Truth is, it is both
rewarding and at times,
disappointing. When I first
came here in 2003, I worked
for a home health therapy
company that required me
to drive around a 100 miles
almost every day. I was
assigned a chauffeur(spell
check please) for the first
month since I didn’t have a car right away. I still have to get a driver’s
license and I am still waiting to get my social security number. Without
your SS number, you can hardly do anything, you can’t apply for a car
loan, you can’t apply for an apartment, you can’t open a bank account.
It took about a month and a half when I got all I needed to have a car
with the help of my former mentor, an apartment and a bank account.
But it didn’t come easy with my former employer constantly pushing
me to get my own car right away. My employer even didn’t have group
health insurance but they would have reimbursed me if I had to buy my
own health insurance.

Unfortunately, I was not able to get a health insurance since
insurance companies required me to be either a permanent resident
or a citizen. My status was still on a temporary working visa at that
time. Without health insurance, you
would end up paying thousands
of dollars out of your own pocket
in health care costs. To see a GP
doctor, you would at least pay $100
just for a few minutes of consultation
or examination. What I did was for
minor ailments I had to go to a truck
stop and get consultation for $30-
$40 from a nurse practitioner, that
was the rate if you don’t have health
insurance but at least it was cheap.
The truck stop is a place you really
don’t want to hang out, seeing these
big and burly truckers speaking very
“colorful” languages. At times, they
talk to me thinking I was Chinese or
Mexican. In some occasions it was a
place where prostitutes hang out to
ply their trade to these truckers. All this I had to endure since I didn’t
have health insurance from my employer. This made me decide to look
for a different employer after a year. Negativity aside, being an OT here
is rewarding in the sense that I felt this as being a necessary occupation
or field. People or patients appreciate the need for OT and the need
to regain functioning since most of the patients I see needed to be
able to take care of themselves. They don’t have the luxury of family
members sacrificing their time and resources just to take care of loved
ones. In the Philippines, I believe it is still not greatly appreciated at
least in adult OT practice. People there would almost immediately opt
to have someone, family or not, to do things for them and independent
functioning is not viewed as a dire need. Culture definitely dictates it.
Don’t get me wrong, this mostly applies to adult OT practice since I
know there is already a good level of awareness of the need for OT in
pediatric and mental health practice in the Philippines.

After my first year here, I moved to a different state and of
course, a different employer. Now I have group health insurance. This
time, I am assigned to work in various clinical settings, mostly hospital
based and some nursing home facilities as well. This was the time I
learned the disappointing fact of OT in some of the workplaces I’ve
been. Mostly in the nursing homes, they tend to ignore your clinical
judgment which you have tried so hard to hone in your 5+years
of schooling and training. All they care is that you see patients for
the longest possible time, even if you already know some patients
have very limited potential of getting back to being independent.
Going back to OT books, it is clearly stated we have the utmost skill
and prerogative to discharge patients that aren’t benefiting from
continued OT. However, in some workplaces they don’t believe
that since they only try to squeeze as much reimbursement as they
possibly can from third party payers. I’m not saying this applies to
all nursing homes, but most especially the ones I worked in. This
is also another thing here in the US that healthcare payments are
usually done by a third party, namely private insurance, Medicare or
Medicaid. If private insurances only give you a few OT sessions being
covered, then you only get to see patients for that time frame, even
if you might think patients would still need more. Nevertheless, I’ve
also experienced the rewards of being an OT in at least 2 hospital
based acute rehab settings. There, patients tend to be very proactive
with achieving their functional goals and very well aware of each
OT goal that is being set. Each and everyday, patients there know
what they needed to work on to get better functionally. Staff meets
almost everyday to discuss progress and come up to a common plan
on when and where to discharge patients. In short, these settings
provided me the opportunity to exercise my clinical judgment in the
most professional and rewarding way.
Now I already have a family of my own
and I again changed employers. I came
back to working in home health since it
allowed me the flexibility of schedule. My
current employer is good at allowing me
again to exercise my clinical judgment.
Right now, my work here as an OT is for
the most part rewarding. Until the time
comes when public funded Medicare
and Medicaid might run out, it is still
a lucrative profession and still very
in demand. I think OT is still a good
profession to be in if you find reward in
its outcome.

Nowadays, I am beginning to look into other opportunities
not related to OT, hoping and praying I can have my own business
and be my own boss. I hope this letter did not offend anyone, but this
is basically what I’ve experienced in my 9 years of being here. Living
here in the US means you have to take care of everything from doing
your own laundry, cleaning, cooking, home maintenance since it is
expensive to hire someone. It also means you have to have thick skin
and educated assertiveness sometimes since this is the only way to
make it here. This is the only way for you to be able to reap all the
benefits this Land of Opportunity has to give.