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Occupational Therapys Role in

Skilled Nursing Facilities


How Does Occupational Therapy Benet Individuals In Skilled Nursing Facilities (SNFs)?
Intervention provided by occupational therapists and occupational therapy assistants in skilled nursing facilities are associated with positive outcomes. Jette, Warren, and Wirtalla (2005) determined that higher intensity occupational therapy during rehabilitation in a SNF is associated with a shorter length of stay as well as functional improvements for a variety of diagnoses. This study, which included 4,988 patients with stroke, orthopedic, cardiovascular, and pulmonary conditions in 70 SNFs, demonstrated that higher OT intensity was associated with greater odds of improving by at least one stage in ADL functional independence as well as improved executive control as measured by the FIM. Occupational therapy (OT) practitioners are uniquely qualied to utilize client-centered evaluations to identify strengths and barriers to occupational performance of roles and activities which are meaningful or necessary for that individual. The outcomes of intervention are focused on enabling individuals to maximize their participation in these daily activities. SNFs are health care facilities, primarily for adults that require medical care for variable periods of time from relatively short to more extended or even permanent residence. Short-term rehabilitation services may be provided to individuals with diagnoses such as joint replacements, stroke, etc. (Roberts and Evenson, 2009). Long-term care is also provided for permanent residents of the facility who have chronic or progressive illnesses or diagnoses such as dementia. Occupational therapy services in this setting are generally reimbursed by Medicare Part A for short-term, acute care clients; Medicare Part B for long-term residents who require skilled services; and usually by private insurance, Medicaid, or private pay for younger clients.

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The Role Of Occupational Therapy In SNFs


Occupational Therapists (OTs) and Occupational Therapy Assistants (OTAs) promote the health and participation of people, organizations, and populations through engagement in occupation (American Occupational Therapy Association [AOTA], 2008). OTs and OTAs provide intervention in many areas of occupation such as: activities of daily living (ADLs) including bathing, dressing, grooming; instrumental activities of daily living (IADLs) including home and nancial management, rest and sleep, education, work, play, leisure, and social participation (AOTA, 2008). They also develop and implement health and wellness programs to prevent injuries, maintain function, and improve safety of residents. For example, OTs and OTAs can take a leadership role in developing and implementing programs to educate clients on compensatory techniques for low vision, customized exercise programs, or strategies to prevent falls. Occupational therapy practitioners may also consult with other sta within the facility or in the community on a variety of topics related to increasing safe engagement in activities. Occupational therapy practitioners can provide a variety of services to short- and long-term residents of a SNF. Based on a client-centered evaluation, the occupational therapist, the client, caregivers, and/or signicant others develop collaborative goals to identify strengths and decits and address barriers that hinder occupational performance in multiple areas. The intervention plan is designed to promote a clients optimal function for transition to home, another facility, or long-term care.

Occupational Therapy Intervention In Short-Term SNF Rehabilitation Can Include:


Training in self-care skills, specically ADLs such as feeding or eating, grooming, dressing, bathing, and toileting Providing training in the use of adaptive equipment, compensatory techniques, and environmental modications to increase safety and independence Remediating IADLs related to the patients discharge environment, such as preparing a meal or managing ones home or nances Training in functional mobility such as how to prepare a meal while using an ambulatory device Addressing behavioral health needs of clients, such as depression or anxiety, in collaboration with other facility sta Preparing the client and family for community reintegration (as appropriate for the clients discharge site) with activities such as public dining or emergency response management Assessing the need for and recommending potential home modications and safety equipment to reduce barriers and promote safe functioning upon discharge Exploring adaptations and compensatory strategies for return to volunteer or paid employment Educating clients and/or caregivers in community resources and strategies to support needs after discharge Assessing current leisure skills to determine whether modications are needed to continue participation and/or assisting with exploration of new leisure pursuits

Occupational therapy enables people of all ages live life to its fullest by helping them to promote health, make lifestyle or environmental changes, and preventor live better withinjury, illness or disability. By looking at the whole picturea clients psychological, physical, emotional, and social make-upoccupational therapy assists people to achieve their goals, function at the highest possible level, maintain or rebuild their independence and participate in the everyday activities of life.

Occupational Therapy For Long-Term-Care Residents Can Include:


Training in ADLs such as eating, grooming, dressing, bathing, and toileting to promote independence and dignity Providing and educating residents about adaptive equipment and compensatory techniques to improve safety and increase participation and independence Teaching functional mobility including use of an ambulatory device and/or transfers to dierent surfaces, such as a bed, chair, toilet, or shower in order to perform self-care and personal tasks; training in wheelchair mobility and safety appropriate for the residents level of cognition and perception Remediating or enhancing IADLs such as ability to use the telephone or emergency calling system Working collaboratively with the facility sta to address behavioral health issues such as those related to depression or anxiety, that may impact performance of daily activities including leisure pursuits Educating residents with cognitive and perceptual decits in compensatory techniques to maximize abilities in areas including attention span, orientation, sequencing, and/or memory Instructing residents with low vision in techniques to maximize their remaining vision and enhance safety through compensatory techniques, environmental modications, assistive technology, and adaptive equipment Instructing residents and caregivers in techniques to improve positioning, reduce restraints, and maintain skin integrity.) Modifying the environment and adapting tasks to maximize safety (e.g. falls prevention and fatigue management) Educating caregivers to utilize a residents remaining abilities to enhance function and preserve dignity for adults with dementia Enhancing quality of life and dignity by providing opportunities for engagement in meaningful activities despite client limitations.

Occupational Therapy Consultation Services


OT practitioners may also consult with SNF sta and administration in a variety of areas such as: Training other sta members to enable residents to participate in relevant groups and activities with appropriate modications Collaborating with residents to identify potential support groups to increase leisure and social participation Consulting with employers, sta, or family on environmental modications for a clients probable discharge location Educating family members about community resources such as senior centers, meals on wheels, exercise groups, etc. Collaborating with other disciplines in the SNF to identify the causes of dementia-related behaviors and possible solutions

Occupational therapy enables people of all ages live life to its fullest by helping them to promote health, make lifestyle or environmental changes, and preventor live better withinjury, illness or disability. By looking at the whole picturea clients psychological, physical, emotional, and social make-upoccupational therapy assists people to achieve their goals, function at the highest possible level, maintain or rebuild their independence and participate in the everyday activities of life.

Occupational Therapys Role In Program Development


OT practitioners are skilled in developing and implementing new programs in SNFs that promote health, remediate decits, and prevent disability. Programs in this setting are developed based on the collaborative goals of the residents in the facility, sta, and OT practitioners. They may be implemented in a series of group sessions, which has the added benet of enhancing social interaction between residents. Some examples of those programs include: Falls preventioneducating patients and caregivers about hazards in the facility that may precipitate falls and strategies to prevent them Dementia managementhelping the sta identify possible causes and interventions for dementia-related behaviors to enhance a clients functioning and quality of life Restraint reductionidentifying positioning methods and alternatives to avoid or minimize the use of restraints to manage challenging behaviors Contracture managementto maintain range of motion and assist in preventing the development or progression of deformities due to lack of movement which can have a negative impact on performance of self-care and other activities Positioning programsto prevent disability and maintain healthy postures to enable performance of activities Therapeutic groupsto address behavioral health issues and provide opportunities for participation, to enhance functional skills, and improve social interaction Pre-driving assessmentto help physicians determine potential to resume safe driving and recommend modications when appropriate. Where appropriate, consulting with an OT who can provide more specialized driver assessments to vehicle modications and needed training. Occupational therapy practitioners play a vital role in providing client-centered, short-term and long-term rehabilitation services to individuals in skilled nursing facilities. They develop and implement a variety of programs and group or individualized interventions to enhance the clients participation in meaningful roles and occupations of daily living. They also provide consultative services to facility sta and residents to promote quality of life and client satisfaction.

References
American Occupational Therapy Association [AOTA]. (2008). Occupational therapy practice framework: Domain & process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683. Jette, D.U., Warren, R.L., & Wirtalla, C. (2005). The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities. Arch Phys Med Rehabil, 86, 373-379. Roberts, P., & Evenson, M. (2009). Settings providing medical and psychiatric services. In E.B. Crepeau, E.S. Cohn, & B.A.B Schell (Eds.), Willard and Spackmans occupational therapy (11th ed.) (pp. 1076-1077). Philadelphia, PA: Lippincott Williams & Wilkins.

Jodi Megan Wronski, * Authors: KellyWashkowiak, OTSSharon J. Elliot, MS, OTS Lori Kay Jones, OTS Eva Velasco, OTS Schrubba, OTS OTR/L, BCG, FAOTA

Occupational therapy enables people of all ages live life to its fullest by helping them to promote health, make lifestyle or environmental changes, and preventor live better withinjury, illness or disability. By looking at the whole picturea clients psychological, physical, emotional, and social make-upoccupational therapy assists people to achieve their goals, function at the highest possible level, maintain or rebuild their independence and participate in the everyday activities of life.