Occupational Therapists Enable Independent Living For Seniors Through Wellness Design Interventions

If your health is exemplary, if you have no physical or mobility challenges, if completing tasks you’ve always handled with ease is still easy, and if no one in your life suffers from any of these difficulties, you may never cross paths with an occupational therapist. And you’d probably be the exception, rather than the rule.

According to the U.S. Bureau of Labor Statistics’ Occupational Outlook Handbook, OT jobs are expected to increase 16% by the end of the decade. A rapidly-aging population has much to do with that, especially the millions of seniors who want to continue living independently in their own homes. (The Covid-19 pandemic has likely increased this number too, as seniors in nursing homes have been especially hard hit by the virus.) Occupational therapists are the healthcare field’s wellness design facilitators.

Keeping Low Income Seniors Safer at Home

Enter CAPABLE, (short for Community Aging in Place – Advancing Better Living for Elders), a program created at the Johns Hopkins School of Nursing and profiled recently in Forbes.com, that brings an OT with a nurse and handyman to low income seniors’ homes to make them safer and more functional. The program has been praised by both the current Secretary of Health and Human Services, Alex Azar, and the Democratic candidate for president, Joe Biden.

Here’s what Biden said about it in a recent speech, streamed live on Facebook in July: “There’s a pilot program now in 27 cities and 16 states where a nurse, an occupational therapist and a handyman come to the home that’s caring for an aging family member… They walk through the house… and install handrails in the rights spots in the house and bathroom, or they fix the door that’s stuck so she doesn’t trip when she tries to open it. It initially found that about $3,000 in program costs yielded more than $20,000 in savings to the government, from hospitalizations and other reasons.”

According to its co-creator, Sarah L. Szanton, a nursing professor and director of the school’s Center for Innovative Care in Aging, Azar has been encouraging about the program’s expansion, and a key HHS committee voted in favor of having Medicare scale it further to test continued cost-effectiveness. Szanton notes that she developed the nursing and handyman portions of CAPABLE as an enhancement to an ABLE program created by the Center’s occupational therapist and founding director Laura Gitlin.

Occupational Therapy and Wellness Design for Seniors

Scott Trudeau, practice manager for the American Occupational Therapy Association, became aware of CAPABLE when it was in the research stage and promising early results were being shared, he recalls. Since then, the organization has consulted and partnered with study leaders to provide their specialized expertise. “In addition,” Trudeau notes, “we have advocated with Congress, CMS [Centers for Medicare & Medicaid Services] and HHS to support codifying important occupational therapy interventions in policy and regulations.” Interventions, a term for professional involvement by an OT, are only effective when there are established mechanisms for reimbursement and payment, he observes.

AOTA has also been involved in educating its members on CAPABLE so that they can be part of its successful implementation and expansion, and in providing direct advice to the leadership team.

The CAPABLE intervention provides for a range of modifications to the home to make it safer and easier for clients to perform the activities they have set as a priority, Trudeau explains. “Key improvements like installing grab bars in bathrooms, or a railing to make it safer to navigate stairs have been widely reported. Very specific needs related to the individual home – changing out steps for a ramp, for instance – are also included. It is not one size fits all, but rather highly tailored to the needs of the individual within their home environment.” The visiting OT recommends improvements that let the senior perform the task safely and successfully and then the handyman implements them. That could be walking a dog for one client, with help from a new entryway ramp, or being able to continue baking for another, with the addition of cabinet accessories that help someone in a walker reach her rolling pins and baking sheets more easily. All CAPABLE clients set their own functional task priorities, giving the program more power to positively impact individual lives.

“This is really a key turning point in our appreciation that health care costs can be impacted by interventions that don’t necessarily fit into the traditional medical model,” Trudeau points out. “Programs like this are why I became an occupational therapist,” he shares.

You may not need occupational therapy for age or disability any time soon, and your income may be too high to qualify for reimbursement under a government program, but the ability to continue living productively and independently at home for decades to come is one an occupational therapist can help you or someone you love achieve.

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