Occupational therapists: Understanding the potential role in long-term care By Appu Jyoti, Registered Occupational Therapist, LifeMark Eldercare [Reprinted with permission from Long Term Care magazine, Vol 18, No 4, pp 34-36.] March 2009- With the myriad challenges in long term care—including the increased complexity of resident care, adherence to compliance standards and the heightened expectations from family and residents—occupational therapists (OTs) are an underutilized professional resource. This is unfortunate, given the role of the OT in enabling individuals to achieve and/or maintain an independent, functional and meaningful life through therapeutic interventions. It is possible—and desirable—to maintain or even improve the independence of individuals who make the transition to long term care. Having access to a team of health care professionals that includes an OT can afford residents the opportunity to enhance their functional independence. Furthermore, with the implementation of the minimum data set and the increased need to record all restorative and rehabilitation activities, the expertise offered by the OT strengthens the long term care home's documentation process. OTs are university-trained registered health care practitioners who work under practice standards established by the Ontario College of Occupational Therapists. OTs work in a wide range of locations, including long term care homes. The age of OT clients also varies, from infants to the elderly, although seniors are the OT's second largest client group, second only to the general adult population. “What We Heard” The Ministry of Health and Long-Term Care (MOHLTC) and the Seniors Health Research Transfer Network hosted a consultation process to develop a common vision of quality in long term care homes that is reflective of all aspects of the resident's long-term care experience. Their findings led to the creation of a document entitled, What We Heard: Long Term Care Quality Consultation 2008. Occupational therapy was not explicitly referenced in the report, which likely speaks to the fact that the role of the OT in long term care is in its infancy. As well, there is no specific funding for this professional service, unlike physiotherapy, which can be accessed through OHIP funding. (There are some long term care homes that can access OT through a rehabilitation company in conjunction with OHIP-funded physiotherapy services.) Instead, residents must attempt to secure OT through their local community care access centre or purchase the service privately. Five themes arose out of the multi-city consultations: • Create an environment that promotes quality of life for residents. • Make ‘home' a central part of the long term care experience for residents and their families. • Build a community that supports quality long term care by leveraging partnerships and creating a positive image of long term care for residents and staff. • Create a culture of quality care and improvement. • Develop leadership, and align incentives and resources to support the quality vision in long-term care. When one considers these themes, it is apparent that the OT should be considered an integral member of the health care team if the vision is to be realized. As client-centered practitioners who use a systematic approach to identifying the needs of the individual and implementing evidence-based treatment, OTs are a perfect fit. The role of the OT OTs are experts in identifying barriers to quality of life in three categories: self care, productivity and leisure. A resident's health, safety and well-being are essential considerations for an OT. Their expertise makes it possible to develop effective strategies that will maximize the quality of life and independence of a resident, while considering his or her unique needs and environmental reality. OTs serve the long term care home in a number of different ways, including: mobility and positioning; restraints; falls prevention; activities of daily living; dementia care; restorative care; splinting; and staff in-service training. Mobility and positioning Mobility and positioning is the most recognizable role for OTs in long term care. Many OTs are assistive devices program authorizers. As such, they complete assessments for mobility and seating equipment (e.g., walkers, wheelchairs, cushions and scooters) and submit the application for funding on behalf of the resident to the MOHLTC's Assistive Devices Program Branch. Ensuring residents have the appropriate mobility devices is a crucial factor in maximizing safety, mobility and comfort and is a key role of the OT. Restraints Most long term care homes have adopted a policy of ‘least restraints.' OTs support the home by offering recommendations for alternative positioning devices that reduce and/or eliminate the need for restraints. The OT works closely with the staff, residents, family members and equipment vendors to determine the best alternatives given the client's specific circumstances. Furthermore, the OT's documentation may help to support adherence to MOHLTC standards. Falls Prevention Reducing the risk of falls requires an interdisciplinary, multi-faceted team approach. OTs collaborate with the health care team to evaluate the resident's status, assess behavioural challenges, provide interventions and make recommendations regarding improvements to the living environment (e.g., rearranging furniture in the bedroom) and to incorporate the use of assistive devices (e.g., grab bars, transfer poles) into daily care. Activities of Daily Living The tasks involved in self-care (e.g., toileting, dressing, eating)—although automatic during our adult lives—can become increasingly difficult as we age. This does not mean that residents who struggle with their own care must become fully dependent on others. OTs are expert at finding solutions that enable residents to maintain or even regain some of their independence and dignity in carrying out their activities of daily living. Treatment can include retraining the resident, the prescription of adaptive equipment (such as Velcro instead of buttons and zippers as fasteners) and the education of front-line staff in ways they can help residents remain or become independent. Meals and the entire dining experience are increasingly important in long term care. For residents who cannot feed themselves or require assistance with eating, the challenge is allocating adequate staff resources. OTs work on retraining residents who have lost their ability to feed themselves due to stroke or injury. The OT can also offer recommendations for adapting the physical environment, mealtime positioning and eating utensils that maximize a resident's independence. For residents with dysphagia, the OT can assist to ensure proper positioning and make recommendations to increase swallowing safety and reduce the risk of aspiration. Dementia Care Behavioural problems associated with the progression of dementia are difficult for long term care homes both in terms of limited resources and risk of injury to staff and residents. OTs can plan specialized activity programs that focus on supporting remaining abilities. Coordinating group activities for residents that provide meaningful and purposeful engagement in a structured setting help to maintain cognitive function and reduce disruptive behaviour. Restorative Care The restorative care approach and the programs that result from this philosophy are an integral component of resident care. The OT can develop and supervise restorative care programs that centre on feeding (e.g., dining programs) and dressing. The OT also assists in ensuring the programs are goal-oriented, resident-centered and outcomes-based. Splinting Whether the result of an injury or a chronic disability, affected limbs can be splinted by the OT to maximize function and prevent further deterioration. Preventative splinting of joints can also help to reduce further loss of range of motion. For example, splinting of the hand post-stroke often reduces the risk of contractures developing and minimizes pain in the hand and wrist. This inevitably makes it easier for front-line staff to keep the area clean and well cared for. Staff in-Service Training OTs should be considered an essential part of any educational program for the health care team in long term care. Instruction on safe transfer techniques, adaptive equipment training and communication strategies for residents with cognitive or sensory impairment are examples of the range of issues to which OTs can contribute solutions in long term care. References • Boudreau ML, King D. Falls and older adults: occupational therapists working in the community to facilitate participation. Occup Ther Now 2007;9(5):6–7. • Dawson DR, Stern B. Reflections on facilitating older adult's participation in valued occupations. Occup Ther Now 2007;9(5):3–5. • Profile of Occupational Therapy Practice in Canada . Ottawa : Canadian Association of Occupational Therapists, 2007. • What We Heard: Long-Term Care Quality Consultation 2008: A Common Vision of Quality in Ontario Long-Term Care Homes. Toronto : Ministry of Health and Long-Term Care, Seniors Health Research Transfer Network, 2008. |