workshops altogether.

My glowing review of the first webinar in which I participated had to do with my excitement around finding another option for CE-- an additional choice available to me. I certainly do not think webinars are the answer to continuing ed.

As economic and time pressures-- as well as increasing demands for productivity in the workplace--create a need for low cost, efficient, localized, and job-specific "trainings," we run the risk of reducing CE experiences to the delivery of information. However, to grow and thrive as professionals we need more than stimulating content; we need to be in community with our colleagues over time, and we need to examine the particular work we do within the broader perspective of our field as a whole.

Learning within this larger context cannot happen in a webinar, where our relationship with our co-learners (who may or may not share our profession) is largely invisible and exists only in the moment. It is possible to develop a sense of camaraderie and collaboration with the other OT's we know in our jobs, communities, or practice areas, [If you are not an OT, substitute your own profession for my specific professional references.] and to give and receive mentoring within this limited circle. But there is nothing like a national, or even state-wide, OT conference for helping us define and re-define ourselves as occupational therapists and expand our consciousness beyond what we need to know in order to fulfill (narrow) job responsibilities.

While other, more focused CE offerings spotlight the "experts" among us (the presenters who have the knowledge that we do not), at an AOTA conference the emphasis is on our profession and our professional community. Seeing other therapists in relatively large numbers, glimpsing our professional membership as a whole, and interacting with colleagues from a diversity of practice areas and a widespread geographical distance--these experiences are educational in and of themselves. Beyond any "CEU-worthy" programming we attend, in joining this gathered body we come to understand that we are not just individual OT's--we, together, are the AOTA, and AOTA membership brings both privileges and responsibilities. As we take our place within the continuum of practice that includes the retired, master clinician and the neophyte student, we are inspired to recognize and honor our profession's past, define and evaluate its present, and envision and invent its future.

Vital statewide and national conferences promote a healthy professional Association, which in turn impacts the welfare and viability of occupational therapy practice as a whole. The AOTA is the linchpin, "anchoring" both practitioners and jobs to the profession.

Faced with intense competition for our CE dollars, today's conference planners must work harder than ever to get our attention and motivate us to register, justify costs and balance the budget, and develop a substantive menu of programming to serve a broad audience. Meanwhile, it's not surprising that a current discussion on "OT Connections" (a forum through aota.org) raises concerns about the strength and influence of AOTA. There's a perception that the grass is greener in "PT land"--that the APTA is a more powerful organization than AOTA--but I don't know whether that's true.

(I welcome COMMENTs from physical therapists, as well as other health care and allied medical professionals, about how we can support and strengthen our own professional organizations while also building alliances with one another to advance our common welfare [as well as the well-being of our clients]).

Insofar as we allow ourselves to operate as Lone Rangers, isolated from our particular professional association, we do a disservice to our own careers as well as our career field.