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The role of occupational therapy
In care homes

Victoria Elliot and Helen Martin discuss the value of employing occupational therapists and how they fit into a care home environment.

According to recent statistics from Age UK, the number of older people living in residential care has reached over 430,000 throughout the UK, with 27 per cent of these remaining in a care home setting for more than three years.

Karin Tancock Professional Affairs Officer at the College of Occupational Therapists was quoted as saying that, ‘Activities, daily tasks roles and routines that are key to our identity are particularly important for older people in care homes who are at risk from health complications if left with nothing to do.’

There are over 34,000 occupational therapists (OTs) in the UK; however, the number of these working within the care sector is sparse. This is despite their ability to provide unique skills and expertise to support care teams, while improving the quality of life and wellbeing of the residents they care for.

Benefits of occupational therapists in care settings

With a knowledge base established on the belief that occupation and engagement in activities that have personal meaning is necessary for the health and wellbeing of all individuals. OTs in care home settings work to incorporate significant daily activities and meaningful roles into the lives of residents, providing an important feeling of identity that empowers older people and gives a sense of purpose.

From helping staff tidy after a meal to watering plants in the garden, purposeful activities like these are life-enhancing and can help lift someone’s mood, give meaning to their life, provide a reason to get up, develop a sense of identity and independence, and may even, according to the College of Occupational Therapists, reduce hospital admissions.

Not only can OTs provide meaningful ways for residents to occupy time, but they can also offer insight and training to care teams that can augment overall communication with residents, as well as improve a home’s physical and social environment and layout.

Involving occupational therapy students

As part of a Trust-wide initiative to improve care quality, increase research and innovation, and heighten the lived experience of care teams and residents, two third-year OT students from the University of the West of England (UWE) were selected to undertake a placement at one of the Orders of Saint John Care Trust’s (OSJCT) Wiltshire homes during autumn 2013. The home selected was residential caring, for individuals with a dementia. Prior to welcoming these students, OSJCT had never worked directly with OTs; however, the benefits these young experts brought to the Trust was invaluable.

As part of their time in the home, the students worked on a variety of projects to enhance the lives of residents, along with the level of care and engagement in appropriate activities provided by staff.

Developing activities to enrich everyday life

The OT students initially supported residents to complete activity checklists to understand better their individual interests and preferred daily occupations. Completion of the checklists highlighted that some residents were not taking part in activities, due to disinterest and/or self-perceived inability to participate.

As a result, the students worked with the activities co-ordinators to implement two new groups into the home’s weekly routine in order to get more residents involved – a gardening group and crochet club.

By developing new activities tailored specifically to the wishes and aspirations of individual residents, everyday lives were improved by providing those living in the home with an opportunity to get involved in the activities and occupations they previously enjoyed doing.

Occupation to resolve anxiety and distress

The students also assisted staff in problem-solving and managing one resident’s ongoing episodes of distress and anxiety. The students observed the resident to detect any triggers or patterns behind the behaviour, which included calling out and becoming tearful at the same time each day. After analysing their findings, the students developed a ‘keep busy’ session that outlined a meaningful set of daily activities and occupations for the resident to undertake, including laying tables, folding laundry and general cleaning around the home.

By implementing familiar tasks and activities to occupy this resident each day, the students were able to break the cycle of anxiety and distress reactions that had been occurring on a regular basis both within this home and in her previous residential home placement.

Enhancing communication

While spending time with a resident who had suffered a brain injury, the OT students recognised patterns of behaviour that showed a favouring of communication from the left-hand side. Testing this finding by speaking to the person from both sides and noting differences, specifically a dramatic drop in response and interaction when speaking from the right-hand side, the students concluded that the resident had limited awareness on their right.

This information was passed to the care team, who then used it to improve the way they engaged with the resident, leading to more meaningful and productive communication.

Environment development

The OT students also provided valuable input about the care home’s environment. They recommended that elements from the home’s reminiscence and destination areas should be incorporated into the home’s communal sitting areas. They also noted that the overall ambience of the home was more feminine than masculine, so using information gathered in the activity checklists, the students worked with male residents to design and construct a bar area – something desired by a majority of men living there.

Benefits of OT student placements

All the staff within the home noted the benefits of the OT student placement. Feedback included, ‘The students’ input has encouraged us to think about things in a different way and helped us to improve how we engage with residents on a daily basis.’

Following the success of its first two OT placement students, the Trust is now looking forward to welcoming placement students from both UWE and Coventry University during autumn 2014.

The unique skills and expertise of the OT students enhanced and developed the knowledge base of the care teams working in the home. Through their role-modelling, they were able to demonstrate a more focused and effective relationship-centred approach to care teams and, in consequence, improve the lived experience of residents.

Victoria Elliot is Principal Care Consultant (Research and Innovation) at The Orders of St John Care Trust. Helen Martin M.Ed BA (Hons) Dip.COT Cert.Ed is a Senior Lecturer and Admission Tutor for the BSc (Hons) Occupational Therapy programme within the School of Health and Social Care at the University of the West of England.

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