Occupational Therapy in a Home Care Setting

By: Erin Berkowsky, OTR/L

An occupational therapist evaluates balance, coordination, endurance, safety awareness, strength, attention, problem-solving, vision, communication, and many other functions while the individual performs daily tasks. Occupational therapists also evaluate the home environment to identify barriers to independence. For example, structures can be identified that increase the risk of falls (e.g., throw rugs) or other present hazards.  The occupational therapist would collaborate with the client, family members/caregivers and potentially a construction company depending on the scope of the necessary home modifications.

Adapting the living environment to meet changing needs will become a necessity during short term illness/ injury, progression of a disease or aging.  These environmental modifications will help the client stay safe and retain his/her independence for as long as possible.  As part of the evaluation, occupational therapists study how a client interacts with the home setting to complete a task or activity. During this process, modifications or intervention strategies are selected with the overall goal of maximizing safety and independence within the home. One example could be adding secure supports, like handrails or grab bars, to assist someone who has difficulty balancing during functional mobility and self-care activities. These modifications can also lower the caregiver’s risk for injury by making tasks, such as transfers, less physically demanding.

Home modifications can be permanent or temporary, simple or extremely sophisticated. Some are easy and inexpensive to implement; others may require costly,  major renovations.  The client and family/caregivers will want to give some thought to priorities and budget when adapting a home. An occupational therapist can offer ideas for addressing problematic areas. Some clients may also consult with a contractor who is knowledgeable about home accessibility if there is a need to create permanent, structural changes to the home.

Examples of common problems that clients experience include difficulty using the toilet and shower, difficulty reaching items, poor lighting, inaccessible areas of the home. The occupational therapist will suggest and implement home modification strategies such as useful adaptive equipment (tub bench, reacher, dressing aids, etc), architectural modifications (ramp, widened doorways), major home renovations (roll-in shower, kitchen renovations for wheelchair optimization), then provide training in using the compensatory supports and strategies during daily activities.

Occupational therapists are skilled at recognizing how an environment may affect the client’s level of independence and overall satisfaction in being able to live in their home with ease.