In the following Q&A, RehabCare Occupational Therapist and Clinical Performance Specialist Allen Johnson shares how OTs create an environment of safety through their recommendations and interventions:
Q. What are the most important steps OTs take to prepare the home at the time of a patient's discharge?
A. OTs collaborate with the interdisciplinary team, patient's family and other caregivers to perform a Plan of Care home assessment. We walk the patient through the paces of what they will need to be capable of when they return home, and one of our primary objectives is to look for environmental barriers to safety both inside and outside the home. We ask ourselves which adaptation or compensation we need to utilize to enable the patient to function safely at home.
Q. What are some of the most high-risk areas and activities? What specifically can you implement to maximize safety?
A. Minimizing risk for falls is a top concern due to the likelihood of injury and the chance of rehospitalization. Outside the home, we examine the number and condition of steps, for example. We look for handrails, and then we determine if the handrails are sturdy enough. Inside, we may optimally arrange furniture, see if there is a need for grab bars, widen doorways and remove area rugs. These are just a few of the things we take into account when we analyze the setting with falls in mind. OTs also look for cooking, driving and bathing issues.
Q. How can you help patients prepare food, bathe and drive safely?
A. We have to see if it is safe for our patient to use the stove or microwave. Often you will see OTs working with patients on kitchen tasks while at the rehab center. We observe whether the individual is able to set the correct cooking temperature and tell when cooking is done. Do they remember to turn the burner off? Are they careful not to leave paper towels or dishrags near the stove? For bathing, we can install seats, no-slip mats, long-hosed shower heads and temperature limiters on the hot water if needed.
Driving is one of the most dangerous activities of daily living, and many OTs specialize in this area. First and foremost we determine if it is safe for the patient to drive. If critical skills are intact, there is much we can do to adapt the vehicle. Vans are commonly outfitted to accommodate wheelchairs. Special hand controls or joystick replacements may be added. Plus, technology now exists in some cars for automatic breaking, side impact warnings, automatic parallel parking and backup camera alerting.
Q. Sometimes solutions and adaptations are not immediately apparent, though. Give us an example of a time when you had to devise a solution to a perplexing problem.
A. For years, my specialty was working with dementia patients. This population has its own set of challenges, but if you understand the reasons for dementia and follow an abilities-based assessment, an OT can offer much to a person with these impairments. I had a patient who suffered from frequent falls, and the interdisciplinary team was struggling to understand why. She'd completed physical therapy with success and had good strength and balance. She had middle to late stage dementia but was able to accomplish many tasks independently or with supervision and cues. So I began to look for trends in her falls. I found that she often fell in the hallway exiting her room in the mid-afternoon. I observed that at that time of day, the lighting was such that a shadow fell across the floor outside her door. Dementia patients retain their physical abilities, but they have perceptual deficits. Therefore this patient perceived the shadow as an obstacle to be stepped over. We increased the lighting, and she no longer fell.
Q. What qualities should program directors look for when they are hiring an OT?
A. OTs must be compassionate and persistent. We never give up on trying to find a solution, because we have the vision to see solutions for patients when they might otherwise give up on themselves.
Q. Might job interviewers present a scenario to an interviewee and ask the candidate to come up with a solution?
A. Absolutely. Doing this will give the interviewer a peek into the prospective OT's ability to perform at the level that will be expected of them. I have always done this with my job candidates as it is an invaluable predictor of that candidate's methods and how well they will fit on your team.