Case Study Presentation
Aged Care and
Rehabilitation Service
October 2012
Aged Care and Rehabilitation Service
(ACRS)
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Aged Care and Rehabilitation Service:
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Multidisciplinary team
Geriatric clients
28 beds
Short and medium inpatient care
Frameworks
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Person-Environment-Occupational
Performance (PEOP):
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Highlights complexity of person-occupationenvironment relationships
Occupational performance as outcome
Client central to care plan
Client-Centred Frame of Reference (FOR):
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Client needs direct planning and intervention
(Christiansen, Baum, & Bass, 2011; Parker, 2012; Cole, & Tufano 2007; Parker, 2011)
Communication and Rapport
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Fosters therapeutic relationship
Honesty
Confidentiality
Respect
Clarity
Client-centred
Pseudonym: Ms Pamela Watson
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Member of aged demographic
Fractured pre-existing hip replacement
Left hemi-arthroplasty
Deconditioned
Bilateral Odema
Urinary precautions
Higher risk of nursing home placement
Extended Aged Care at Home Package (EACH)
(ABS, 2011; Spealstra, Given, You, & Given, 2012; McCallum, Simons, Simons, & Friedlander, 2005;
Koval, Skovron, Aharonoff, & Zuckerman, 1998, Australian Associated of Occupational Therapists,
2001; Altizer, 2005; Australian Department of Health and Ageing, 2009)
Function
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Pre-morbid:
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Admission:
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Independent with all Activities of Daily Living
(ADLs)
Assistance with showering
Maximum assistance with ADLs
Current:
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Minimal assistance with ADLs
(Bynon, Wilding, & Eyres, 2007; Van Huet, Parnell, Mitsch, & Mcleod-Boyle, 2011)
Framing
Framing
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Automatic referral
Responded to in timely manner
Comprehensive client evaluation
Occupational Therapy Code of Ethics
Little Company of Mary
(Little Company of Mary Health Care Ltd, 2007; Australian Association of Occupational
Therapists, 2001; Roberts, & Evenson, 2009)
Focussing
Focussing
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Acquired client 3.5 weeks into Occupational
Therapy Practice process (OT Process)
Handover provided
Gather current function and further deficits
Minimum standards for information gathering
Maintained confidentiality
(Occupational Therapy Australia, 2010; Australian Association of Occupational
Therapists, 2001)
Informing
Informing
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Integral to Occupational Therapy Practice
Process
Determine effect of intrinsic and extrinsic
factors on occupational performance
PEOP and client centred FOR guided
assessment process
(Hocking, 2010; Roberts & Evenson, 2009; Welch & Lowes, 2005; Liu et al, 2005;
Christiansen, Baum, & Bass, 2011; Parker, 20122; Cole, & Tufano 2007; Parker, 2011)
Assessments
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Functional Independence Measure (FIM)
Assess physical and cognitive function level of
assistance required for care
 Measures patient progress and rehabilitation
outcomes
 Responsive to change
 Initial:
 Develop occupational profile
 Fosters therapeutic relationship
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(Glenny, Stolee, Husted, Thomspon, & Berg, 2010; Henry & Kramer, 2009; Haidet &
Paterniti, 2003; Rogers, 2009; Rogers, & Holm, 2009)
Assessments
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Rowland Universal Dementia Assessment Scale (RUDAS):
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Valid screening tool for cognitive impairment
Culturally diverse
Applicable to range of settings and diagnoses
ADL assessments:
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Bed mobility
Shower
Toileting
Meal preparation
(Unsworth, 2011; Rowland et al, 2006 Measurement scales used in elderly care,
N.d; Liu et al, 2005)
Assessments
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Home Access Visit:
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Identifies barriers to home discharge
Integral aspect of discharge planning
Geriatric Depression Scale (GDS):
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Assess presence of depression
Clinically valid and reliable in rehabilitation setting
(Welch & Lowes, 2005; Wancata et al, 2006)
Identifying
Occupational Issues
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Unable to transfer in/out of bed
independently
Unable to maintain stamina to perform light
meal tasks
Unable to dress lower limb independently
Unable to perform self-care tasks with
minimal assistance
Naming
SMART Goals
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By the end of 6 weeks, Ms Watson will be able to
independently transfer in and out of bed within the
ACRS setting utilising her own physical strength and
endurance. Ms Watson will practice transfers daily
and a weekly follow up discussion will be utilised to
identify progress.
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By the end of 6 weeks, Ms Watson will be able to
independently make a cup of tea in the ADL kitchen
utilising the toaster, tap and condiments. Ms Watson
will practice making tea weekly and weekly
functional observation will be utilised to measure
progress
(Occupational Therapy Australia, 2010)
SMART Goals
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By the end of 6 weeks, Ms Watson will be able to
independently dress the lower limb within the rehab
setting utilising her own physical strength and
flexibility. Ms Watson will practice daily, reducing the
nursing assistance provided. Functional observation
and review will be utilised to measure progress
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By the end of 6 weeks, Ms Watson will be able to
independently transfer on and off the toilet using an
over toilet frame in her rehab room. Ms Watson will
receive less nursing assistance daily and functional
observation and review will be utilised to measure
progress
(Occupational Therapy Australia, 2010)
Doing
Intervention
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Client-centred
Compensatory:
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Equipment provision
Recommendations
Remedial:
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Retraining
Practice
(Christiansen et al, 2011)
Intervention
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Functional task retraining:
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Increases physical functioning and independence
Maximises functional recovery following hospital
related debility
Group Participation:
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Re-learn adaptive skills
Maintain occupational performance
Facilitate socialisation
(Pierce, 2008; Hagsten, Svensson & Gardulf, 2006; Kortebein, Bopp, Granger,
& Sullivan, 2008)
Intervention
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Equipment provision in hospital:
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Adjustable shower chair
Over toilet frame
Long handled reacher
Case Conference:
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Weekly
Presented current care plan and goals
(Koval & Cooley, 2005)
Intervention
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Family Meeting:
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Multidisciplinary
Discharge destination
Future improvements required
Recommendations post-home visit:
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Client function, intrinsic factors
Environmental modifications, extrinsic factors
Intervention
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Unable to achieve SMART goals
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Discharged from occupational therapy
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Awaiting Nursing Home Placement:
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Unsafe for discharge home
Reviewing
Service Evaluation
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Integral to professional reflection and
development
Functional review
Observation
FIM
(Duncan, 2011; Glenny, Stolee, Husted, Thomspon, & Berg, 2010 ; Australian Association
of Occupational Therapists, 2001)
Service Evaluation
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Challenging result
Improvements not always achieved
Duty of care
Client safety central to care
(Australian Association of Occupational Therapists, 2001)
Reference List
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Altizer, L. (2005). Hip Fractures. Orthopaedic
Nursing, 24, 283-292
Australian Association of Occupational
Therapists. (2001). OT Code of Ethics
Australian Bureau of Statistics. (2011).
Population by Age and Sex, Regions of
Australia (No. 3201.0). Retrieved from
http://www.abs.gov.au/ausstats/abs@.
nsf/mf/3235.0
Australian Department of Health and
Ageing.(2009). Extended Aged Care at
Home (EACH) Packages: Information
Sheet no. 4. Canberra: Author
Bynon, S., Wilding, C., & Eyres, L. (2007). An
innovative occupation-focussed service
to minimise deconditioning in hospital:
Challenges and solutions. Australian
Occupational Therapy Journal, 54, 225227
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Christiansen, C., Baum, C.M., & Bass, J.(
2011). The Person-EnvironmentOccupational Performance Model. In
E.A.S. Duncan (Eds.) Foundations for
practice in occupational therapy (5th
edition pp 93-104). London: Elsevier
Cole, M, & Tufano, R. (2007). Applied Theories
in occupational therapy: A practical
approach. Thorofare,N.J: Slack
Eyres, L., & Unsworth, C.A. (2005).
Occupational therapy in acute
hospitals: The effectiveness of a pilot
program to maintain occupational
performance in older clients. Australian
Occupational Therapy Journal, 52, 218224.
Reference List
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Glenny, C., Stolee, P., Husted,
J.,Thompson, M., & Berg, K.
Comparison of the
responsiveness of the FIM and
interRAI Post Acute Care Assessment
Instrument in Rehabilitation of older
adults. Archives of Physical Medicine
and Rehabilitation, 91, 1038-1043
Hagsten, B., Svensson, O., & Gardulf, A.
(2006). Health-related quality of
life and self-reported
ability
concerning ADL and IADL after
hip fracture. Acta Orthopaedica,
77(1), 114-119
Haidet, P., & Paterniti, D.A. (2003).
“Building” a history rather than
“taking” one. Archives
of Internal
Medicine, 163, 1134-1140
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Henry, A.D., & Kramer, J.M. (2009). The
interview process in occupational
therapy. In E.B. Crepeau, E.S. Cohen,
& B.A. Boyt Schell (Eds.), Willard &
Spackman’s Occupational therapy
(11th edition pp. 342-358). Baltimore,
MD: Lippincott William & Wilkins.
Hocking, M. (2010). Process of assessment and
evaluation. In M. Curtin, M. Molineux &
J. Supyk-Mellson (Eds.) Occupational
Therapy and Physical Dysfunction (6th
edition pp 81-93). London: Elsevier
Kortebein, P., Bopp, M.M., Granger, C.V., &
Sullivan, D.H. (2008). Outcomes of
inpatient Rehabilitation for older adults
with debility. American Journal of
Physical Medicine and
Rehabilitation,87, 118–125
Koval, K.J., & Cooley, M.R. (2005). Clinical
pathway after hip fracture. Disability
and Rehabilitation, 27(18-19), 10531060
Reference List
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Koval, K.J., Skovron, M.L., Aharonoff, G.B., &
Zuckerman, J.D. (1998). Predictors of
functional recovery after hip fracture in
the elderly. Clinical Orthopaedics and
Related Research, 348, 22-28
Little Company of Mary Health Care Ltd. (2007).
Philosophy: the philosophy of the
health, community and aged care
service which is a ministry of the
Sisters of the Little Company of Mary
Liu, S., Kuo, J., Wei, H., & Banks, R. (2005).
Clinical Value of ADL Assessments for
Inpatients post-Total Hip Replacement
Surgery. (Unpublished Student
Research Project). University of
Queensland and Mater Adults Hospital,
Queensland.
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McCallum, J., Simons, L.A., Simons, J., &
Friedlander, Y. (2005). Patterns and
predictors of nursing home placement
over 14 years: Dubbo study of elderly
Australians. Australian Journal on
Ageing, 24(3) pp 169-173
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Measurement scales used in elderly care.
Retrieved Oct 4, 2012 from
http://www.dementiaassessment.com.au/symptoms/FIM_m
anual.pdf
Occupational Therapy Australia [OTA]. (2010).
Australian Minimum Competency
Standards for New Graduate
Occupational Therapists.
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Parker, D.M. (2011). The client-centred frame of
reference. In E.A.S. Duncan
(Eds.),Foundations for practice in
occupational therapy (5th edition pp
140-152). London: Elsevier
Reference List
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Pierce, S.L. (2008). Restoring Mobility. In
M.Vining Radomski & C.A.Trombly
Latham (Eds.) Occupational therapy for
physical dysfunction (6th edition pp
817-853). Baltimore: Lippincott
Williams and Wilkins
Roberts, P., & Evenson, M. (2009). Settings
Porividng Medical and Psychiatric
Services. In E.S.Crepeau, E.S.Cohn, &
B.A. Boyt Schell (Eds). Willard &
spackman’s occupational therapy (11th
edition pp 1074-1079). Philadelphia:
Lippincott Williams & Wilkins
Rogers J.C., & Holm, M.C. (2009). The
Occupational Therapy Process. In
E.S.Crepeau, E.S.Cohn, & B.A. Boyt
Schell (Eds). Willard & spackman’s
occupational therapy
(11th edition
pp 478-518). Philadelphia: Lippincott
Williams & Wilkins
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Rogers, J.C. (2010). Occupational reasoning. In
M. Curtin, M. Molineux, & J. SupykMellson (Eds.) Occupational Therapy
and Physical Dysfunction: Enabling
Occupation (6th edition pp 57-65).
London: Elsevier
Rowland, J., Conforti, D., Basic, D., Vrantsidis,
F., Hill, K., LoGiudice, D., Russell, M.,
Haralambous, B., Prowse, R., Harry, J.,
&Lucero K. (2006). A study to evaluate
the Rowland Universal Dementia
Assessment Scale (RUDAS) in two
populations outside
of the
Sydney South West Area Health
Service. Retrieved Oct 4, 2012 from
http://www.fightdementia.org.au/comm
on/files/NAT/20110303-Nat-CALDRUDASvalidation2007.pdf
Reference List
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Spealstra, S.L., Given, B., You, M., & Given,
C.W. (2012). The Contribution Falls
Have to Increasing Risk of Nursing
Home Placement in CommunityDwelling Older Adults. Clinical Nursing
Research 21(1) pp 24-42
Van Huet, H., Parnell, T., Mitsch, V., & McleodBoyle, A. (2010). Enabling engagement
in self-care occupations. In M. Curtin,
M. Molineux & J. Supyk-Mellson (Eds.)
Occupational Therapy and Physical
Dysfunction (6th edition pp 341-355).
London: Elsevier
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Wancata, J., Alexandrowicz, R., Marquart, B.,
Weiss, M. & Friedrich, F. (2006).
The criterion validity of the Geriatric
Depression Scale: a systematic review.
Acta Psychiatrica Scandinavica , 114
(6), 398-410 retrieved from
http://onlinelibrary.wiley.com/doi/10.111
1/j.1532-5415.2005.53461.x/full
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Welch, S., & Lowes, J. (2005). Home
assessment visits within the acute
setting: A discussion and literature
review. British Journal of Occupational
Therapy, 68(4), 158-164