Innovative Solutions to Systemic Trends in Delivery of Complex Wheelchair

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Innovative Solutions to Systemic Trends in
Delivery of Complex Wheelchair Seating Systems
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• Meeting the health care needs of Canadians means
  having the right number of health care providers
  with the right set of skills, in the right
  settings.
• CIHI, 2008

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Trends

• Aging population
• More complex/chronic medical conditions
• Health care funding
• Funding structure for ambulatory services
• Fiscal constraints
• Organizational changes (LHINS, hospital mergers,
  etc)
• Home first initiative
• Wait lists/demands for services
• Changing OT workforce

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Need for Innovation

• Thinking outside of the box
• Utilize wheelchair seating clinics
• Use of support personnel
• Collaboration
• Consultation
• Joint partnership

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Wheelchair Seating Clinics

• Dedicated seating focus
• Use of assessment resources
• Inter-professional collaboration-established
  seating team
• Increased exposure to products and opportunity
  for clinical application
• Increased exposure to complex seating needs and
  mobility needs

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Why use support personnel?

• COTO Position on Support Personnel
• Practice Profile for Support Personnel in
  Occupational Therapy (CAOT-2009)
• Improves efficiencies in practice
• Time OT can see more than one client
• Money OTA costs less than having a second OT

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Collaboration

• The number of Canadians living with chronic
  diseases is on the rise, and with it the need for
  complex collaborative care.
• CIHI, 2008

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Collaborative model-why?

• Increased complexity of population serviced
• Decreased resources (staff, time, money)
• Increased wait times
• Movement towards OT as generalist
• Environmental barriers

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How do we collaborate?

• Collaborative Model
• Working together with community therapists
• Capitalize upon skill set and environmental
  access of community therapist, Seating clinic
  therapist Seating Clinic Support Personnel
• Seating clinic OT completes initial assessment in
  collaboration with community therapist and with
  the assistance of the OTA
• Follow up in home by community therapist with
  feedback to seating clinic
• Sharing of paperwork/funding applications etc.

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Case Study - Collaboration

• Client with ALS
• Initial assessment occurred with seating clinic
  OT at ALS clinic visit
• Set up of power wheelchair trial in hospital
  setting
• Follow up in home with CCAC OT and Seating clinic
  OT present
• CCAC OT followed client in home to address
  integration of power device into home
  environment.
• ADP application completed by seating clinic OT
  with corroboration from community OT
• Application to ALS society for non-ADP funding
  completed by community OT.

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Consultation

• Consultative Model
• Provide 1-2 visits with client and community
  therapist.
• In community or at hospital clinic
• Seating clinic OT completes assessment together
  with community therapist and with the assistance
  of the OTA
• Community Therapist can also consult with the
  clinic for the environmental benefits and for use
  of Support Personnel to complete assessment.
• Community therapist implements recommendations
• Seating clinic therapist available for future
  phone consult or one additional visit

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Case Study - Consultation

• Client with history of MS with postural and
  positioning needs referred to community OT via
  CCAC
• Unable to assess in home due to environmental
  factors
• Assessed in clinic with assistance of OTA for mat
  assessment and to trial power w/c with power tilt
  in safe environment
• Further assessment of power mobility in home done
  by community OT

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Case Study Collaborative/Consultative

• Client with history of ABI and most recent
  bilateral rotator cuff tears compromising
  manual wheelchair and scooter mobility
• Referred by CCAC OT and second referral by
  Hospital OT from acute short term stay secondary
  to falls in apartment
• Assessed in clinic with assistance of OTA for mat
  assessment and to trial power w/c with power tilt
  in safe environment
• Collaboration with Out patient OT for further
  cognitive/perceptual testing and collaboration
  with CCAC OT for integration of power mobility
  into home environment.

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Joint Partnership-Community Service Provider

• Issues identified
• Residential group homes
• Aging with disability
• Complex seating and mobility needs
• Inappropriate referrals sent to seating clinic
• Increasing wait list times
• Inconsistent follow-up of seating/positioning
• Need for staff education

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Joint partnership-community service provider

• Solution
• Development of joint partnership
• Development of OTA and OT role to provide
  specialized community based seating and
  positioning intervention

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Joint partnership-community service provider

• OTA ROLE
• First point of contact with front line staff
• Visits homes monthly to provide
• Seating clinic follow-up
• Education
• Screening
• Monitor need for repairs
• Initiates referral process
• Attends and assists at Seating Clinic appointments

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Joint partnership-community service provider

• OT Role
• Supervises OTA role
• Facilitates educational supports
• Identifies and implements educational in-services
  to front line staff
• Collaborates in policy and procedures related to
  positioning, transfers etc.
• Ensures effective communication between OT/OTA,
  support staff, family and other stakeholders as
  required

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Joint partnership-community service provider

• OUTCOME
• Improved quality of life
• Improved staff satisfaction
• Reduction of care needs
• Reduction in staff/transportation costs
• Reduction in clinic wait times
• Expanded OTA/OT role

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Conclusions

• Changing societal health care trends
  necessitate need for innovation in meeting
  clients complex seating and mobility needs.
• Capitalize upon skill sets of all health care
  professionals
• Seating clinic OT
• Community OT
• Support Personnel
• Consider option for community partnerships with
  health care facilities

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Future directions

• Continual monitoring of changing trends and their
  impact on complex wheelchair and seating
• Establish ongoing Professional networking and
  support systems
• Consider other community partnerships

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