Sue Paul COO,OTR/L has been the Chief Operating Officer of Baker Rehab Group since 2002. Ms. Paul has held certifications in geriatrics through the American Occupational Therapy Association and served as AOTA representative for the End of Life Practice Recommendations for the National Alzheimer’s Association in Washington D.C. She is the author of the Head, Hands, Heart Dementia Assessment System, which is a healthcare provider tool for assessing and treating persons with dementia.
Well here we are at the end of OT Month 2015 and we’ve had some great insights and lessons shared by some of our colleagues. But not everybody got the chance to share. Not only was April #OTTakeover Month, it was also annual compliance month, and let’s-install-a-new-electronic-medical-record-month, and spring break month… and a month filled with a ton of work and growth and “stepping up” at BRG. Our therapists have been pushed to the max this month so we’ve decided to spread the love out over the rest of the year. So watch your inbox and the Baker Beacon for additional nuggets of OT wisdom. It’s good stuff.
But since it is still technically OT Month, allow me to share with you my own recent “a-ha” lessons. I’ve been an OT for almost 25 years, which means I pretty much know what I know, and I know what I don’t know. But it turns out, what I thought I knew is really something I used to know, or maybe I still know, but I lump in with other things I know into a fuller body of knowledge. Such are the fruits of maturity and experience. However, it seems I’ve been neglecting to put into practice some key principles that are really important in the delivery of quality occupational therapy services. Even more eye-opening is that I learned these valuable lessons from a new grad.
I have been covering patient treatments for one of our younger, newer therapists while she is on vacation. I have been pleasantly assured by all of her patients that her skills and aptitude for home health OT is top notch… they all love her. The one thing that they each have mentioned to me, and that they really appreciate, is how she has been able to break down the parts of task into smaller components. By reviewing each step of a task, they are able to hone in on each weak link and work on corrective actions. I keep hearing the same feedback over and over, “She really breaks it down for me.”
In occupational therapy lingo, this is called task analysis. We spend a lot of time in OT school breaking down functional tasks into components that consider movement patterns, cognitive processes, and environmental and psychosocial elements. It’s OT 101.
When you’ve seen the same task performed hundreds of different ways over the course of 25 years, you tend to take a more macroscopic view of issues. Or you tend to assume that the problem is obvious to everyone, because you’ve seen it so many times before. I have been reminded lately how crucial it is to explain task analysis to our patients. I had forgotten how much they appreciate understanding our reasoning behind treatment approaches, even the most obvious detail, and how important it is to show them the weak link in a sequence. I may know what the problem is and how to fix it, but may not bother to break it down into smaller steps for the sake of better compliance and participation. I tell them to trust me. When did I become such a know-it-all?
So I’d like to thank Rachel Hensberger for her stellar contribution to the OT community and for reminding me how valuable our basic guiding principles are. She has done her patients, her profession, and her “boss” a great service. I am humbled and grateful.
After graduating from college, I found myself working in a wonderful long-term care facility in the rehab department. This setting was where I did most of my clinical fieldwork while I was a student, hence making me most comfortable in this setting. Inpatient rehab is a great stepping stone before patients transition to home. I did my best to explain to my patients exactly what occupational therapy is since there tends to be a disconnect for a lot of people. Many people are familiar with physical therapy, so I had to put a little more effort into explaining my role.
During my treatment sessions at this facility, I would assist patients with their ADLs (activities of daily living) and encourage them to do everything as independently as possible with my recommendations. We would review how to get in and out of the shower, use the rehab kitchen to practice home management and cooking, and other simulated tasks, but still I had patients saying “This isn’t what my bathroom looks like; my shower isn’t as equipped,” or “My kitchen is so different than this one, it won’t be the same at home.’” My patients would reluctantly continue to participate and practice these tasks because it was ultimately preparing them for life at home. Still, I found myself frustrated not knowing if they were fully prepared to return to their own environment.
A year and an half later I decided to try out home health. I had never worked in this setting but it very much appealed to me. Now, I’m four years into it and I’ve never been so happy with my choice to work in this setting. I learned very quickly how beneficial home health occupational therapy is. Below are some examples:
Maximizing function in one’s environment: Simulated exercises and activities at rehab facilities can begin to help prepare someone for life at home but being able to actually work on interventions with a patient in his/her home can be greatly beneficial to making them safer, more prepared, and more confident being back home. Practicing shower transfers, getting in and out of bed, and preparing meals all in the patient’s home are just a few ways home health OT is beneficial. Being able to “age in place” is so important to keep our patients out of assisted living or long term care for as long as possible.
Assessments for fall prevention: When the OT visits the patient’s home for therapy, he or she can immediately point out a few safety issues that could be changed or modified to help prevent falls. For example, throw rugs, cords from lamps or TV’s, and tight spaces are all just a few red flags that can pose a threat to the patient. OT’s can make recommendations like rearranging furniture, removing throw rugs, and helping to make clearer pathways for a walker or wheelchair to patients and their families to improve the safety of the home environment.
Recommendations for home modifications: Many OT’s have references or someone they can recommend to help install grab bars or ramps to help make the home a safer place. Placing a piece of masking tape on the spots of a shower or bathroom of where the grab bar should go can help guide the family member or whoever is installing them to put them in the correct position. OT’s can also assess the shower to determine if it is recommended that patient obtain a tub bench, hand help shower, non-slip mats, and other tools to help modify the home so it is safer. They can also provide recommendations on how and where to get these items at an affordable cost.
Medication Management: Home health OT’s can assess a patient in their home on how they manage their medications. Asking the patient to prepare or select appropriate medications they take can highlight any errors that can be corrected through training. OT’s can recommend strategies and tools to help eliminate error and establish a routine for taking daily medicines. For example, creating an alarm, writing reminders and placing them in well seen spots, the use of automatic pill dispensers or daily pill cases are all ways to make sure the patient is able to properly and safely manage their own medication.
Caregiver/Family Training: Home health OT’s can help train family members or caregivers on ways to safely transfer someone with a disability, teach them exercises to do with the patient to maintain the patient’s strength and endurance, or educate them about dementia and what to expect when caring for a loved one. These are just a few ways Home Health OT’s can help educate the caregiver.
Katie Schroeder-Smith, MOT, OTR/L has practiced occupational therapy for over 13 years after studying psychology at UNC Chapel Hill and receiving her Masters in OT at Nova Southeastern University. Katie is certified in sensory integration (SIPT) and has received advanced training in pediatric and therapeutic yoga, handwriting, and Therapeutic Listening. She has diverse experience with all ages from infants to adults in home-based, school-based, and clinic-based settings, as well as hospital and nursing homes. Katie sees patients for Baker Rehab Group as an independent contractor, which allows her to work for a number of different providers in a variety of settings. Her contribution to the BRG OT network has been invaluable.
What do occupational therapy (OT) and yoga have in common?
First of all, to define occupational therapy, it is helpful to know that the “occupation” part actually comes from the verb: to occupy oneself, purposefully, meaningfully, and driven by ones own motivation and goals. Dysfunction, occupationally speaking, could occur in any aspect of one’s purposeful life.
There’s physical dysfunction (perhaps a person is limited by chronic back pain, arthritis, a heart condition or a broken bone) and psychological dysfunction (depression, anxiety, dementia, autism, ADHD).
Dysfunction may even occur at a deeper level, where a person has lost motivation and goal oriented activity, or has perhaps been enabled by learned helplessness or perceived inability. Dysfunction may result from a mismatch between a person and his/her environment. Think of an elderly individual with severe arthritis and osteoporosis who lives in a 3-story row home with narrow doorways, or how about a child with ADHD who lives in a disorganized house without family support who frequently loses his homework.
Dysfunction can present itself in activities of daily living—think again of the arthritic woman who can no longer dress herself or carry things up and down the stairs, or the child with ADHD who cannot sequence his morning routine. It can present in work related tasks– the woman who has poor balance in standing to cook a meal for her family, the child who struggles to sit still or write a sentence in school; or in leisure tasks- the woman who cannot perform her favorite hobbies of needlepoint and gardening, the child who has difficulty participating in organized sports.
However, as the American Association of Occupational Therapy (AOTA, www.aota.org) points out, OTs ask a client “what matters to you?” rather than “what’s the matter with you?”
When a person is not well for whatever reason, he/she often experiences a disintegration of body, mind and spirit, and what matters to that individual is not always readily apparent to even that person. The individual who suffered a stroke must now learn to function inside a body where he can only control one arm and one leg, struggling with basic skills such as rolling over in bed, using the toilet and brushing his teeth. Ask that person what matters to him now, and it’s not yet golf or returning to work; it’s simply walking, talking, and eating.
Yoga can be defined simply as “unity”. Unity of body, mind and spirit. As an OT, I can’t help but extrapolate that to unity of person and environment, unity of person and task, unity of person and person. Yoga is a discipline, traditionally based in eastern philosophy. Occupational therapy, using principles, strategies and poses from this ancient holistic perspective, merges beautifully with the foundations on which the profession of occupational therapy was built. Looking at a person holistically, the OT with a yoga perspective will consider the following 5 tenets of yoga: relaxation, exercise, breathing, eating and positive thinking.
Relaxation, noticeably important in cases of anxiety or stress, is also very significant to recovering from a physical injury. I haven’t met a person with an orthopedic injury who doesn’t tense up or compensate with other muscles. Yoga can help develop body awareness and coping strategies to relax the muscles that don’t need to work, and focus on working the ones that need it. Yoga can also help a child or adult with self-regulation, or learning how to find that calm alert state for optimal attention, focus, and social skills.
Exercise is perhaps the most obvious similarity between yoga and OT as a rehabilitation profession. What is special to yoga however is even the most basic poses require the use of core muscles, those abdominal and spinal muscles that provide stability and alignment for all of life’s activities and movements. Yoga, as a form of exercise, can also be easily adapted to all ages, from infancy to the oldest of adults, and can be graded to the individual’s needs and abilities.
Perhaps one of the most significant contributions of yoga is its focus on breathing. Learning proper breathing methods is critical to those with cardiovascular and respiratory conditions, of course, but it is also crucial for both relaxation and exercise to properly occur. Focusing on the breath allows one to be in the present moment, engaging in an occupation of choice. Breathing techniques are also one of the most effective strategies for self calming, an area that many kids on the autism spectrum or with sensory sensitivities struggle with.
Eating, as a vital activity of daily living is an area that OT traditionally focuses on with regard to independence, adaptation, meal preparation, or oral motor skills/ swallowing. Using a holistic yoga perspective, which foods a person eats and how they regulate their eating patterns also becomes important.
Lastly, positive thinking seems like a no- brainer, for any professional looking to help and heal others. Through the principle of non-judgment and use of strategies such as meditation and positive affirmations, yoga is a wonderful adjunct to OT as a client deals with frustration and patiently works towards his/her goals.
OTs use occupation as both and ends and a means. Simply stated, not only is the person working on a goal in one or more areas of his occupation (I.e. Putting a shirt on independently) but as a means of achieving that goal.
One of my favorite quotes about OT comes from a renowned OT, Mary Reilly: “Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.”
There is more to occupations than activities, purpose, and meaning. Occupations affect our health. What we choose to do, or not do, to occupy our time, profoundly influences our health. Occupations change and evolve over our lifetime, and are most definitely influenced by illnesses, traumatic events, or injuries that occur along the way.
My father was always an avid skier until he had a bad fall and broke his leg. Physically he could have returned easily to the sport after recovering, but his motivation to engage in this was severely changed by his traumatic experience. Luckily, he found other healthy occupations to replace this one.
Yoga can be a healthy, doable replacement for occupations that were unhealthy, impractical, or no longer enjoyable. Yoga can also be a therapeutic means in which to reach another occupational goal, for example improving posture to be able to sit upright to feed oneself, or to optimize focus in the classroom. Last but not least, yoga can be a lifestyle change, in which it is integrated into daily life routines to positively influence health, decrease stress, and improve performance of occupations throughout the life span.
I did not even mention all of the research pointing to the benefits of yoga for health, various medical conditions, and in school age children, to name a few. Look for another post in the near future!
Theresa Davis is an independent contractor who provides occupational therapy services for BRG clients, as well as through other providers in Maryland. Theresa has spent the majority of her career working the older client. She has such great insight into the benefit of occupational therapy in the home health setting.
After working in various settings for 20 plus years as an Occupational Therapist, the one thing I have learned is the importance of being patient, caring and loving with our elderly residents.
There is so much we can teach our patients about being stronger, improving their endurance, increasing their hand dexterity, dressing themselves with less assistance, learning to walk better to use their bathrooms, etc… However there is so much they can teach us as well.
They teach us to listen better, to be empathetic and understand all the troubles they are having. This in turn allows us to find the best ways to motivate them. The most important thing to most of them is that we care and that we are there to “listen” to them. As therapists, we sometimes undervalue our role and the importance of “touch” for this population. For many of them, they have been placed in a facility against their choosing in which their families either can’t or don’t come to see them, leaving them to feel both empty and abandoned. I have to come to realize over the last several years the vast importance of empathy, hugs, smiles, asking how their day is going, and just providing the acknowledgement that I care about them and am invested in their well being. Even the residents that are not being seen by therapy services in a senior living setting still benefit from the acknowledgement and caring attitudes we give them. We have several residents that come into our clinic just to be around us and talk.
Additionally, we need to help bridge the gap between the overworked caregivers- who may not understand the disease process of the cognitively impaired- and the residents who need so much more than basic care. This population needs additional love, touch and empathy, even when their minds and bodies are failing them. They can still understand a smile, a hug, and positive body language. So, sometimes when we feel frustrated because the physical progress may not be as aggressive as we would like, we need to remember the positive impact we are having on our residents in other ways to improve their well being.