  |
 |
Hippotherapy to maintain function
When do you discharge a client?
The program I work for has several clients who recieve services to maintain, not improve function. We direct bill clients, not insurance companies leaving it up to clients to submit for reimbursement so my question does not relate to reimbursements. These clients are considered too involved to manage a TR class for safety reasons or because of the complexity of treatment or because they do not respond well in the more chaotic environment of a group. Some have been recieving services for several years. As they grow older and larger it is becoming increasingly difficult to find appropriate horses and therapists able to work with the clients, but there is a reluctance to discharge because there is evidence that the weekly session does prevent illness and delay regression. It becomes similar to when do you retire an aging horse. How do you determine that you can't manage one more session? What do you recommend to the client's caregivers when you discharge in terms of alternative therapies or activities, especially for clients that are confined to wheelchairs, lack postural control, fine motor skills, and speech?
|
Copyright © 2007, The American Hippotherapy Association, Inc. |
Discharge
Tina,
You bring up an interesting and challenging situation. You question highlights the importance of developing a discharge plan when beginning treatment. However, like you I have started with a caseload of patients that were being treated by another OT before I came onto the team and didn't have a chance to create a discharge with all families and have later had to face the same decision you are now facing.
You may be able to do a re-evaluation of all clients after your facility has a break in programming that would allow you to discuss the changes in safety for these challenging clients. From the information you provided it seems like you are ready to discharge these patients. If you can design a program that would entail time on the ground with the horses while patients are in their chairs then you could provide staff training for this type of program that was more recreational in nature. Since your clients seem to enjoy time around the horses you could teach a very simple hand over hand grooming session and "stroll around the farm" to help keep them involved. They may not get the benefit of equine movement, but will still reap social/emotional benefits.
Good luck, let us know how it works out.
gina taylor, OT