By Karin Tancock
Occupational therapy is founded on the core knowledge that occupation is essential for health and wellbeing. Occupation – the activities, daily tasks roles and routines that are key to our identity – is particularly important for older people in care homes who are at risk from health complications if left with nothing to do.
There are patchy examples of occupational therapists working in care homes but their expertise is untapped, called upon for crisis intervention rather than a preventative approach that keeps people safe, mentally and physically well, and out of A&E.
Typically, care home residents are in their 80’s or older, have one or more long-term health condition, 80% will have dementia and many are frail. Before going into a care home it is likely that they will have had several hospital admissions, possibly falls or other frightening episodes, or experienced a period of loss such as bereavement. Can we really expect care home staff to have the expertise and time to address all these issues?
Shift in mindset needed
There is much more that needs to be done to ensure commissioning in care homes considers the skills of occupational therapists and the wellbeing as well as medical needs of residents. A shift in mindset is needed.
The College of Occupational Therapists has developed the Living well through activity in care homes toolkit to tackle this issue and ensure that older people have the same rights and access to occupation as everybody else. The toolkit has had widespread support from the sector, including care provider representative body Care England and Alzheimer’s Society, and acts as a quality standard for activity in care homes supporting the care home team, nurses, social workers and community partners.
The College recently held a summit with leaders in health and social care where care home staff spoke about using the toolkit and how its improved residents’ mood, behaviour, relationships with others and, ultimately, their quality of life. This goes against many people’s perception that older people who can no longer live independently do not want to, or cannot, be active, which is simply not the case.
Many care homes now build activity engagement into care planning. Activity co-ordinators are common and inspectors expect to see group and event programmes in place in the home. But are these activities accessible to everyone and are they ones people value and enjoy? Some residents may love singing, bingo and light entertainment but many do not.
The culture of care homes is influenced by three factors: the beliefs of the staff that then shapes their judgements and behaviour, procedural and environmental factors, such as rotas and routines.
Occupational therapists working within care homes can offer support and training to staff to recognise how their beliefs impact on their practice and how approach and language can be enabling to a resident, or encourage dependency. Environmental factors are key too, such as how a communal room is laid out and availability of appropriate seating. Correct positioning when seated can increase a person’s awareness of what is going on around them, help their communication and improve their reach and ability to do activities.
The toolkit is the first step in offering support and expertise to care home staff. It is free, accessible and designed to promote a conversation between management, staff, residents and their family so that they can improve and maintain quality of life in the care home. The College believes that activity is a measure of quality of care.
Occupational therapists, however, need to be commissioned and employed within the sector. Commissioning more occupational therapists from health and social care to provide in-reach support would enable them to take a more proactive approach. By focusing on empowering residents to be active, occupational therapists’ contribution can be measured in outcomes such as fewer unplanned hospital admissions or safeguarding alerts.
Care home groups choosing to employ occupational therapists will have a professional who is able to analyse the culture of each home and train others on providing a positive activity culture.
Karin Tancock is professional affairs officer for older people and long-term conditions, College of Occupational Therapists
College of Occupational Therapists (2013) Living well through activity in care homes toolkit.
Davies HTO, Mannion R (2007) Organisational culture and quality of health care, Quality Health Care, 200(9) 111-119.
Department of Health England (2014) Wellbeing and health policy guidance.