Last year (2018) the American Occupational Association (AOTA) celebrated its century milestone. That one-hundredth birthday means that their members have been providing home assessment, modification, and consultation services for longer than we have been thinking of aging in place as a specific discipline – a lot longer.
It’s appropriate that we acknowledge and talk about this achievement during “National Occupational Therapy Month” which occurs every April. OTs (Occupational Therapists – OTR/L typically, along with Occupational Therapy Assistants – COTAs) are responsible for evaluating home well someone functions inside their home and what additional measures or adjustments might be necessary or recommended to improve their overall lifestyle and level of performance.
What separates OTs from other professionals is their focus on the home environment and how well someone relates to that. It is more than just improving function, although that is important. It is enabling them to have a more complete and successful approach to their activities of daily living (ADLs).
These activities of daily living are not survival skills per se or something that creates a life and death situation, but they are a measure of how well someone can continue to remain independent in their living space. They are basic life skills.
We want people to be able to perform more than just this minimum amount, but to the extent they require some assistance to perform these essential tasks for themselves, they likely are going to require the services of a caregiver – a family member or someone coming into their home for this purpose. As it becomes more difficult for them to manage these activities and for others to assist them, a move to a managed care facility of some type might be necessary.
Some people assign more than just the basic human performance tasks to the ADL category, and while we want people to have the capacity to do such tasks for themselves, they don’t into the essential range but to an extension of that.
What is considered essential for someone to do for themselves – with assistance by anyone – includes many of the activities that a person would undertake in starting and ending their day at home. Someone needs to be able to awaken and get themselves out of bed in the morning and then return to bed at night and be able to fall asleep, they need to select the clothes appropriate for that day’s weather and planned activities and dress themselves, they need to use the bathroom to attend normal continence functions, they need to clean and groom themselves (showering or bathing or washing their face, shaving for men, combing or brushing their hair, and brushing their teeth), sitting and standing (as well as walking about inside their home and changing their physical position), and feeding themselves although not necessarily preparing the meal. These generally are grouped into as few as five categories and as many as eight or more – depending on the person describing them.
These ADLs are independent of any specific injury or cognitive limitations that someone might have although that might restrict or impair someone’s ability – temporarily or long-term – to perform some of them.
Then, the OTs take a look at the living space itself and how safe it is for someone to use their home and how accessible it is. The focus is on performing the required tasks to manage their home and their lifestyle within it without the risk of injury or discomfort to themselves. For example, many of can retrieve something from a shelf that is beyond our comfortable or normal reach by stretching for it, standing on our toes, getting a coat hanger or something else to help push it off the shelf and then catch it as it falls, or by getting a step ladder or stool to stand on (and hopefully not using a chair or other makeshift way of increasing our height).
Safety in the home is a paramount concern to aging in place specialists, and we look for ways to make home environments better for the occupants. OTs are instrumental in making these assessments and add their observations about how people use the various items in the home (appliances, fixtures, switches, controls, furniture, passageways, and other areas) as well. They provide invaluable insight for creating appropriate renovations for people as they remain in their home – even if those aren’t elaborate or expensive changes that need to be made.
We should all find an OT (or more than one) to partner with (as an independent contractor) to make our aging in place business more successful and effective. They bring a level of expertise that many of us can’t be expected to have no matter how many assessments or renovations we have done.