Field Work - round 1

Last week I had the opportunity to spend three working days with an occupational therapist. As part of field work there were some assignments associated with the experience but it was great to be out of the classroom and see how what we are learning actually applies in real life. All of my previous exposure to OT has been in a hospital setting so I didn't really know what to expect when I was assigned to home care. Home care is for those who are considered "home-bound." In most cases the client has recently come home from the hospital but it is exhausting to go anywhere so the additional care they need comes to them. Most of the people we saw were over 65. The diagnosis ranged from by-pass surgery to a fractured vertebra to chronic obstructive pulmonary disease to Parkinson's. Each visit could be a story in itself but that would go against confidentiality rules so I'll stick to some of the things I learned.

During one of our visits the first day, I found myself rather uncomfortable. I couldn't really put it into words but I found myself wondering if I really wanted to do this job. As the OT did a cognitive evaluation and tried to help the client figure out what had happened to one of her medications something didn't seem right. As we drove to the next appointment, the OT put words to my uneasiness when she said, "I know there is really nothing I can do that will make a difference in her life." I suppose that is part of every job that works with people and it is better to recognize it and focus on those you can help.

Another visit that first day left me flabbergasted. Instead of seeking medical help following an injury, this particular person had sat on the couch--for months--waiting for it to get better before seeking medical help. Sitting around that long leads to extreme weakness and muscle tightness that, in this case, made it almost impossible to stand. I was shocked. How could something like this happen?! The OT didn't really know what to do in the situation either. She could help the person obtain a wheelchair to allow movement around the home. But beyond that, "This one is going to take a team meeting (with the nurse, physical therapist, & social worker...) to figure out what to do."

Almost all the people we visited had simple home exercise programs. Some of them used the thera-bands for resistance but for the rest, gravity was enough. Just move the arms in and out, punch, walk in place and kick. In every case, people were making progress. One woman had gone from not being able to do any of the exercises standing to doing each for 1 minute while standing and recovering quite quickly. She needed to be at 2 minutes each before she was ready for cardiac rehab but she had already come a long way. The OT taught me that simple is almost always better.

Several people we visited had spouses who were doing a lot of work to help with care. It's can be a hard adjustment for them. The OT talked about how she can tell which spouses will burn out if they don't get help. We met one of man who is a good candidate for burn-out. It was obvious that he loved his sweet wife but he was also very aware of the new limitations that her illness brought to their life. He was mourning all the outdoor activities he loved to do that were no longer available to them.

One of the most encouraging things I saw was some great families: sisters, children, and grandchildren who came together to care for Mom/Grandma on a short-term or more long-term basis. The last day we did several evaluations to see if a particular person needed anything within the  new living situation. In the case of one great-grandmother, the doctor requested a cognitive evaluation. She was living with one of her children, was able to get around on her own and was rarely left alone and then only for a few minutes. The results of the cognitive evaluation wouldn't change anything the family was doing to care for her so the OT just asked her a few questions. In another situation, the client was in quite a bit of pain so the evaluation was more related to looking at what her kids were doing to make things work for their mom following a recent hospital stay. They were doing a great job. A few suggestions and a plan for when to return reassured the family. In home care, working with the family is just as important as working with the client.