Practice

Continuing Education Article
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• [Referring clients] back to their pharmacy/doctor or
referral to nursing if the patient needs to be taught specific
information about a medication that is not provided on
written instructions
• [Ensuring] that patients know how to take their medications
and are in fact taking them as directed. If not, the OT
can explore reasons why they are not being taken or are
taken incorrectly.
• [Identifying], through the assessment process, when the
patient takes medications within their daily routine and
when there have been disruptions to that routine that
interfere.
• Identifying habits and routines that have worked to support
appropriate medication management for the patient in the
past. How can we work with them vs. changing them?
• [Assessing] medication management as part of the patient’s
overall ADLs so tasks can be accomplished timely, allowing
for medications to be taken within the prescribed time
frame relative to food, blood sugar, etc.
• [Considering] how OT skills and knowledge around energy
conservation techniques can assist with managing all
ADLs.”
(AOTA Legislative Affairs and State Regulatory Affairs, 2016)
Given that medication non-adherence is a significant risk
factor for hospital readmissions, it is essential that practitioners
understand their potential role and initiate providing these
needed and valued services.
ROLE OF OT IN ACQUISITION OF AT
AT is frequently part of an effective discharge plan, as it
facilitates functional performance and minimizes barriers to
function. However, for provision of AT to be an effective part
of reducing hospital readmissions, individuals must be receptive
to and actually benefit from the AT.
“Despite their utility, a high proportion of assistive technology
users abandon their device for reasons relating to
unmet expectations of the device, difficulty of use, lack
of social support or inappropriate instruction. Adopting
an assistive technology device that meets the needs of the
individual requires collaboration between the assessors,
the client and their family/caregiver, and the service provider.”
(Harris, Rosenwax, Hunter, & Andrews, 2014)
Therefore, it is crucial that recommendations for AT are
based on a skilled assessment of fit between the individual’s
needs and features offered by the equipment (Stark, Somerville,
Keglovits, Smason, & Bigham, 2015). Occupational therapy
practitioners’ understanding of occupational needs and performance,
coupled with their skills in activity analysis and focus
on achieving client goals, are indispensable to the AT provision
process (AOTA, 2015a). Occupational therapy practitioners can
provide a broad range of services in the process of AT provision,
including evaluation, recommendation, justification of need,
advocacy, awareness of funding resources, fabrication, customization,
training, and follow up (AOTA, 2015b).
Occupational therapy practitioners also recognize that
recommendation is only the first step of the extensive AT
provision process. Recommendations of AT must be followed
by identifying sources of funding, as well as providing support
to acquire the equipment and training for correct use. Often,
the individuals’ needs and desires for AT and durable medical
equipment are not sufficiently met with federal and private
insurance alone. Thus, community resources, such as diseaseand/or
injury-focused nonprofit organizations, area agencies
on aging, and Medicaid Waiver Programs, may serve as critical
sources of support for obtaining a needed piece of equipment.
Practitioners may also collaborate with individuals to leverage
their existing relationships with local organizations to obtain
additional sources of support.
ROLE OF OT HOME ASSESSMENT AND MODIFICATION
Home assessment and modification are essential to the discharge
planning process, as they can directly impact individuals’
ability to participate safely in ADLs and instrumental ADLs
(IADLs) in their home and enable older adults to age in place.
The role of the occupational therapist is to assess occupational
performance in an individual’s home to gain a better understanding
of his or her to complete desired activities there.
Through the assessment process, the occupational therapist can
identify environmental barriers that prevent the individual from
engaging in activities. This is especially important prior to discharge,
because an individual’s abilities may have changed and
he or she may need additional supports at home to live independently.
This assessment process provides the occupational
therapist with the opportunity to identify and address any safety
issues in the home prior to discharge that could lead to a fall
and result in readmission, and help determine whether a person
should be discharged home.
In addition to an in-home assessment, the occupational
therapist can make recommendations for home modifications,
such as adding grab bars, ramps, lifts, railings, shower
chairs, and other adaptive equipment, as well as removing
environmental barriers, such as clutter, throw rugs, or cords
across pathways, which could contribute to a fall and hospital
readmission. An occupational therapy practitioner can also
assist the individual in obtaining the equipment, through a
local durable medical equipment vendor or a health equipment
lending program; coordinate with local contractors to
install architectural modifications as needed; and follow up
to provide necessary training to ensure that the recommendations
meet the needs of the individual. Home assessment and
modification help ensure that an individual’s home is safe and
provides appropriate support for the individual to engage in
activities after they are discharged, while reducing their risk
of readmission.
CE-4 ARTICLE CODE CEA0816
AUGUST 2016 l OT PRACTICE, 21(15)