Carlie Whittle Occupational Therapist ORA service (Wellington Community) Community ORA service Comprised of multi disciplinary team (OT, geriatrician, liaison nurse, social work, psychologist, family therapist, physio, SLT, rehab assistants). Assessment, treatment and rehabilitation. People (16 yrs. +) who have experienced a health event or health condition which is significantly impacting function. 3 community ORA teams (Wellington, Kenepuru, Kapiti). Dementia Problem with managing or home situation crumbling. Safety concerns. Perceived unsafe behaviour. Level of care / support need decisions. To assist with providing diagnosis. What role does OT have? Enabling optimal health and well being through engagement in meaningful activity. Advocating a person’s right to autonomy. Using meaningful activity to enable optimal participation in daily life activity. Process of intervention Information gathering. Battery of assessment (e.g. Allen’s Cognitive Level, COGNISTAT, RBMT, Assessment of Motor and Process skills). Functional assessment. Support and education. How is this useful? Helped me to understand what is happening to me. Helped me to understand what the diagnosis actually means for us as a family. Given me hope. Your support has been crucial. You have helped me to manage as well as I can. David J (false name) 57 years. Alcohol related dementia. Dementia specialist care facility. Referred to team for medication review. Assessed by geriatrician. Referred to OT re; challenging behaviour. Goals Facility: To have David medicated to stop the challenging behaviour. David: To return to community living. Initial hypothesis ? Behaviour caused by: Lack of contact with other people functioning at a similar level. Lack of cognitive stimulation. Absence of meaningful activity. Lack of opportunity to function at his optimal ability. Loss of freedom and autonomy. OT Ax revealed Global cognition – areas of impairment and areas of STRENGTH. Functioned at reasonable level. Basic routine activity well established. New learning possible (slowly by rote). So why in DSC? Placed directly from community. Involved with 4 separate hospital departments leading to placement. Two themes emerged re placement decision: 1. Impairment focused. 2. The influence of risk on clinical reasoning. Reside at RH level? More enriched environment. Opportunity for autonomy and greater level of freedom. Access to required cognitive assistance. Able to participate in meaningful activity. BUT no locked doors!! Outcome Moved to RH level care. Carefully chosen environment. Residing with people functioning at a similar level. Able to function at his best ability. Participate in activity of enjoyment. No challenging behaviour! Still there! Useful reminder...... Powerful influence of the environment (the problem is often not a problem with the person but with the human / non-human environment). Focus on STRENGHTS! Don’t underestimate the potential for new learning. Trial of least restrictive option first. Manage our feelings around risk. Questions??? How can you refer to ORA / for OT Anyone can refer! Referrals faxed via Care Co-ordination Centre F: 2382022 How to contact me Carlie Whittle PG Dip Occupational Therapy carlie.whittle@ccdhb.org.nz T: 04 9185261