Occupational Therapy Its the Ticket Home Presented by: Amy H. Avery - PDF document

8/25/2016 Occupational Therapy It’s the Ticket Home Presented by: Amy H. Avery MS OTR/L & Vicky Hall MS OTR/L What is occupational therapy?  The American Occupational Therapy Association (AOTA) defines occupational therapy as “assisting people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes.” 1

8/25/2016 What is occupational therapy?  Occupational therapy services may include comprehensive evaluations  Home and other environments  recommendations for adaptive equipment and training  guidance and education for family members and caregivers Evidence based research  Occupational therapy assists older adults with developing routines that help enhance self-efficacy in illness management (Marian Arbesman & Letha J Mosley, 2012)  Engaging in daily health-enhancing practices contributes to a variety of outcomes, including a reduction in mortality, disability and frequent mental distress (Marian Arbesman & Letha J. Mosley, 2012)  Participation in physical and occupational therapy in the earliest days of critical illness was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, shorter duration of delirium, and more ventilator-free days compared with standard care (Brahmbhatt, Murugan & Milbrandy)  Occupational therapy provide solutions that go beyond the traditional medical model. Occupational therapy programs provide much-need in-home care, save money, free up in hospital space for patients (Rexe, McGibbon, Zweck, 2013) 2

8/25/2016 When to refer to occupational therapy?  When there are concerns for functional independence or safety  New medical diagnosis  Cognitive changes  Physical limitations  Caregiver training  Discharge planning  Medication adherence  Issue and educate on medical equipment Occupational therapy inpatient setting  Common referral reasons…  Assess a person’s level of independence with activities of daily living (ADLs) and instrumental activities of daily living (IADLs)  Educate on surgical precautions  Educate on medical equipment  Provide caregiver training  Recommend additional therapy services as needed  Assess and recommend additional supports in the home  Assess functional cognition 3

8/25/2016 Inpatient evaluation  Patient’s concerns  Patient’s goals  Prior level of function  Medical equipment  Quick visual screen Falls Risk Assessment Tool  Quick functional cognitive screen  Assess fall risk  Screen functional movement  Assess level of independence with ADLs Based on evaluation  Recommend additional therapy  Refer to other services in and out of the hospital setting  Issue needed medical equipment to promote safety and independence  Provide patient and caregiver training  Discuss recommendations with interdisciplinary team 4

8/25/2016 Inpatient case  This is Max.  Max is a 65 year old male who came into the hospital after a ground level fall fractured his right hip. At the hospital doctors recommended surgery and patient underwent an ORIF. After surgery doctors recommended that Max remain TTWB for 6 weeks until his follow up appointment. Max lives with his 85 year old mother in an apartment on the 3 rd floor. Max drives to his full time pharmacy job 5 days a week. Max referred to occupational therapy  Max referred for an occupational therapy evaluation  Interdisciplinary team meeting prior to discuss patient’s needs  Complete evaluation  Patient’s mother has mild dementia and he provides care  Home is not wheelchair accessible  Max does not have any medical equipment and has never used any before  Max has a sister who lives 2 blocks away with her family  Max’s cognition is intact  Can manage his basic activities of daily living with education and equipment  Max has difficulty standing for long periods of time and often gets unbalanced  Max wants to go home after discharge and to return to work as soon as possible 5

8/25/2016 Occupational therapy recommendations  Issue and educate on DME/AE  Review precautions and doctors orders  Education on home safety and fall prevention  Recommend family providing temporary assist  Additional therapy as outpatient  Discuss return to work needs  Education on techniques to increase safety and independence  Discuss transition to home According to a 2010 AARP study  More than 80% of people 50 and older want to remain in their own homes  About 25% of respondents want to stay in their homes because they can’t afford to move  80% have a full bath and a bedroom, or room that could be a bedroom, on the main level  36% reported having an entrance without steps 6

8/25/2016 When to ask for a home safety evaluation?  When there are concerns for:  Ability to manage other aspects of routine life (IADLs)  Ability to manage basic self-care (ADLs)  Suspected cognitive deficits Safety  Safety  Falls and mobility  Oxygen safety  Access to the home and necessary rooms  Possible unsafe/unsanitary conditions in the home  Medication adherence  Equipment needs  Adequate social support in the home  Other hazards 7

8/25/2016 The Home Safety Evaluation  Patient has had a decline and family was wanting recommendations in order for patient to be as independent as possible. Caregiver was give recommendations for tub/shower. 12 inch vertical bar for getting in and out of tub. Diagonal bar on tub wall for safety during bath/shower. Patient’s toilet is in a room of its own and OT would recommend a grab bar on wall for safety and for standing while performing needs. 8

8/25/2016 Comprehensive home safety evaluation  General idea of ADL/IADL skills, noting problem areas  Observation of cognitive deficits in the patient and caregiver  Observation of the home environment  Support network Home environment  Outside observations  Street view: neighborhood, walkways, steps/railings, general tidiness  Entrances: stairs, railings, lighting 9

8/25/2016 Home environment  Inside observations  Living areas: lighting, flooring, furniture, trip hazards  Kitchen: appliances, cleanliness, clutter  Bathroom: access to facilities, presence of grab bars/DME 10

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8/25/2016 Home environment  Bedroom: bed height/accessibility, pathways, clutter  Proximity to bathroom  Night light? Other  Interior stairs  Poor sanitation/infestation/food safety  Difficulty with medication management  Transportation  Difficulty accessing telephone/doesn’t know 911  Smoke detectors  Adequate heating/cooling  Oxygen safety (smoking?)  Guns  Pets  Weather conditions 12

8/25/2016 Documentation should include  Objective findings with emphasis on identified problems  Patient/family education  Recommendations for equipment, modifications, other services  Follow up plan Special considerations  Dementia (patient and/or caregiver)  Behavioral problems  Mobility limitations  Morbid obesity  Rental home 13

8/25/2016 References  Arbesman, M. & Mosley, L (2012). Systematic Review of Occupation-and Activity-based Health Management and Maintenance Interventions for Community-dwelling Older Adults. The American Journal of Occupational Therapy, 66, 277-283.  Brahmbhatt, N., Murugan, R. & Milbrandy, E (2010). Early Mobilization Improves Functional Outcomes in Critically Ill Patients. Critical Care 2010, 14:321. D’Amico, M. (2011). Updated on Productive Aging in the American Journal of Occupational Therapy 2011, 66(4), 61 -72.   Rexe, K., Lammi, B. & Zweck (20130). Occupational Therapy: Cost-Effective Solutions for Changing Health System Needs. Healthcare Quarterly, 16(1), 69-75.  http://assets/aarp.org/rgcenter/general/home-community-services-10.pdf  2010 AARP study on home and community preferences for the 45+ population  http://nihseniorhealth.gov/falls/causesandriskfactors/01.html  NIH Senior Health. Falls and older adults: causes and risk factors  http://www.aota.org/~/media/Corporate/Files/Practice/Aging/rebuilding-together/RT-Aging-in-Place-Safe-at-Home-Checklist.pdf?la=en  2-page checklist to help identify potential problem areas in the home  http://agingresearch.buffalo.edu/hssat/  Home Safety Self Assessment Tool: 61 pages, includes diagrams, photos, some ADA and local information  http://www.cdc.gov/HomeandRecreationalSafety/pubs/English/booklet_Eng_desktop-a.pdf  Large-print format with tips for basic environmental changes to improve home safety  http://www.unmc.edu/media/intmed/geriatrics/nebgec/pdf/frailelderlyjuly09/toolkits/sample_home_safety_checklist.pdf  Brief checklist that looks at common areas that can be problematic  http://www.homesafetysmartcheck.com/siteimages/2010/11/RoombyRoomOlderAdultNov11.pdf  Room-by-room safety checklist for older adults  http://www.ces.ncsu.edu/depts/fcs/pdfs/FCS-461.pdf  Four-page safety checklist organized by separate rooms and areas Thank you for your time 14