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You’ll try to keep your loved one home as long as you can. Personal stories from the frontlines, plus advice.

Home, Safe Home

Home, Safe Home

by RICHIE ASSALY

Occupational Therapists are trained to identify and support a client’s needs, strengths and capabilities in their home; their expertise can be invaluable for clients living with dementia.

She has lived in the same home for nearly 50 years. It has not changed much. The walls are covered with memories, and the rooms are filled with history. She plans to live here for the rest of her life. However, as her disease progresses, her family fears that the risk of living at home is becoming too high.

Cooking has become increasingly difficult, and even dangerous. The stove has been disengaged, but this has only led to agitation and phone calls to the electrician. The door to the basement, where she used to do her laundry, has been locked, causing distress and confusion. 

Her family cannot agree on solutions to the mounting problems. Even the beloved but hazardous old throw rug at the front door has become a point of contention. 

Our job is to find out what you used to be able to do that you are now struggling to do, and to find out how we can help you return to that level of function.

At the family’s request, an occupational therapist arrives. Observing the home and speaking at length with the client and her family, the OT seeks to establish an accurate sense of the client in her most familiar environment.  For those living with dementia, life can seem like a series of losses, as one’s independence slips away.

Occupational therapy, the OT explains, focuses on strengths, not losses. It can increase independence, restore function, and assist caregivers in connecting to the resources they need to plan for the future.

“Working together,” the OT assures the family, “we can make this a safe and comfortable home, and we will make it easy for her to do the things she loves to do.”

**

Occupational therapy is a person-centered practice that helps individuals with mental, physical, or developmental challenges to maintain or restore daily occupations.

It’s “all about function,” explains Sylvia Davidson, the Professional Practice Lead for Occupational Therapy at Baycrest Centre in Toronto. “Our job is to find out what you used to be able to do that you are now struggling to do, and to find out how we can help you return to that level of function.”

To put it simply, an OT is a problem solver. While a physiotherapist may look to improve the mobility of a patient with a back injury, it is the OT’s job to ensure that the patient is still able to do their laundry with ease, or can safely use the shower or tub. 

At the center of occupational therapy is an approach to care that requires looking above and beyond the immediate problems.

“Providing clients with holistic care involves approaching all individuals as multi-faceted beings who do not perform activities in isolation, but rather in a dynamic environment,” explains Alena Mandel, a student completing her degree in Occupational Therapy at the University of Toronto. Unfortunately, individualized care can be limited in an institutional setting.

“Institutionalization means uniformity,” says Davidson. “It means everyone is going to get up at the same time, eat the same food, go to bed at the same time. Sometimes it has to happen, but just because someone starts to show signs of getting lost or disoriented, or even leaves the tap on and floods the bathroom, doesn’t mean we need to start planning for institutionalization.”

According to Julia Rice, an OT in Baycrest’s behavioral neurology unit, a home safety assessment by an OT can be an essential tool for aging at home.

“OTs have the special ability to look at an environment and see both its risks and its benefits,” explains Rice. “Usually, a caregiver is motivated to have the client stay at home as long as possible, and our job is to support them in making the changes and modifications required to meet this goal.”

OTs have the special ability to look at an environment and see both its risks and its benefits.

By adapting an individual’s environment to their specific needs and strengths, a home safety assessment can both improve safety and enhance independence. This can involve measures as simple as rearranging furniture, or more complex such as like installing a flush censor on the toilet or the bathroom sink.  

The challenge lies in striking a balance between a client’s safety and their independence. A kitchen outfitted with a toaster oven and clearly labelled shelves can reinvigorate one’s love for cooking. A custom-made blister pack can ensure that one’s medications are taken reliably. 

Occupational therapists also work to alleviate the adverse behaviors associated with dementia that are often used to justify institutionalization. As an example, Davidson describes an individual in a wheelchair, who is restless and agitated.. 

 “OTs look at this behavior as at any other. What is the meaning behind it? What we have to do is break down that behavior and find out why he is getting up. Maybe he needs to use the toilet, and has lost the ability to express this need. Maybe he is bored or restless, and he has lost the ability to initiate activities,” suggests Davidson. 

“A lot of the behaviors we associate with dementia really come from an unmet need, and if we discover what that need is, we can reduce the behavior.”

**

The public remains largely unaware of many of the services that occupational therapists provide, despite their important presence in almost every corner of the health care system.

A lot of the behaviors we associate with dementia really come from an unmet need, and if we discover what that need is, we can reduce the behavior.

Davidson has played a vital role in developing the soon-to-launch partnership between the Canadian Association of Occupational Therapists and the Alzheimer’s Society of Canada. The formal agreement between the two organizations aims to share knowledge, combine and expand networks, and build the capacity of OTs across the country working in dementia care. 

For Davidson, if your loved one has been diagnosed with dementia, or is showing signs of cognitive decline, it is never too early to speak with an OT.

“I firmly believe that you should start planning with your support system for what the end of your life will look like. There is no cure for dementia, and the one thing we know for sure is that you will reach a point where you can no longer express your needs,” Davidson explains. 

“OTs are ideally situated to help somebody who has dementia to work with their family to flag different areas where help is needed, and help link people and their families to the resources they are going to need.” 

Richie Assaly is a Toronto-based writer.

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To learn more about occupational therapy in Canada, visit the Canadian Association of Occupational Therapy’s website at www.caot.ca. To find an occupational therapist in your region, click here

For home care support or to request a home safety assessment in a province or territory, please refer to the following:

Toronto – Community Care Access Centre (CCAC)
Web – http://healthcareathome.ca/torontocentral/en
Phone – 310-2222 (toll-free; no area code required)

Ontario – Ontario Home Care Association
Web – http://www.homecareontario.ca/public/

Quebec – Health and Social Services (CSSS)
Web – http://www.santemontreal.qc.ca/en

Alberta – Alberta Health Services
Web – http://www.albertahealthservices.ca
Phone – 780-496-1300

British Columbia – British Columbia Health Authorities
Web – http://www.health.gov.bc.ca/socsec/

Saskatchewan – Saskatchewan Health Care System
Web – http://www.health.gov.sk.ca/service-finder

Manitoba – Winnipeg Regional Health Authority
Web – MyRightCare.ca
Phone – 788-8330

Yukon – Yukon Home Care Program
Web – http://www.hss.gov.yk.ca/homecare.php
Phone – 867- 667-5774

PEI – Health PEI
Web – http://www.healthpei.ca/homecare

Nova Scotia – Nova Scotia Department of Health and Wellness
Web – http://novascotia.ca/dhw/ccs/home-care.asp
Phone – 1-800-225- 7225

Newfoundland – Department of Health and Community Services
Web – http://www.health.gov.nl.ca/health/personsdisabilities/fundingprograms_hcs.html#phsp



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