Occupational therapy is a key part of improving long-term care in Ontario

I read with interest the May 29 article, “We already have the road map on how to make long-term care a home.”

I am an occupational therapist who provides services to residents in six long-term-care (LTC) homes in the GTA. I support the views expressed, but was dismayed to find that occupational therapy was not included as an essential discipline providing rehabilitative services to residents in LTC. This may have been an unfortunate oversight as I am sure the author is aware that Ontario’s Long-Term Care Homes Act (2007) is framed upon a restorative approach to care in long-term-care homes that requires each home to provide an organized interdisciplinary program with a restorative care philosophy that promotes and maximizes residents’ independence. Homes must arrange or provide occupational therapy and speechlanguage therapy as well as on-site physiotherapy on an individual basis or in a group setting based on residents’ assessed care needs. In light of the significant needs identified in long-term-care homes that occupational therapists could assist to address, I feel it important to bring attention to this profession and its contributions to resident care.

Occupational therapists (OTs) are regulated health professionals who assist LTC residents to overcome or minimize barriers to managing day to day tasks, activities, and interactions. They work to maximize residents’ ability to participate to the fullest of their potential in activities that are meaningful to them with a focus on enabling quality of life. The foundation of our profession is rooted in the science and understanding that one’s ability to engage in meaningful activity contributes to health and well-being. While residents of today’s long-term-care home have become more complex and potential for full independence are more limited, the demands on care staff have increased. Now, more than ever, there is a need to maintain residents’ abilities as long as possible and to address needs and risks that can result in falls, pressure injuries, responsive behaviours which not only compromise the resident’s health and well-being, but also demand more care time and potential hospital admissions.

Occupational therapists are trained to be problem solvers, to assist residents in LTC to meet their functional needs within the existing parameters of the residents’ physical, cognitive and behavioural function and the existing environmental, staffing, and financial resources. Occupational therapy assessment and intervention may focus on: á Promoting abilities to manage self care tasks as independently as possible; providing assistive devices or modifications; assessing for seating and mobility needs and the prescription of walkers, wheelchairs, seating systems, etc.; assessment for and fabrication of splints or prescription of prefabricated orthotics to maximize and maintain function and range of motion; formal and informal cognitive assessments of residents to monitor their cognitive function and identification of strategies to mitigate weaknesses, consulting to staff to share effective strategies; á Address falls prevention strategies and behavioural issues associated with dementia such as agitation and aggression; á Individualized resident programs which address the whole resident’s needs (physical, cognitive, behavioural) are developed to maintain cognitive function and reduce disruptive behaviours; á Consultation and education to support nursing staff to promote functional independence, use adaptive equipment, position residents properly in seating systems, engage in strategies to reduce responsive behaviours, etc.

Unfortunately, occupational therapy services have been chronically underfunded as government has not mandated the level of occupational therapy services to be provided to LTC residents, other than stating that residents must have access to occupational therapy. LTC homes (for profit and not-forprofit) maintain that there are not adequate funds in the Program and Support Services budget (PSS) to fund occupational therapy services. Most outsource their OT staff and it is not uncommon to see meagre contracts of five hours per week in a 180-bed LTC home.

The author’s points drive home a message that we can begin to improve long-term care now. Ontario occupational therapists support her message and urge governments to address the critical need for attention and funding to enable this. One way to commit to improvement is to resource longterm-care homes with the staffing mix required to meet the needs of residents in a collaborative, interprofessional manner that lends to efficiencies and effectiveness. Occupational therapists should figure prominently in this staffing mix.