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Therapy professionals: sorely needed and irreplaceable

The Report: August / September 2000 vol.21 num.4

by YUKIE KURAHASHI

Its time that health professionals in therapy, counselling, and rehabilitation receive recognition for the skills, training and expertise that they bring to their jobs. This expertise can often makes a real difference with respect to health outcomes and a patients quality of life. Thats the message HSA is sending out as part of an awareness campaign on therapy and rehabilitation services.

Encouraging awareness of therapy services
Trained as a physiotherapist and occupational therapist, HSA President Cindy Stewart has a deep connection to the issues that therapy professionals face. "I feel strongly about the field of rehabilitation," she says. "Its one thing to mend a bone, and its another to make sure the elbow works again. I know what therapy can contribute with respect to peoples lives ... the difference it can make."

"Its an absolutely critical piece for people in terms of their interface with the health care system and what they derive from it," she adds.

Stewart says enhancing the role of HSA members in therapy is of utmost importance, as well as raising awareness of the contribution of these professionals to the continuum of health care. "There are two main reasons why health professionals in rehabilitation, counselling and therapy ... all highly trained HSA members ... are increasingly needed," she explains.

"First, to ensure the highest standards of care, it is critical that these services be provided by professionals with the appropriate skills, training, and expertise. Second, health professionals such as physiotherapists, occupational therapists and speech / language pathologists have years of specialized training in their field.

"Diagnosis and assessment by a trained health care professional reduces the likelihood of long-term complications and hospital re-admissions. Most importantly, this significantly improves the outcomes and quality of life for the patients. In addition, it also saves the health care system thousands of dollars in future costs."

Therapy, counselling, and rehabilitation services are a critical part of treatment for:
  • spinal cord injuries
  • acquired brain injuries
  • strokes
  • multiple traumatic injuries
  • serious burns
  • amputations
  • acute arthritis
  • complex orthopaedic injuries
  • multiple sclerosis
  • Parkinson's disease
  • post-polio syndrome
  • preparation for independent living

    Stewart emphasizes that the recent erosion of public rehabilitation services must immediately be reversed. "Rehabilitation is an area that is under pressure and at risk for privatization, because its an area within the hospital that has tended to be reduced in order to balance the budgets with respect to traditional acute care services," she says.

    "Were concerned about this erosion. We want people to be aware of the value and importance of these services. We want to tap into the commitment and passion that our members bring to their work, and give it a voice ... to be able to advocate on behalf of their needs at a time when the health care system is in such transition."

    At the same time, however, Stewart says the health care system is facing a serious shortage of health professionals. "Its not just nurses and doctors who are facing shortages," she notes passionately. "We are actively lobbying the government, health employers, and post-secondary institutions to address paramedical shortages by developing effective recruitment and retention strategies."

    Stewart says there are many pieces to a possible solution, including more training spaces in post-secondary programs, strategies to address current and ongoing workload problems, and fair compensation. She anticipates that a wage will be a priority for the next round of bargaining for paramedical professionals.

    "Part of the problem is the immense pressure on therapists to leave the public system. Unfortunately, many therapists find that compensation in the public system doesnt measure up, and isnt commensurate to the many years of specialized post-secondary training that they undergo. Add to this the increasing instability, cutbacks and restructuring in rehab services departments, and an ever-increasing workload ... some therapists are inevitably going to be pushed into making a very difficult decision," she explains.

    Stewart says that while she is proud of the work HSA has done to improve wages and working conditions for therapists, much more needs to be done ... and quickly. "Therapists constitute almost 20 per cent of our membership," she says. "Therapists in the public sector have job security, and flexibility to move within the system and port benefits. HSA works hard to ensure good working conditions, and excellent occupational health and safety protocols.

    "But they definitely deserve better wages," she adds. "Other improvements needed include an increase in education and career path opportunities, flexibility around hours of work and work conditions ... and we really need to address workload. We need to ensure a place for rehab within the public health care system."

    HSA professionals providing therapy, counselling, and rehabilitation services include:
    • physiotherapists
    • occupational therapists
    • social workers
    • speech / language pathologists
    • remedial gymnasts
    • recreation therapists
    • music therapists
    • orthotists
    • prosthetists

    Stewart knows that the scope of work within hospitals can be broad and fulfilling. "As a health professional, theres a satisfaction in being able to follow individuals through their acute phase and then on to rehab," she says. "You really feel that you had accomplished something ... that you made a difference."

    She adds that the continuum of care is extremely important, as well as the quality and breadth of care. "From a therapy perspective it can be very rewarding to treat a broad range of conditions, from the neurological to the orthopaedics, to the chronic to the paediatric. In this work, you really have to use a lot of knowledge, and apply it. Its a marriage of art and science," she says.

    "The science is the knowledge base that you have. But then to apply it to make a difference in someones life is the art ... and I really enjoyed that art. In order to encourage the maximum from people you have to be creative. Its very satisfying work," she says. "Youre dealing with issues that are very important to people, and to who they are — like quality of life, returning to work, and daily functions. You certainly have your heartaches and challenges, and to a degree you have frustrations. But overall its a wonderful field to go into.

    "Now, with the spread into fields and specialties, it has enormous potential. Were trying to ensure that this isnt lost in the current changes to health care system."

    Review of rehabilitation services
    HSAs key role in the ongoing review of rehab services in the Vancouver / Richmond Health Region is paving the way for many of the goals Cindy Stewart identifies for improving working conditions for therapists in BC. The Vancouver / Richmond Rehabilitation Review Committee was formed following a public outcry this winter, when the health region announced plans to close GF Strong and move the services to Pearson Hospital.

    Sheila Vataiki, a former physiotherapist who now works as a senior labour relations officer, represents HSA on this review committee. "The goal of this committee is to develop a position paper, and a strategic plan around the changes that the Vancouver / Richmond Health Board should make relative to the delivery of rehabilitation services in the region," she says. "This review is planned to conclude by the end of the year. And although this review is being conducted in this one health region, it has much broader provincial implications; this is one of the biggest, most densely populated and well-funded regions in the province, and many of the services are tertiary health care services."

    Vataiki anticipates that for these reasons, the recommendations from this review process will have an impact on other health regions and community health councils around the province.

    A major component of this review entails a study of "best practices" in rehabilitation and therapy services. "One of the big issues under discussion is how absolutely critical it is for rehab services in the initial stages to be provided by qualified, capable professionals, both in acute admissions and in the acute rehab phase," she says.

    "The first six months after any incident ... whether its brain trauma, or stroke, or spinal cord injury ... are pivotal to recovery," she emphasizes. "What happens to you in that first six months can make the difference to what level of care you progress to. This means the difference between going home to independent living, or going into an assisted living program, or whether you have to go into an extended care facility.

    "This affects your quality of life, as well as your long-term interaction with the health care system," she adds. "Obviously, the more dependent you are at the end of that process, the more support youre going to need from the health care system."

    She says although some of these factors are predetermined by the extent of the injury, for some patients, receiving therapy from a qualified health professional can make all the difference for the rest of their lives. "You could have two very different levels of outcomes for two patients, even if they start with a similar level of brain trauma, for example," she says. "In treating a stroke patient, for example, when Im having them go from sitting to standing, or transferring them out of a wheelchair, the entire time Im doing a hands-on assessment of muscle tone, of strength, of control ... and adjusting the treatment plan accordingly."

    Because this review will likely have an impact on other health regions, Vataiki considers HSAs participation of primary importance. "We want it recognized that paramedicals are the foundation and cornerstone upon which to build this system," she says.

    Additionally, the review is examining inefficiencies in the current system. "We are telling the review committee about the money wasted when people are stranded in narrow beds in acute care hospitals, even when theyre ready to be discharged. But there are no beds for them at the rehab level because there are people in those rehab beds who should be at home, but they cant go home because theres not enough community services," she says.

    One statistic quoted in the review reflects that 59 per cent of patients in the neurological ward at Vancouver General Hospital should no longer be in an acute care setting. "All of these inefficiencies in the system are things that our members know about, because these are the frustrations we face," Vataiki says.

    "And the wonderful thing is that most of the issues we are raising are now reflected at this stage in the position paper being developed. We are playing a very strategic role in getting our concerns reflected in this document. Clearly, our voices are getting heard," she says.

    "Traditionally, the professionals in this group put other people first and help other people get their needs met. And its time to get their needs met."

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