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The current situation
Mr Jones is a 60-year-old gentleman admitted to the hospital following a fall. He has had a number of falls in the last six months, following a steady decline in his overall mobility. Mr Jones has a history of arthritis. He suffers from sleep apnea and also has diabetes. He is 5ft 8 inches tall and weighs 12 stones. Mr Jones lives with his wife in a privately owned bungalow. Mrs Jones has been her husband’s sole carer for a number of years and was finding it increasingly difficult to transfer her husband up to the point of his last fall.
Mr & Mrs Jones were at the point of referring to the local community occupational therapist (OT) when the last fall occurred. Following a period of rehabilitation in the hospital, Mr Jones was unable to regain his mobility and as such, now needs to be hoisted for all transfers. Mr Jones expressed a clear wish to return home but did not want formal care. His wife fully supports his wishes and will continue his care for as long as possible.
Holistic assessment
The OT’s assessment uses the Person-Environment-Occupation (PEO) model as a frame of reference for the assessment. However, you will see how compatible this model is with a basic Task – Individual – Load – Environment (TILE) risk assessment structure.
Considering the person
When considering Mr Jones’s wishes the OT established that he did not want assistance from formal carers. Facilitating this would reduce his stress levels as he was also motivated by maintaining the close relationship he has with his wife and her supporting him with his care. Mr Jones was also motivated by trying to do as much for himself as he could, which in this case was turning himself in bed. This goes beyond that of the TILE approach of a person as simply a load and considers what the person is able to do and their motivations.
Assessment of the environment
Mrs Jones is able and happy to support her husband’s wishes not to have outside carers. The OT established that Mr Jones could assist when turning in bed, reducing the strain on Mrs Jones and making it possible to support her with personal care and fitting a sling. This could be made easier with the provision of a patient turning device if required in the future. During the assessment, the OT concluded that Mrs Jones would be unable to hoist her husband on and off the bed to a commode or an armchair using a mobile hoist as it would be too cumbersome and difficult for her to do. In addition, the space did not allow a sufficient turning circle for a mobile hoist. As such, an alternative would be required. However, the fit between the person and the environment remains poor.
Although Mrs Jones would not be able to manage a mobile hoist on her own, she is able to fit a sling around her husband. There was adequate space in one of the families living areas for a height-adjustable profiling bed and a mobile commode. The OT carried out a feasibility study to establish if a ceiling track hoist could be fitted, which was confirmed, as well as an overhead gantry option as an interim measure. The provision of such equipment could improve the fit between the domains. Again, using PEO the OT considered the physical environment as required using a TILE structure, but also considered the relationships, and the individuals involved in a more holistic manner.
Occupation
The OT looked at the occupations in more detail with Mr and Mrs Jones in the hospital, practising transfers and personal care with Mrs Jones using moving and handling techniques, to establish if Mrs Jones could manage the care of her husband at home. This trial was conducted over five days.
The OT considered how the provision of equipment would improve the fit between the domains, reducing the disability and aiding Mr and Mrs Jones in attaining their goals. The assessment using the PEO model covered all the transfers as required in a TILE structured assessment looking at the task, but goes further in linking all the domains together.
The solution
The OT ordered a temporary overhead gantry hoist to be delivered and assembled, as well as a mobile commode, an armchair on wheels and a height-adjustable profiling bed. This package allows Mr Jones to support her husband with personal care and hoist him to the commode or onto an armchair. Mr Jones’s bed mobility makes personal care in bed a lot easier. However, patient-turning options may be required in the longer term.
This improves the fit between the domains, reducing the overall disability. The OT also referred to community housing OT colleagues to look at the longer-term installation of permanent ceiling track hoists throughout Mr & Mrs Jones’s home, along with bathroom adaptations is also feasible.
The above recommendations supported timely hospital discharge and met the family’s requirement not to have formal carers in place in the interim on discharge. Longer-term needs were also considered, and a referral was made to community OT services to continue the assessment for longer-term needs such as permanent ceiling track hoist and bathroom adaptations, continuing to support Mr & Mrs Jones’s wish for Mrs Jones to be the sole carer, thus supporting a single-handed care approach. The use of the PEO model ensures that a more holistic approach is taken, but at the same time, satisfies the need for proper risk assessment, encompassing all the elements of a TILE structured approach.
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This case study is provided as an example of a scenario and possible solutions and is intended for guidance only. A trained professional must carry out a full and thorough risk assessment before implementing a care and/or equipment package. The article above is from the ‘Enabling single-handed care for an elderly couple to remain at home’ by Invacare, Safe Patient Handling.
