Mary* was short of breath and her heart rate was high when HopeHealth Visiting Nurse Occupational Therapist Elizabeth Barr arrived at her home on a recent Monday morning.
Liz sat down at the kitchen table with Mary, who has chronic heart failure, and called her doctor right away. In short order, Liz and the doctor discovered Mary had missed her night medication and were able to quickly remedy the problem. A cardiologist was scheduled to call back in the afternoon. It was a relief for Mary — she was adamant about not going to the hospital to be evaluated again.
“Once she sat down, she stopped being short of breath,” says Liz, who guided Mary through deep breaths in through the nose and out through the mouth. “I kept her calm and focused on the breathing. She needed to pace herself.”
Whatever the focus, occupational therapy involves activities that are personally meaningful.
It’s one example of how Liz makes a difference, and she did it just minutes into the start of a new workweek. The American Occupational Therapy Association has declared April as Occupational Therapy Month, a time to honor clinicians like Liz who help people do the activities they want and need to do. Don’t let her job title fool you.
“We don’t put you back to work,” Liz says. “We look at the whole picture. We look at how you’re functioning in your environment and give you pointers or adaptive equipment.”
Occupation in this sense means anything you do as part of your life. It could be something you enjoy doing like gardening. It could be tasks involved with daily living like preparing meals. It could be personal care like using the toilet, showering, and getting dressed every morning. Whatever the focus, occupational therapy involves activities that are personally meaningful.
‘Quality of life therapist’
Because Liz works in home care, her special focus is on helping patients remain safely in their home.
“It’s really about being independent with whatever skills are important to you,” she says. “I call myself a quality of life therapist.”
Liz has been with HopeHealth Visiting Nurse for eight years and works out of the Lincoln, Rhode Island, office. Occasionally, she sees hospice patients in addition to home care patients. Her team cares for people living in Rhode Island and southeastern Massachusetts.
In the last year, HopeHealth occupational therapy staff evaluated more than 2,000 individual patients and logged nearly 9,000 visits. Many of their patients live with chronic and complex health problems and need help with protecting skin from pressure sores and managing edema, which is the swelling caused by excess fluid trapped in parts of the body.
Occupational therapists also help their patients come up with simple strategies to compensate for vision impairments and memory problems. They help patients adapt and find what they need quickly by placing objects in a clockwork method and keeping to-do lists in notebooks.
Underscoring this important work is the reassurance occupational therapists give to their patients.
“During the pandemic, a lot of focus has been on psychosocial issues, like stress management and coping skills,” says HopeHealth Occupational Therapist Courtney Crone-Socha MS, OTR/L.
“Some of these more subtle sensory changes or losses over time can really affect how a person is able to manage functionally,” Kim says.
Sometimes that means caring for caregivers as well as patients, especially with an increase in families taking care of bed bound family members at home during the pandemic. HopeHealth Occupational Therapist Kim Gilbert says she spent more time showing family members how to safely transfer or adjust the position of a patient in bed last summer and fall.
An OT evaluation can help a family uncover the reason why a loved one has stopped doing a certain activity, adds Kim, the president of the Rhode Island Occupational Therapy Association. Sometimes patients don’t even recognize they are slowly losing their vision, hearing or sensation in their hands or feet — until an OT starts asking a patient to perform simple tasks.
“Some of these more subtle sensory changes or losses over time can really affect how a person is able to manage functionally,” Kim says.
“Often, it’s so gradual nobody’s even thinking about it. Sometimes when I say to a patient, ‘Are your feet numb?’ and they say ‘yes,’ everybody looks shocked.”
Liz spent an hour total with Mary, her chronic heart failure patient. After resolving the cause of her shortness of breath, for the rest of the visit, Liz discussed the importance of conserving energy, advising Mary to sit down when she makes a sandwich for her husband. Liz also made sure Mary could safely walk — slowly and safely — to the bathroom and bedroom. She sent emails to let her fellow care team members know how Mary was doing and ensure a nurse would visit the next day.
Solving problems, building trust
Liz’s next patient, Carla*, is blind and recently moved to a private nursing home after having a stroke. Carla was being fed by staff, but Liz worked to help Carla have the dignity of feeding herself again. Liz helped her sit upright at her dining room table and helped guide her hand onto the table. Liz then instructed her where to find her food and drink by giving cues based on the hours on a clock. She also arranged for Carla to get a lidded cup to use to drink her beverage.
A half hour later, Carla was so happy. “She was excited that she was able to feed herself,” Liz says.
More than half of her patients have a mental health concern in addition to a physical challenge, Liz estimates. She always checks in with her patients to ask how they are feeling.
“I really love looking at the whole picture and what we need to do to keep a patient home.”
Liz works to build trust and companionship with her patients, including Vanessa,* who was coping with a severe anxiety disorder. Vanessa stopped using her private caregiver who took care of food shopping for her, due to concerns with COVID-19.
To help Vanessa get the things she needed while easing her anxieties, Liz taught her how to successfully order groceries online using her new iPad. Liz also ordered adaptive equipment for the bathroom so she could shower again, something that meant so much to Vanessa.
“I love my job,” Liz says. “I’m so lucky I get to do what I love every day. I really love looking at the whole picture and what we need to do to keep a patient home.”
Are you having difficulty recovering from a chronic illness, injury or physical impairment? You might benefit from an evaluation by an occupational therapist. Learn more about how HopeHealth home care services can help you.
*Patients names changed to protect privacy.