A week in a community OT's life


Arrived in the office at 8.30. Caught up with some admin. Liaised with a hospital OT to discuss a service user being discharged from hospital. He has been in hospital for several months following spinal surgery that has left him requiring use of a wheelchair. His property is not conducive to a wheelchair so he has been referred to me to look at this when he returns home. He has steps at the front door which he will not be able to use. He cannot access his bathroom at all and the kitchen is difficult to access. Planned to visit him later in the week with the community access team who will be looking at him accessing services in the community. I will also be taking the OT student who is with our team on this visit. The hospital OT sent me a home visit report she had completed with the service user while in hospital, and the multidisciplinary report. I read these to gain an understanding of his abilities and his environment. I then went out to visit a service user who was discharged from a spinal unit at the end of last week. He sustained a complete spinal cord injury leaving him paraplegic. He is 30 years old and lives with his wife in a privately rented flat. I had already completed a visit there while he was still in hospital so I could provide equipment to enable him to return home. I was liaising with his hospital OT about this. I have provided him with a bath board, a shower chair and portable ramps. The ramps were just to enable him to have access for weekend leave and final discharge. He requires someone to put them down for him which means he cannot be independent. On my visit we discussed this. He is able to drop down the one step in his wheelchair but cannot get back up. There is also a door opening system that he has to wave a fob on front of while on the ramp to gain access. He is going to speak to his land lady as he thinks she has a fob that can be used from a distance therefore allowing him to open the door before propelling up the ramp. He also mentioned some work to the front entrance is being planned. He is going to give me the details of a committee member of the building to discuss this with. It may include a proposal for a permanent ramp. In the mean time, as he is capable of propelling up a reasonable gradient, I decided I would look into shorter, light weight ramps so he could pick it up himself and lay it down. He has been having some difficulty with the shower chair. It was ordered from the quote that the hospital OT arranged. It has a front access aperture so he can manipulate his bowels. He found that the gap is too small for his hand. He wants to persevere with it for a while to see if the back pain he has subsides which will give him more freedom to lean forward. If not, I will look into replacing the seat with a wider gap or changing the seat or whole chair if required to have side access rather than front. This can be easier to manage bowels. I am still waiting for a padded bath board to be delivered for him to use on the bath to access the over bath shower. He has practises this transfer in hospital so it should be suitable. I returned to the office in time for half an hour lunch break, then went out again to visit another service user. He was a new referral and I had had to arrange an interpreter as he only speaks Cantonese. I arranged this through the Chinese centre at the referral suggested instead of the usual formal channel. They arranged for his friend to be there to interpret. Unfortunately, her English was quite difficult to understand so I just did the best I could. His difficulties were accessing the bath and toilet transfers. His bath is very high, he did have a shower attachment. I agreed to provide a bath board and step. Once these arrive, I will revisit to try him with them and look at fitting grab rails. For the toilet I am providing a free standing toilet frame to give him something to push up from like arms on a chair. I will get a formal interpreter for the next visit to ensure all the information is given correctly. After this, I returned to the office to research ramps for the service user this morning. The one in the standard equipment catalogue by the provider was 1.3kgs heavier than another one I found. The price difference was £14 so I felt it was justified to get the lighter one. It needs to be as light as possible for him to lift it from the ground and store it somewhere. Once I had ordered this and spoken to him to inform him, I caught up on phone calls for other service users, chased up outstanding equipment, wrote case notes and assessments.


Day 2

In the office for 8.30 again. Admin work, including letters and case closures. Then went to visit an 80 year old gentleman who has cerebral palsy. He is a wheelchair user and lives with his wife who has the same condition and also is a wheelchair user. They both have powered wheelchairs. 2 years ago this SU was being hoisted following heart surgery. He had to be PEG fed as his swallow was so poor. He is now off the PEG and hoping to have it removed. He can also stand to transfer. He is a fiercely independent man. He relies on carers for assistance with some personal cares. They have been assisting him to get up in the mornings and go to bed at night. The times they visit do not suit the SU. He wants to get up before they come and go to bed after they have been. I felt he was safe enough to carry out this transfer once I had fitted a bed lever to his profiling hospital bed. His wife had concerns about this so I agreed to refer to physio so we could work on the transfers together. Today I visited with the physio. We observed him transfer onto the bed. I repositioned the bed lever to make it easier for him. We gave him some advice about where to position his wheelchair and then where to position his bottom on the bed to get in the correct position first time. We did this transfer twice and then he was tired. He struggled to get from lying to sitting even with the bed head raised a bit. We are going to try a rope ladder with him so he can pull himself up. The physio is going to visit twice more this week to practice and when the rope ladder arrives, we will do another joint visit. The aim is to ensure he is safe to carry out this transfer independently so he is not relying on carers to get him up and assist him to bed. This will give him more control over his life. After I finished here, I headed back to the office, ordered his rope ladder, write his case notes and had lunch. After lunch, I headed off to meet with a physio from the learning disabilities team and a rep to look at a chair for a SU. This person is in her 40's and has cerebral palsy and a learning disability. She has a lot of postural needs. Her wheelchair does not support these needs and to make it do so would make it too heavy for family to push. Therefore we are looking at providing a chair for her to sit in at home. It needs to be able to move from bedroom to living room as she has a ceiling track hoist in her bedroom for all transfers. She will be transferred into the chair in her bedroom and then pushed through into the living room. I met her today at the day centre she attends every day. Her sister and mother were also present. We tried her with a careflex hydrotilt chair. It was a large and she requires a small but it was for assessment purposes only. We did not quite achieve the postural support we wanted for her. The rep suggested putting wedges in the back to provide more lumbar support. He is going to arrange to bring the smaller chair with wedges in 2 weeks’ time. After he left, we discussed trying another chair from a different company also to compare them. I will now arrange for another rep to visit and assess their chair. I also discussed the ceiling track hoist with her sister as we are in the process of replacing it. It is being held up by processes through the system as it is not a standard hoist. I am still chasing it up, informed sister of this. Headed back to the office. Contacted rep to arrange visit and did more admin.



Day 3

Spent the morning in the office completing paper work. This included arranging a direct payment for someone. This is the first one to be completed where I currently work. This means that social services give the amount of money that they would have spent on equipment to the service user so they can purchase their own. In this case, an intercom with door release is required. The neighbouring flat would like an intercom also but the occupiers do not have a disability so social services would not fund this. By giving the SU a direct payment, they can hire their own contractor to fit the intercom for both flats and the neighbour can contribute toward the cost. This meets everyone's needs and social services have met the SU need. I then arranged for a stair climber to be delivered to a SU. It has been difficult as there was one in the equipment store but when I ordered it, I was told it wasn't there. After a lot of phone calls it was found and I arranged to have it delivered. I also need to arrange for a compatible wheelchair for it through the wheelchair services. I will then need to arrange for the stair climber to be serviced and for the rep to provide training to the SU's husband. After lunch I took the student that is with us out to see the gentleman I mentioned I mentioned at the beginning of day 1. He was discharged from hospital 2 days ago. The accessible transport team were also there. They tried a stair climber with him and determined this was possible. This now means he can use the transport to go to day centres. I discussed the possibility of moving to a new property with him and he was open to this. He does own his property at the moment so I need to look into whether he is eligible for council or housing association properties. His intercom only allows him to speak to people, not let them in, so he has to then get all the way out to open the door. Also, his handset is in the hall which is difficult to get too. I am going to look into getting him an intercom with door release and a remote handset so he can answer the door from anywhere. The door to the flat opens inwards and he has to get around it to enter the flat. I am going to look into the possibility of rehanging it outward but may not be able to as the neighbours’ entrance may be blocked. He does have a lack of insight into his condition. He can be impulsive and complete transfers without the appropriate equipment. He may improve as he adapts to his environment. He does have carers twice a day to assist with personal cares. He would also like to start attending a drawing class weekly that he used to go too. I am going to look into transport options for him. This SU will require quite a lot of input to try and give him as much independence as possible.



Day 4

Started the day in the office doing admin. Went on a visit to see a lady in her early 60’s who is having difficulty getting her scooter into her property. She needs the scooter as she has problems with her breathing and cannot mobilise very far. Authorities do not provide scooters, but can sometimes provide the adaptations to get it into properties for storage and charging, depending on local policy. She lives in a council ground floor flat. There is lip at the gate onto the public path, which she has just put some wooden planks onto. This is not safe. There is also 2 steps into the front door, where 2 portable channel ramps have been put down and screwed into the step at the top. This has not left much room to stand on the step to use the intercom or unlock the door. There are also other people needing to use this access as it is communal and it is not safe for them to walk down the channel ramps. I am going to supply a 1m portable suitcase ramp for the lip as she is able to lay it down. For the main access, I am going to discuss it with the surveyor with the view to providing a permanent concrete ramp with a platform at the top. This will enable her to get her scooter inside and be safe for other people to use. Spent the afternoon arranging visits for next week, ordering equipment and discussing cases with senior OT.



Day 5

First thing, I met with carers and the daughter of a SU to demonstrate how the new ceiling track hoist works. We hoisted the SU from her hospital bed into her specialist chair with no difficulties. This is now much easier for the carers as they do not need to move the mobile hoist around. Also, it can be done with one carer instead of 2. The SU has been sitting in her sling in the chair. He current sling is not appropriate for this as it could cause pressure areas. I am going to provide 2 new slings that are suitable to sit on all day. I will also write a manual handling care plan that will go to the SU, the social worker and the care agency.

I then went to visit a SU who had collected her bath board that was issued by prescription. I fitted this for her, demonstrated its use and measured up for a grab rail. This is for use with an over bath shower. I then ordered the rail and arranged the appointment.

My next visit was to see a chair that had been delivered to a SU to try for assessment. She has multiple sclerosis and finds as she becomes more fatigued during the day, her sitting balance deteriorates. She then ends up leaning to her left. The assessment chair rises to assist her to stand. It also tilts so that when she is struggling to sit, she can tilt it so her body can relax back and not fight to remain upright. I measured her and will now order this chair in the right size for her.

Headed back to the office to complete paperwork and make orders for equipment.