OT Across America: Carbondale, CO with Mandy Chamberlain OTR/L

For this OT Across America interview, I got to sit down with my friend and fellow OT blogger Mandy Chamberlain, OTR/L, founder of Seniors Flourish.

In the interview, Mandy shares her perspective of occupational therapy in Carbondale, CO along with the ins and outs of starting an occupational therapy business. We also got the extra bonus of camping in her driveway for three days while getting to explore the beautiful Colorado mountains 🙂

For more about Mandy, be sure to check out her Seniors Flourish website and podcast. Both are fantastic resources for students and new occupational therapy practitioners interested in working with older adults.

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Tell us about your background. What drew you to occupational therapy?

I grew up in a sandwich generation family, so my grandfather lived with us after my grandmother passed away and he ended up having a stroke. He ended up going to rehab which exposed me to occupational therapy. I was always really interested in mental health and psychology, and thought I would go into social work.

I was exposed to OT through his rehab process and found that you could do both mental health AND physical disabilities? That’s pretty cool. Your family goes through those situations and you learn about the profession through that.

What settings are you in and how long have you been practicing?

I went to University of North Dakota and have been practicing since 2003, so 15 years now. I do a little bit of PRN in skilled nursing facilities since it’s very flexible with having a young family. Most of my time is spent on my business, Seniors Flourish, that I started when my kids were really young because I wanted to stay connected to other occupational therapists. I started it as more of an OT and caregiver education focus and then more OTs started reaching out saying, “We really don’t have a lot of blog information for other OTs” so I shifted my focus.

I then started the Seniors Flourish Learning Lab because people were asking questions about treatment ideas, ethics or that they needed some mentorship, for example. The membership consists of students on fieldwork and new graduates that might feel like they’re struggling and want to feel more confident in their job. Also we have people that have worked in pediatrics a long time and are transitioning to working in home health, for example.

Seniors Flourish is a bit non-traditional but when I was working full time, I’d have fieldwork students and LOVED it. I really felt like I was giving back. I had such a good relationship with my students and I felt like my role was to nurture the new professionals. I had a really good experience doing that, and now I feel like I’m doing it now, but online, where I can still help make an impact.

What does your typical day look like?

That’s a really good question! Right now, it’s family first so I’m with the kids a lot. I get the kids ready for the day (they go to school a couple days a week), so I have a few days a week where I can work exclusively on the website.

I do a lot of work on Seniors Flourish after hours after the kids go to bed, where I do things like edit the Seniors Flourish podcast at 9:00 at night. I do have those a couple days where I devote to catching up on emails, getting new free content out there, or new content for the Learning Lab members.

There’s just always something to do when you work for yourself! It can be very time consuming and take a lot of devotion, and a lot of hard work. It’s a lot more time consuming than you would think but it’s also really rewarding. [Sarah: I fully agree with this statement!]

What are your productivity standards when you’re working PRN?

For productivity when I work in skilled nursing, I work in nationwide-facility contracts, which have much stricter productivity standards like 90% for an OTR. I think it also depends on the type of setting and where you are.

There are lot of things that go into that, like where I live there aren’t a lot of PRN therapists, so if I don’t have very good productivity I’m at a place in my career where I explain if I had a day of 70% productivity, I can say “I did X, Y and Z,” and I do what I can.

Maybe with some facilities you may be let go or not asked to return, but around here it’s like, “We still need you!” So I always justify that I do what I can but it always just depends on the day.

But then you have some local facilities that are in-house therapy and they’re wonderful! So I think there are pros and cons to each type of facility and I loved working in some of those facilities that are in-house.

The in-house skilled nursing facilities are out there and they can be awesome. They really put the patient first They still have productivity per se but they’re a little more lenient on it. It’s just different from big corporations.  I’ve seen both sides. In the good skilled nursing facilities, I’ve really enjoyed it. It can be really rewarding.

How many patients do you see in a day? Do you see multiple patients at a time?

In general when I work, I’m just doing a lot of evaluations and paperwork. Most of the SNFs where I work do not do groups. If sessions are 60 minutes, I can end up seeing eight patients a day, but they don’t overlap with Medicare rules and that sort of thing. The amount of patients just depends on the day.

What are the most common diagnoses you see?

Now that I’m working in skilled nursing in general, I’d say a lot of diagnoses are post-surgical, delirium post-hospitalization, generalized weakness, failure to thrive, or they might be deconditioned, or had had a CVA. A lot of people are going directly home post-CVA lately.

What do you like most about your job?

I like working PRN since I can go in there, do my job well, and then just go home. I do really like working with the older adult population. I love the stories and the idea of really helping a population that I feel gets left behind a lot, and not advocated for as strongly as they should. So I have a heart for that. And in a smaller skilled nursing facility, I also really enjoy getting to know the CNAs and having that family environment.

With my business, I love connecting with other people and helping give the resources that they need. I feel like it’s actually making a difference in the OT world, and online your voice gets to speak to many people versus just one on one. You get to reach a wider audience through the website, podcast and membership site. Anybody can read it.

It’s crazy to see people from 180 different countries listening and reading! I think that’s really cool and one of my favorite parts. And I love program development, so I feel like with the Learning Lab Membership site that’s what I get to do, like create resources or help with topics that the members want. It’s just a really neat way to connect with other OTs on a different, non-traditional level.

What are the biggest challenges in your jobs?

In skilled nursing, the biggest challenges I think are productivity issues, and seeing the lack of carryover of our recommendations. In home health, you have a 1:1 caregiver or when you work in outpatient, you don’t see the direct impact as much. But in a SNF, you see the direct impact. You draw pictures, make videos, post things, do education sessions and a splint will still be on upside down or something crazy like that.

And you think, “Man, I’m working so hard on this!” and you’re not in charge of the CNAs, so you can educate, educate, educate but you’re not their boss, so that’s hard. I’ve worked with some awesome CNAs but I think that’s the biggest challenge: You need the CNAs to do a lot of that carryover and it’s really hard especially with cognitive things. I get it, I was a CNA in college and you have 100 patients to see and you’re trying to do the best you can, and it’s just a hard dynamic. That’s the hardest part of skilled nursing.

The hardest part about my online business is time management! There just aren’t enough hours in the day and we’re driven to work hard and make it happen and get everything done. But you have your own responsibilities. But that’s part of working for yourself. It’s always trying to divide the time between family and self-care, like work-life balance, is that even a thing? Haha.

So I think it’s better when I make routines and habits, like I have to sleep. For me that’s the hardest part. I really like working on the business, so I get started on it and I don’t want to stop, but I have to sleep and want to spend time with my family. So dividing it all up is tricky.

What is the job market like in your area?

In this area, I wouldn’t say there are tons of jobs or over-saturation. I think there are a lot of PRN jobs but it’s not like living in a city where there are a lot of full-time options as well. In my area, it’s kind of unique that you have some really rural little towns that do always need people, so it’s just different. You could work a lot of PRN jobs, which can be overwhelming for some people.

Is there anything unique about occupational therapy and your region? 

Around here, you get a lot of ranchers and a more rural population when working “down valley,” and you can work at the other end of the valley with a lot of active older adults [near Aspen, Colorado]. So you can have a bit of the extremes, so that’s kind of unique. So working outpatient, you’ll see a lot of skiing and mountain biking injuries even with older adults.

Is OT appropriately represented in your SNF settings? Do you feel like you need to advocate for it?

I don’t think OT is necessarily represented well in most places. I really don’t feel like any of the facilities I’ve worked in the last 15 years really have a good understanding of what occupational therapy does. You have to advocate for our profession which is really hard because what they see you doing and what you’re actually doing are two different things.

I try to use the analogy of if you’re working with a physical therapist that doesn’t understand the value of OT, it would be like telling them “You just give exercises, why can’t they just go to a personal trainer?” And they’d say “Well we do more than that!”

We’re not just getting people dressed; we’re skilled and there’s way more to it. And I feel that specifically in skilled nursing, we don’t represent and do enough cognitive evaluations. I think if we could do that better then you can definitely see a different area of OT that we really do well that isn’t necessarily represented well.

But the hard thing about that is the carryover, so it’s kind of a catch-22 because I think sometimes it gets brushed over. OTs might think “I’m assessing subjectively” but we could assess and objectify a lot of information and show that to nursing or your fellow therapists and show that “this is why that functional activity is good for the patient and this is how we can help with adverse behaviors.”

So if we can assess cognition correctly, we can modify the environment for patients to be more successful. I don’t think that gets done enough; I think part of that is us but I think it’s also hard to educate and tell people what we do. It’s so specific to the setting because you do a little bit of a role in each setting trying to advocate and educate.

I think some of the easiest ways can be if you end up talking to a doctor that you have the same patient with, you can educate them one on one. You can say “This is how I can help your patient.”

I’ve said to doctors, “This patient is showing this, this and this, and this is how I can specifically help your patient.” And they might say, “Huh, I didn’t really realize you did it that way.” Versus just saying “We promote independence,” since that’s so broad.

How would you rate the compensation for OTs in your area?

I think in this area it’s a little bit higher. Colorado is a little higher unless you work in Denver. There are a lot of practitioners in Denver so it’s lower there.

Colorado can be a more expensive place to live so many places do compensate more. And I think it’s all about supply and demand as well. PRN pay is higher than regular full-time and SNF’s pay more than other facilities which is pretty typical.

What are your future plans for your occupational therapy career?

I would really love to expand the website, expand the podcast and expand the membership site! Now it’s an OT business; before it started out as a hobby and now it’s an actual business. I’m very driven to make it a buyable business but also make it a really good resource for other OT practitioners and students.

I’d still like to work PRN and maybe when the kids go back to school pick up more PRN work than I do now. It’s good to keep my foot in the door and keep my skills up and stay in the loop of OT. It’s important you don’t lose those clinical skills since things evolve, like documentation systems and payment systems.

My biggest goal is to grow Seniors Flourish and be an amazing resource!

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I want to thank Mandy again for sitting down with me for this “OT Across America: Carbondale, CO” edition and for letting us camp out at her home! For more information about becoming a member of the Seniors Flourish Learning Lab, be sure to check it out here.

And if you’re an OT practitioner in Colorado (or you’re an OT business owner anywhere!), please feel free to share your experiences in the comments below.