Ashley Opp Hofmann
Although it may defy conventional logic, the time spent in a skilled nursing facility or nursing home can be activity filled and engaging. Through occupational therapy, residents can develop function as well as an increased sense of competency and personal happiness. Occupational therapy can enable residents to “live life to its fullest™” in many ways, from helping short-term residents regain the skills they need to return home to enhancing the lives of long-term residents.
A skilled nursing facility is a not always a permanent residence—it is a health care facility that provides continual medical care and therapy. This broad definition for the setting means that a facility’s clients encompass many age groups, diagnoses, and circumstances, and care can be short term or long term.
“The population in skilled nursing facilities has changed,” says Vickie Pierman, an occupational therapist for Genesis Rehab Services. In addition to the traditional long-term population, clients are staying in hospitals for less time so they are getting fewer therapy services, and many of them now come into a skilled nursing facility to continue their recovery.
“We’re preparing many patients to return home to their previous roles as a mom, a grandfather, an employee,” Pierman says, rather than for permanent residence in the facility.
Occupational Therapy in a Skilled Nursing Facility
In a skilled nursing facility, occupational therapists tailor their approach to each person. It is common for them to help residents develop skills for what are known as activities of daily living—self-care tasks such as feeding or dressing. Occupational therapists and occupational therapy assistants provide equipment to assist with these activities, modify the person’s environment to maximize independence, and facilitate participation in the center’s activities.
If someone comes to a skilled nursing facility for a short-term stay, an occupational therapist might address activities of daily living and educate him or her on energy conservation and task simplification. An occupational therapist may also evaluate the person’s home for safety after discharge, then recommend and teach the person to use adaptive equipment, such as a shower chair or a walker, how to care for themselves safely, and how to pursue regular activities—like cooking or driving—as they continue recovering.
For residents with dementia or Alzheimer’s disease, occupational therapy practitioners focus on adapting activities throughout the stages of the illness. “We work to keep the patient as functional and as independent as possible, providing them with dignity and enhancing their quality of life,” Pierman says. Depending on the stage of a disease, practitioners establish treatment approaches and goals so that clients achieve their highest level of function for as long as possible.
Each resident’s occupational therapy services depend entirely upon his or her unique circumstances and goals. For example, one of Pierman’s long-term-care clients was an 89-year-old woman who came to the skilled nursing facility from an acute care hospital with a diagnosis of lung cancer. She was likely to remain in the facility for the rest of her care, but occupational therapy made that time productive and meaningful to her.
“She indicated she had lived a really full life,” recalls Pierman. “She had lived in New York City and had had a variety of life roles, which included being a Broadway entertainer who had traveled to Europe during World War II to entertain the troops. She had had relationships with many actors and just reveled in her memories of that.”
An important part of occupational therapy also involves working with the client to identify his or her own personal goals. In this case, the client had a son and grandchildren. “She was confronting the end of life and wanted to create a memory book for her family,” says Pierman. As her occupational therapist, Pierman helped the woman find mementos in her apartment and obtained a scrapbook so she could organize her these items related to her life events.
Creating the memory book gave Pierman’s client something to look forward to each day and provided her with visual, perceptual, cognitive, and fine motor activities. Her activity tolerance improved, she had a reason to get out of bed, and the activity fostered psychosocial well-being. “She had a sense of comfort and closure, which I think increased the quality of her life,” Pierman says. “By engaging in this task, she had a sense of competency and satisfaction. She adapted to her life circumstances and experienced a sense of spiritual dignity.”
Short-term residents arrive at skilled nursing facilities for myriad reasons, but occupational therapy helps all of them prepare to return home. One of Pierman’s clients was a 37-year-old man recovering from a motor vehicle accident. He had fractures throughout his body and was undergoing a long course of rehabilitation and treatment. He had a family and a job and was afraid of losing his prior roles of being a playful father and earning a living.
“We gave him a lot of encouragement but also real solutions to enable him to function. We created and modified eating and bathing equipment so he could do those things himself. We got him on the computer, which we also adapted, so he could e-mail his children. We got him into a wheelchair and positioned comfortably,” Pierman says. “We saw him through this. He came in very disabled and he walked out of here. He was able to resume all of his life roles.”
Finding a Skilled Nursing Facility
How do you ensure that you or a loved one receives high-quality medical care in a skilled nursing facility? When researching skilled nursing facilities, Pierman recommends looking at how the facility provides rehabilitation. Talk to hospital therapists in your area and ask them for recommendations on reputable facilities.
The most important thing, though, is carefully examining the site. “An individual should tour through a facility several times,” she says. “Go through it at different times during the day and in the evening if possible, and talk with staff.” Pierman also encourages using all of your senses and paying attention to absolutely everything.
Someone going to a facility for a short-term stay should ask about the probable daily schedule, services provided, and the facility’s ability to evaluate and implement any necessary home modifications post-discharge. When considering a facility for long-term care, ask about how residents’ needs are evaluated and addressed as changes occur in function. During these conversations, find out of occupational therapists are involved in care planning.
Occupational therapy practitioners are experts in the performance, physical, mental, and psychosocial aspects of illness and injury. “We are qualified to do the work that we do through our education and training. But what makes us successful is having and developing patience, creativity, adaptability, compassion, empathy, and respect for diversity. It’s not just having the education—it’s having all of those other things too,” Pierman says. “That’s why I love my profession.”
Ashley Opp Hofmann is AOTA’s senior staff writer.