How occupational therapists help keep older people out of hospital
Photograph: John Birdsall
Older people are big users of the NHS, with patients over 65 accounting for half of all hospital bed days and over-85s twice as likely to have an emergency admission to hospital as the general population.
There is a growing recognition that, as the population ages and the squeeze on NHS resources continues, better ways of supporting older people outside hospital need to be developed. Multidisciplinary teams, bringing together other health professionals to work alongside doctors and nurses, will be crucial. As the independent Commission on Improving Urgent Care for Older People put it in its report earlier this year: “A focus on wellbeing and, often, community support can help avoid an older person being admitted to hospital and preserve their independence in day-to-day living.”
Occupational therapists (OTs), with their skills in promoting greater mobility, are a key ingredient in this multidisciplinary, more proactive approach. Professor David Oliver, president of the British Geriatrics Society, says it is not just about admission prevention, but also about reducing older people’s hospital stays. “At every stage of the process, OTs are important,” he says.
” But what tends to happen in the public dialogue is we talk about doctors and nurses and not the wider health professionals. We’ve still got a fragmented system.”
In its report, the commission recommended that multidisciplinary teams might often be best placed in GPs’ surgeries, and in some areas this is already happening. But, according to Dr Nav Chana, a GP and chair of the National Association of Primary Care (NAPC), more needs to be done to get genuinely joined-up healthcare in a primary care setting.
“If you look at it from an average jobbing GP’s perspective, there are not many using OTs’ skills directly within their practice teams,” Chana says. “But we are trying to get people to live independently, to prevent hospital admissions and to make discharges work. All those things sit very squarely within OTs’ remit.”
The NAPC is developing a new model of primary care with a workforce built around the ongoing needs of the population it serves and is working with the College of Occupational Therapists to promote the profession within that.
In many areas, similar thinking is driving new work on integrating healthcare professionals, including OTs, to maximise resources and to improve patient care. Dr Maggie Keeble, clinical lead, proactive care, for South Worcestershire clinical commissioning group, which is currently planning its own multidisciplinary teams, says GPs can benefit from greater team-working.
“A GP will often be reactive,” Keeble says. “They will go in if there’s a problem and someone has fallen or got an infection. But they won’t necessarily be the best placed to see that if we can sort out aids and equipment at home, we can protect this person from deteriorating further.”
“It’s not about keeping people out of hospital if they need to be there, but so often they don’t need to be in hospital”
Photograph: Paul Kingston/North News & Pictures Ltd
For occupational therapist Kathryn Hubbard, each working day is different. When she visits an older person at home, she might help with mobility equipment or simply have a chat to boost morale. But while her caseload is varied, there’s a common theme.
“We are trying to see people before they come to us in a crisis, getting the equipment and the strategies in place so that when a crisis situation arises, they won’t necessarily have to bounce straight into hospital,” she says.
Hubbard’s work at a Gateshead general practice is part of a trailblazing project targeting older patients most as risk of hospital admission. Since she began work in January 2015, she has been able to take the pressure off GPs at the Oxford Terrace and Rawling Road Medical Group while also getting better outcomes for the patients she sees. “Sometimes the person does have to be admitted however much you want to help them stay at home – but that hospital admission, stay and discharge are all a lot less stressful and shorter than they otherwise would have been,” she says. “It’s a much preferable pathway for the patient.”
It is too soon to measure the impact of Hubbard’s work on hospital admission figures. But a practice frailty nurse helped reduce A&E attendances and admissions by 54% and GP home visit requests by 81%. Practice manager Sheinaz Stansfield hopes adding occupational therapy will further boost that success.
“By providing a more proactive service, she says, “we are helping people to maintain their independence and keeping them at home longer”
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