Elder Care

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Elder Care

• Emily K. Schulz, PhD, OTR/L
• OT 675
• Fall 2003

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Quick Quiz - Elders

• 1. Mental confusion is an inevitable consequence
  of old age
• 2. The leading cause of accidental death in
  people older than age 75 is motor vehicle
  accidents
• 3. The largest portion of Medicare funds is used
  to pay for nursing home care for the elderly
• 4. The numbers of old people in the US population
  have stabilized and are expected to hold steady
  well into the next century
• 5. More than 50 of all US citizens older than
  age 65 live in some kind of assisted living
  facility

• 1. T or F
• 2. T or F
• 3. T or F
• 4. T or F
• 5. T or F

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Quick Quiz - Elders

• 6. Exercise is not recommended for older people
  becauase of a high risk of muscle strain and
  broken bones
• 7. Most elderly people eventually require nursing
  home care
• 8. More men than women survive to old age
• 9. The area of greatest concern to elderly people
  is death and dying
• 10. American families have by and large abandoned
  their older family members

• 6. T or F
• 7. T or F
• 8. T or F
• 9. T or F
• 10. T or F

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Elders- Typical Practice Sites

• Skilled Nursing Facility
• Long Term Residential Care Facility

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Elders - Alternative Practice Sites

• Assisted Living
• Community-based residential facility
• State regulated and licensed
• privately operated apartment complex
• (unregulated)
• midway point between home and NH
• Home with modifications - Home Health
• Hospice
• Retirement or Senior Centers
• Intermediate Care Facility
• Day Care Programs

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Treatment Team -Hospitals and Skilled Nursing
Facilities (SNFs)

• Nurses
• Nurse Practitioners
• Physician Assistants
• Social Workers
• Nursing Assistants
• Medical Technologists
• Client
• Family

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Treatment Team - Senior Centers and Residential
Care Facilities

• Lay Workers
• Volunteers
• Under direction of Program Manager
• Client
• Family

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Treatment Team -Home Health Agencies

• Nurses
• Occupational therapists
• Physical therapists
• Speech therapists
• Client
• Family

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Treatment Team - Day Care Programs

• Social Workers
• Occupational Therapists (OTR OTA)
• Volunteers
• Client
• Family

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Treatment Team - Hospice Care

• Nurses
• Social Workers
• Therapists
• Volunteers
• Lay Practitioners
• Client
• Family

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Theories of Aging

• Psychosocial
• Activity Theory
• Disengagement Theory
• Continuity Theory
• Developmental
• Erikson - ego development
• Havighurst - life tasks
• Kohlberg - Moral development
• Biological - Theories of Aging
• Wear and Tear
• Genetic
• Stress and Adaptation

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Goals - Elders

• Goals - Should Be
• Holistic (physical, cognitive, psychosocial)
• Address issues from common health issues
  (arthritis, diabetes, hypertension, visual
  impairments, hearing impairments Depression)
• Client-centered
• Address Occupational Performance Areas and
  Performance Contexts
• Preventative

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Intervention with Elders

• Preventative
• Psychosocial
• Mental Health
• Cognitive
• Physical
• Language
• ADLs

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Legislation Impacting Elders

• 1935 - Social Security Act
• 1965 - Older American Act
• 1965 - Medicare Medicaid
• 1972 - Social Security Income Bill
• 1983 1984 - New Reimbursement Policy for
  Medicare Pts in Hospitals (DRGs)
• 1987 - The Nursing Home Quality Reform Act
• 1990 - Americans With Disabilities Act
• 1997 - Balanced Budget Act

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New Models of Service Delivery

• Community Agencies
• Private Practice
• Outpatient Programs

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Trends and Issues - Elders

• Staff Shortages - Graying of America
• Need for Long Term Care Funding
• Long Term Care Insurance
• Elder Abuse
• Suicide - especially males 65
• Greater Attention to Cognitive Impairments -
  Alzheimers Disease
• Care of the Old Old
• Changing philosophies in long term care
  -preserving autonomy of elders

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Elders Without Walls
http//www.elderswithoutwalls.com/Assisted20Livin
g/index.html
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Elders - Websites

• http//www.eldersaction.org/
• http//www.sicc.sk.ca/elders/
• http//www.aoa.gov/AIN/default.htm
• http//www.aoa.gov/eldfam/eldfam.asp
• http//leatherspinsters.com/elders.html

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A Question to Ponder

• Should the United States focus its limited funds
  available for medical spending on the young and
  productive members of society rather than
  prolonging the life of elders?

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Practice in Home Health Care

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Home Health Care - Three Types of Community
Program Sites

• Home Health Agencies
• Independent Living Centers
• Private Practice (Contract Workers)

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Treatment Team - Home Health

• OTRs OTAs
• Public Health Nurses
• Physical Therapists
• Speech Therapists
• Home Health Nurses
• Social Workers
• Home Health Aides - 70 of services
• Client
• Family

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Key Concepts in Community Care

• The value of the home environment
• A holistic approach
• Skills needed to work in home health care
• independence, flexibility, adaptability,
  ingenuity good communication, organization good
  time use.
• Knowledge base
• Client centered
• (support client in own environment, work on
  problem-solving skills of clients),
• community-based rehabilitation
• (targets community to prvide equal opportunity
  for clients with disabilities)
• independent living
• (self-help, peer-support, research, direct
  service, referral services, advocacy for
  individuals with disabilities).
• Networking
• Cultural Issues

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Issues and Trends

• Educating Students for Home Health Care
• Marketing Occupational Therapy Services in Home
  Health Care
• Mental Health Home Care - emerging
• Rural Outreach Programs
• Pediatric Home Health Care
• Issues of Personal Safety

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A Question to Ponder

• You have been assigned to provide OT services to
  someone living in a rough neighborhood. You are
  afraid of getting attacked or mugged. What steps
  can you take to protect yourself?

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Advanced Career Choices

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Lifework in OT - Advanced Career Choices

• Practitioner
• Educator of Peers and Consumers
• Fieldwork Educator
• Supervisor in a Practice Setting
• Consultant
• Academic Fieldwork Coordinator
• Academic faculty
• Academic Program Director
• Researcher/Scholar
• Entrepreneur

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Lifework in OT

• Most therapists agree that working as an OT
• They can make an important contribution
• They can use their best talents
• They can perform the activities it requires
• They can earn a good income

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A Question to Ponder

• Have you experienced burn out in your life - if
  so, under what circumstances?
• How do you plan to handle burn out on the job as
  an OT?

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Professional Resources and Contemporary Trends

• Occupational Therapy Organizations
• International Occupational Therapy
• Contemporary Issues and Trends

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Occupational Therapy Organizations

• AOTA (www.aota.org)
• AOTF (www.aotf.org)
• State Organizations
• ALOTA (www.alota.org)
• WFOT (www.wfot.com)

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Questions to Ponder

• Are you a member of ALOTA?
• What are the benefits of membership for students?
• Are you a member of AOTA?
• What are the benefits of membership for students?
• Are you a member of WFOT?
• What are the benefits of membership for students?

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International Occupational Therapy

• WFOT - World Federation of Occupational
  Therapists
• www.wfot.org
• WHO
• The World Health Organization - closely
  associated with WFOT

http//www.who.int/en/
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World Federation of Occupational Therapists (WFOT)

• Founded in 1952
• MEMBERSHIP- There are currently (2002) 57 member
  associations of which 8 are Associate members.
• Organisation membershipA country which has an
  occupational therapy association with an approved
  constitution and educational program may become a
  full member of WFOT.
• Associate membershipA country with an approved
  constitution can become an associate member of
  WFOT.
• Individual membershipThrough their national
  organizations, qualified occupational therapists
  and occupational therapy students can become
  individual members of WFOT and receive the WFOT
  Bulletin.

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International Occupational Therapy - Regional
http//www.otdirect.co.uk/link-assoc.html

• Committee of Occupational Therapists for the
  European Communities. (COTEC) http//www.cotec-eu
  rope.org/
• Australian Association of Occupational
  Therapists http//www.ausot.com.au/
• Verband der Diplomierten ErgotherapeutInnen
  Österreichs (Austrian Association of Occupational
  Therapists) http//www.ergotherapie.at/
• Bangladesh Occupational Therapy
  Association(BOTA) http//www.botabd.netfirms.com/
  
• Nationale Belgische Federatie van de
  Ergotherapeuten (Belgian Association of
  Occupational Therapists) http//users.swing.be/e
  rgobel/
• Canadian Association of Occupational Therapists
  http//www.caot.ca/
• Deutscher Verband der Ergotherapeuten (German
  Occupational Therapy Association)
  http//www.ergotherapie-dve.de/

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International Occupational Therapy - Regional
http//www.otdirect.co.uk/link-assoc.html

• Ergoterapeutforeningen (Occupational Therapy
  Association of Denmark) http//www.etf.dk/bund.h
  tm
• Suomen Toimintaterapeuttiliitto ry Finlands
  Ergoterapeutförbund rf (Finnish Occupational
  Therapy Association) http//www.toimintaterapeut
  tiliitto.fi/framekeski.htm
• Association National Francaise des
  Ergotherapeutes (ANFE) - French association of
  occupational therapists (in French)
  http//www.anfe.asso.fr/
• Icelandic Occupational Therapy Association
  http//www.ii.is/
• All India Occupational Therapists' Association
  http//www.aiota.org/
• Association of Occupational Therapists of
  Ireland http//www.aoti.ie/
• Israeli Society Of Occupational Therapy (in
  Hebrew) http//www.isot.org.il/

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International Occupational Therapy - Regional
http//www.otdirect.co.uk/link-assoc.html

• Associazione Italiana Dei Terapisti Occupazionali
  (Italian Association of Occupational Therapists)
  http//www.aito.it/
• Korean Association of Occupational Therapists
  (inc. English translation) http//www.kaot.org/l
  ogon.asp
• Association Luxembourgeoise des Ergothérapeutes
  Diplômés (Luxemburg association of occupational
  therapists) http//www.socialnet.lu/org/aled/hom
  e.html
• Nederlandse Vereniging voor Ergotherapie (Dutch
  Occupational Therapy Association)
  http//www.ergotherapie.nl/
• New Zealand Association of Occupational
  Therapists http//www.nzaot.com/
• Norsk Ergoterapeutforbund (NETF) Norwegian
  Occupational Therapy Association (with English
  version) http//www.netf.no/

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International Occupational Therapy - Regional
http//www.otdirect.co.uk/link-assoc.html

• Singapore Association of Occupational Therapists
  http//www.cyberway.com.sg/saot/
• Occupational Therapy Association of South Africa
  http//www.occupational-
  therapy.co.za/frontpage.html
• Förbundet Sveriges Arbetsterapeuter - Swedish
  Occupational Therapy Association (in Swedish)
  http//www.fsa.akademikerhuset.se/
• Ergotherapeutinnen-verband Schweiz (Switzerland)
  http//www.ergotherapie.ch/
• Occupational Therapy Association, Republic of
  China (Taiwan)
  http//www.ot-roc.org.tw/ot1.htm
• OT Australia-NSW http//www.otnsw.com.au/index.p
  hp
• British Columbia Society of Occupational
  Therapists http//www.bcsot.org/
• Ontario Society of Occupational Therapists
  http//www.osot.on.ca/osot.html
• College of Occupational Therapists of Ontario
  http//www.coto.org/

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WFOT Members

• MEMBER COUNTRIES OF WFOT
• Country (Full Members) Year of Entry
• Argentina 1970
• Australia 1952
• Austria 1978
• Bangladesh 2000
• Belgium 1968
• Brazil 1994
• Canada 1952
• Chile 1980
• Colombia 1976

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WFOT Members

• MEMBER COUNTRIES OF WFOT
• Country (Full Members) Year of Entry
• Denmark 1952
• Finland 1972
• France 1964
• Germany 1958
• Greece 1992
• Hong Kong 1984
• Iceland 1976
• India 1952
• Indonesia 2000

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WFOT Members

• MEMBER COUNTRIES OF WFOT
• Country (Full Members) Year of Entry
• Ireland 1970
• Israel 1952
• Italy 2002
• Japan 1972
• Jordan 1992
• Kenya 1976
• Korea Rep. of 1998
• Latvia 1998
• Malaysia 1990

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WFOT Members

• MEMBER COUNTRIES OF WFOT
• Country (Full Members) Year of Entry
• Malta 1994
• Netherlands, The 1960
• New Zealand 1952
• Norway 1958
• Pakistan 1992
• Philippines 1968
• Portugal 1964
• Republic of China (Taiwan) 1986
• Singapore 1992

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WFOT Members

• MEMBER COUNTRIES OF WFOT
• Country (Full Members) Year of Entry
• South Africa 1952
• Spain 1972
• Sri Lanka 1992
• Sweden 1952
• Switzerland 1962
• Tanzania 2002
• Thailand 2002
• Uganda 1996
• United Kingdom 1952

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WFOT Members

• MEMBER COUNTRIES OF WFOT
• Country (Full Members) Year of Entry
• United States of America 1952
• Venezuela 1968
• Zimbabwe 1990

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WFOT Members

• Country (Associate Members) Year of Entry
• Bermuda 1992
• Cyprus 1996
• Czech Republic 2000
• Luxembourg 1990
• Mauritius 1998
• Mexico 1998
• Namibia 2000
• Nigeria 1992
• Slovenia 2000

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WFOT Members

• Country (Contributing Members) Year of Entry
• Caribbean
• CLATO 2002
• COTEC 1994

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Issues and Trends

• Community-Based Rehabilitation in developing
  Countries
• Push for practice of Independent physicians in
  more highly developed countries.
• Recruiters seek to augment therapists in western
  countries with therapists from Asian and African
  countries (Brain Drain)
• Development of regional associations of OT
  practitioners in less populated areas.
• Only the US has COTAs

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International Publications - In English

• Occupational Therapy International
• The Journal of Occupational Science Australia
• The Scandinavian Journal of Occupational Therapy

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Other Issues

• Working Abroad Requirements
• know the language, adaptability, good emotional
  and physical health, good professional knowledge,
  knowledge of own country sources of financial
  support in foreign country financial
  implications of taking money out of one country
  into another.
• International and Regional Conferences
• International Congress every 4 years - WFOT
• Last one was in 2002 in Stockholm, Sweden
• 2006 WFOT Congress will be in Malaysia

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Questions to Ponder

• 1. How might the occupations of work, leisure
  activities, and self-care vary with culture and
  country? How would you address these differences
  in practice?
• 2. Have you ever been interested in working in
  another country as an occupational therapist?
  Where and why? If not, why not?

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Contemporary Issues and Trends

• Social and demographic changes
• increased uninsured, elders, cultural diversity
• Health Care trends in the US
• Managed Care, no universal insurance, reduction
  in home health coverage, consumers more educated
  about health, increase in chronic conditions,
  disability the nations greatest problem
  alternative medicine/complementary care focus on
  wellness and prevention, integrated delivery
  systems, telemedicine, computer use, people with
  mental health issues falling through the cracks
• Legislative trends
• Occupational Therapy Educational trends
• Masters Degree entry level, fieldwork issues
• Occupational Therapy Practice trends -
• community based, updated terminology,
  population-based services, focus on enabling
  occupational performance, broader view of
  outcomes, use of therapeutic occupations as tools
  to achieve these broader outcomes

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Contemporary Issues and Trends

• Occupational Therapy Employment Trends
• Increased specialization, new roles supervisor,
  consultants, managers new practice areas use of
  OT Aides traveling therapists
• Occupational Therapy Research Trends
• Nature of occupation replication studies are
  needed which procedures require an OTR vs an OTA
  to perform them? outcome studies evidence-based
  practice

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Contemporary Issues - 10 Emerging Practice Areas

• Ergonomics consulting.
• Driver rehabilitation and training.
• Design and accessibility consulting and home
  modification.
• Low Vision Services.
• Private practice community health services.
• Technology and assistive device development and
  consulting.
• Welfare-to-work services.
• Health and wellness consulting.
• Ticket to Work services.
• Addressing the psychosocial needs of children and
  youth.
• http//www.aota.org/members/area7/links/link23.asp
  ?PLACE/members/area7/links/link23.asp

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Contemporary Issues -Emerging Practice Areas

• Resources
• Practitioners interested in new and emerging
  markets should join the AOTA Special Interest
  Sections (SIS), which offer quarterly newsletters
  and the opportunity to network through Internet
  discussion groups.
• Several emerging practice areas are already "hot"
  topics within the Listservs for example, the
  Work Programs SIS (ergonomics consulting), the
  Home Community Health SIS (consultation to
  assisted living facilities, community and civic
  groups), the Physical Disabilities SIS (driver
  rehabilitation, home modifications), and the
  School System SIS (interventions to address
  violence prevention and other adolescent issues
  through school and community recreation
  programs).
• For more information on SIS resources, see the
  "Platform" in the January 3, 2000 issue of OT
  Practice, "Join the SISs in Finding Our Hidden
  Colleagues," by Virginia Stoffel, chair of AOTA's
  SIS Steering Committee.
• http//www.aota.org/members/area7/links/link23.asp
  ?PLACE/members/area7/links/link23.asp
• http//www.aota.org/members/area7/index.asp?PLACE
  /members/area7/index.asp

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Contemporary Issues - Planning for the Future

• Protect and strengthen state licensure laws and
  strengthen the professions scope of practice
  (See new Practice Framework)
• Engage in lobbying efforts to protect
  professional and consumer interests
• Promote and fund outcomes research
• promote the profession to consumers and health
  industry decision makers

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Contemporary Issues - Maintaining Traditional
Values in an Era of Change

• Heighten public awareness of the profession and
  what it does
• Become a respected service that can stand alone
• Reconcile our dreams with the reality of 21st
  health care
• Conceptualize occupational therapy as a service
  for persons with disabilties as well as typical
  persons
• Achieve consensus about the breadth and scope of
  occupational therapy practice

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Questions to Ponder

• Which of the 10 emerging practice areas interests
  you as a future occupational therapy practitioner
  and why? How would you plan on learning more
  about that practice area?
• What occupational therapy services do you think
  will be in the greatest demand in this century?
• What do you think is the biggest challenges to US
  health care in the 21st century?

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Questions and Answers

• ?