Why occupational therapists should be the experts of technology enabled care

Nov 5, 2018

Occupational Therapy (OT) helps people who have a mental health illness, physical or learning disability achieve independence, using a holistic and person-centred approach. OTs are registered by the health and care professions council, following their degree in occupational therapy. They study all health conditions, anatomy, physiology and psychology, so they can work out how those conditions impact on a person’s ability to complete daily activities.

Visual observation is taught as a fundamental skill, underlying all occupational therapy assessments. This is how OTs know exactly what a person is able to do for themselves or if they could do things in a different way to make things easier. Sometimes, people need support from equipment, adaptation or others. OTs are experts in recommending just the right amount of support, which enables independence and manages risks. OTs are able to provide social care with the evidence based practice they need to ensure bespoke care packages.

During the theory of their degree and practical application on clinical placements, OTs learn how to use their clinical reasoning to determine if people are able to learn new or regain skills. If they are unable due to their condition, OTs use a compensatory frame of reference (equipment provision & environmental adaptation) to facilitate independence. They are trained in responsible prescribing and the practical use of selecting appropriate equipment for people’s needs.

Observing and prescribing

Over the years, I have observed the differences between an OT prescribing technology and alternatively/unqualified staff. Enabling independence is not a case of ‘this is what we have in the catalogue’ or ‘this doesn’t work for people with…’ It’s about accessing the whole and ever changing market of equipment. It’s about assessing the whole person, using their strengths, to determine what is right for them and often using the equipment creatively.

It’s important the prescriber of technology is an expert in the predominant clinical condition, with an understanding of associated conditions. Through many years of experience, I have specialised as a learning disability (LD) OT, enabling me to have a deep understanding of the complex needs of people who have LD and the needs of the people who support them.

I have done master’s level training in sensory integration, so I can understand the neuroscience behind processing sensory information. This has been invaluable in how I am able to support people with sensory needs. I use their strengths to select, adapt, teach and introduce programs to ensure assistive technology is used in a way that is meaningful for them. I often assess a sensory processing disorder, such as difficulty filtering auditory information, so ensure technology is silent at source and on vibrate/alert only to reduce stress. I have also used desensitisation programs to enable people who are tactile defensive to build up a tolerance to a wearable epilepsy sensor.

As a best interest assessor, under DoLS (deprivation of liberty safeguards) I have learnt how to fully assess a person’s mental capacity, using communication methods appropriate to them, such as Makaton. I have often identified less restrictive practices than those authorised and worked with the DoLS team for change. I removed the need for bed rails, with OT assessment and the provision of a bed exit sensor. I have made sure that best interest decisions are carefully considered for those who lack capacity, when weighing up the use of assistive technology.

Putting theory into practice

A recent example of the impact of technology when properly applied is our work with 13 people with learning disabilities who live in residential care.

The situation

13 individuals are living in three connected flats and are supported by four waking night staff (one in each flat and one ‘roving’). Nine of these people have been assessed as having risks including epilepsy, incontinence, falls/fractures, autism, dementia, Sensory Processing Disorder and pica*. We undertook a thorough assessment:

• Assessed their mental capacity/made best interest decisions for OT and assistive tech.
• Observed/assessed/developed daily living skills, recommending 1:1 hours needed.
• Assessed night support needs using technology to provide evidence based practice.
• Provided OT equipment/adaptations

The solution

We worked with Tunstall to install a range of TEC and equipment to promote independence, including sensors to detect epilepsy, enuresis, bed leaving, room exit.

• A slide sheet and ceiling track hoist, enabled single handed care, promoting privacy and dignity and freeing up staff to assist others.
• Provided a sensory diet to reduce incidence of pica* and used wireless tech to reduce risk.
• Advised DoLS to re-assess authorised restriction (bed rails) after provision of bed exit sensor.
• Provision of connected AT enabled staff to move between flats, alerted to people’s needs when needed.
• Night ‘checks’ not needed for risks monitored by tech. Care provider voluntarily made first reduction after seeing the benefits of technology enabled care.
• Parents advised peace of mind regarding epilepsy sensors detecting seizures.
• Cost of assistive technology approx.: £4K (majority from Tunstall, including install).
• Initial step down from 4 to 3 waking staff = £40K saving – with plan to reduce again to 2 waking staff
  = another £40K saving. Reduction of 1:1 hours = £97K – Local authority & NHS Continuing Heath Care to implement. Total savings identified: £274K (PA ongoing).

#ValueOfOT

(Royal College of Occupational Therapists campaign ‘improving lives, saving money’)

• Independence, increased safety, privacy and dignity for people who have learning disability.
• Peace of mind for parents.
• Reduced costs of staffing and increased prioritisation response for the care provider.
• Reduced costs of care to the local authority and NHS continuing health care.
• Benefits to all stakeholders: Clinically assessed, evidence based and bespoke care packages.

Occupational Therapy Consultants, Technology Enabled Care Ltd is an independent provider of OT, TEC and learning disability services to Local Authorities, NHS and care providers: ot-consultants.com

*Eating nonfood items