Occupational Therapy’s Role in Skilled Nursing Facilities

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How Does Occupational Therapy Benefit Individuals In Skilled Nursing

Facilities (SNFs)?

Intervention provided by occupational therapists and occupational therapy assistants in

skilled nursing facilities are associated with positive outcomes. Jette, Warren, and Wirtalla(2005) determined that higher intensity occupational therapy during rehabilitation in a SNF is

associated with a shorter length of stay as well as functional improvements for a variety of

diagnoses. This study, which included 4,988 patients with stroke, orthopedic, cardiovascular, and

pulmonary conditions in 70 SNFs, demonstrated that higher OT intensity was associated with greater

odds of improving by at least one stage in ADL functional independence as well as improved

executive control as measured by the FIM. Occupational therapy (OT) practitioners are uniquely

qualified to utilize client-centered evaluations to identify strengths and barriers to occupational

performance of roles and activities which are meaningful or necessary for that individual. The

outcomes of intervention are focused on enabling individuals to maximize their participation in

these daily activities.

www.4720 Montgomery Lane, PO Box 31220, Bethesda, MD 20

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Skilled Nursing

Facilities

Occupational Therapy’s Role in

SNFs are health care facilities, primarily for adults

that require medical care for variable periods of

time from relatively short to more extended or even

permanent residence. Short-term rehabilitation

services may be provided to individuals with

diagnoses such as joint replacements, stroke, etc.

(Roberts and Evenson, 2009). Long-term care is

also provided for permanent residents of the

facility who have chronic or progressive illnesses or

diagnoses such as dementia. Occupational therapy

services in this setting are generally reimbursed byMedicare Part A for short-term, acute care clients;

Medicare Part B for long-term residents who require

skilled services; and usually by private insurance,

Medicaid, or private pay for younger clients.



The Role Of Occupational Therapy In SNFs

Occupational Therapists (OTs) and Occupational Therapy Assistants (OTAs) “promote thehealth and participation of people, organizations, and populations through engagementin occupation” (American Occupational Therapy Association [AOTA], 2008). OTs and OTAs provideintervention in many areas of occupation such as: activities of daily living (ADLs) including bathing,

dressing, grooming; instrumental activities of daily living (IADLs) including home and financialmanagement, rest and sleep, education, work, play, leisure, and social participation (AOTA, 2008).They also develop and implement health and wellness programs to prevent injuries, maintainfunction, and improve safety of residents. For example, OTs and OTAs can take a leadership role in

developing and implementing programs to educate clients on compensatory techniques for lowvision, customized exercise programs, or strategies to prevent falls. Occupational therapypractitioners may also consult with other staff within the facility or in the community on a variety of

topics related to increasing safe engagement in activities.

Occupational therapy practitioners can provide a variety of services to short- and long-term residentsof a SNF. Based on a client-centered evaluation, the occupational therapist, the client, caregivers,

and/or significant others develop collaborative goals to identify strengths and deficits and addressbarriers that hinder occupational performance in multiple areas. The intervention plan is designed topromote a client’s optimal function for transition to home, another facility, or long-term care.

Occupational Therapy Intervention In Short-Term SNF RehabilitationCan Include:

• Training in self-care skills, specifically ADLs such as feeding or eating, grooming, dressing,bathing, and toileting

• Providing training in the use of adaptive equipment, compensatory techniques, andenvironmental modifications to increase safety and independence

• Remediating IADLs related to the patient’s discharge environment, such as preparing a meaor managing one’s home or finances

• Training in functional mobility such as how to prepare a meal while using an

ambulatory device• Addressing behavioral health needs of clients, such as depression or anxiety, in

collaboration with other facility staff • Preparing the client and family for community reintegration (as appropriate for the client’s

discharge site) with activities such as public dining or emergency response management• Assessing the need for and recommending potential home modifications and safety

equipment to reduce barriers and promote safe functioning upon discharge• Exploring adaptations and compensatory strategies for return to volunteer or paid

employment

• Educating clients and/or caregivers in community resources and strategies to support needafter discharge

• Assessing current leisure skills to determine whether modifications are needed to continueparticipation and/or assisting with exploration of new leisure pursuits

Occupational therapy enables people of all ages live life to its fullest by helping them to promote health, make lifestyle or

environmental changes, and prevent—or live better with—injury, illness or disability. By looking at the whole picture—a client’spsychological, physical, emotional, and social make-up—occupational therapy assists people to achieve their goals, function at

the highest possible level, maintain or rebuild their independence and participate in the everyday activities of life.



Occupational Therapy For Long-Term-Care Residents Can Include:

• Training in ADLs such as eating, grooming, dressing, bathing, and toileting to promoteindependence and dignity

• Providing and educating residents about adaptive equipment and compensatory

techniques to improve safety and increase participation and independence• Teaching functional mobility including use of an ambulatory device and/or transfers todifferent surfaces, such as a bed, chair, toilet, or shower in order to perform self-care and

personal tasks; training in wheelchair mobility and safety appropriate for the resident’slevel of cognition and perception

• Remediating or enhancing IADLs such as ability to use the telephone or emergency callingsystem

• Working collaboratively with the facility staff to address behavioral health issues such asthose related to depression or anxiety, that may impact performance of daily activitiesincluding leisure pursuits

• Educating residents with cognitive and perceptual deficits in compensatory techniques tomaximize abilities in areas including attention span, orientation, sequencing, and/or

memory• Instructing residents with low vision in techniques to maximize their remaining vision and

enhance safety through compensatory techniques, environmental modifications, assistivetechnology, and adaptive equipment

• Instructing residents and caregivers in techniques to improve positioning, reduce restraints,and maintain skin integrity.)

• Modifying the environment and adapting tasks to maximize safety (e.g. falls prevention andfatigue management)

• Educating caregivers to utilize a resident’s remaining abilities to enhance function and

preserve dignity for adults with dementia• Enhancing quality of life and dignity by providing opportunities for engagement in

meaningful activities despite client limitations.

Occupational Therapy Consultation Services

OT practitioners may also consult with SNF staff and administration in a variety of areas such as:

• Training other staff members to enable residents to participate in relevant groups and

activities with appropriate modifications• Collaborating with residents to identify potential support groups to increase leisure and

social participation

• Consulting with employers, staff, or family on environmental modifications for a client’sprobable discharge location

• Educating family members about community resources such as senior centers, meals onwheels, exercise groups, etc.

• Collaborating with other disciplines in the SNF to identify the causes of dementia-relatedbehaviors and possible solutions


environmental changes, and prevent—or live better with—injury, illness or disability. By looking at the whole picture—a client’spsychological, physical, emotional, and social make-up—occupational therapy assists people to achieve their goals, function at

the highest possible level, maintain or rebuild their independence and participate in the everyday activities of life.



Occupational Therapy’s Role In Program Development

OT practitioners are skilled in developing and implementing new programs in SNFs that promotehealth, remediate deficits, and prevent disability. Programs in this setting are developed based on thecollaborative goals of the residents in the facility, staff, and OT practitioners. They may beimplemented in a series of group sessions, which has the added benefit of enhancing social

interaction between residents. Some examples of those programs include:

• Falls prevention—educating patients and caregivers about hazards in the facility that may

precipitate falls and strategies to prevent them• Dementia management—helping the staff identify possible causes and interventions for

dementia-related “behaviors” to enhance a client’s functioning and quality of life• Restraint reduction—identifying positioning methods and alternatives to avoid or minimize

the use of restraints to manage challenging behaviors• Contracture management—to maintain range of motion and assist in preventing the

development or progression of deformities due to lack of movement which can have anegative impact on performance of self-care and other activities

• Positioning programs—to prevent disability and maintain healthy postures to enableperformance of activities• Therapeutic groups—to address behavioral health issues and provide opportunities for

participation, to enhance functional skills, and improve social interaction• Pre-driving assessment—to help physicians determine potential to resume safe driving and

recommend modifications when appropriate. Where appropriate, consulting with an OTwho can provide more specialized driver assessments to vehicle modifications and neededtraining.

Occupational therapy practitioners play a vital role in providing client-centered, short-term andlong-term rehabilitation services to individuals in skilled nursing facilities. They develop andimplement a variety of programs and group or individualized interventions to enhance the client’s

participation in meaningful roles and occupations of daily living. They also provide consultativeservices to facility staff and residents to promote quality of life and client satisfaction.

References

American Occupational Therapy Association [AOTA]. (2008). Occupational therapy practice framework: Domain & process (2nd ed.). American Journal of Occupational Therapy , 62, 625-683.

Jette, D.U., Warren, R.L., & Wirtalla, C. (2005). The relation between therapy intensity and outcomes of rehabilitation in skilled nursingfacilities. Arch Phys Med Rehabil, 86, 373-379.

Roberts, P., & Evenson, M. (2009). Settings providing medical and psychiatric services. In E.B. Crepeau, E.S. Cohn, & B.A.B Schell (Eds.),Willard and Spackman’s occupational therapy (11th ed.) (pp. 1076-1077). Philadelphia, PA: Lippincott Williams & Wilkins.

Authors: Jodi Washkowiak, OTS • Megan Wronski, OTS • Lori Kay Jones, OTS • Eva Velasco, OTSKelly Schrubba, OTS • Sharon J. Elliot, MS, OTR/L, BCG, FAOTA

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environmental changes, and prevent—or live better with—injury, illness or disability. By looking at the whole picture—a client’spsychological, physical, emotional, and social make-up—occupational therapy assists people to achieve their goals, function atthe highest possible level, maintain or rebuild their independence and participate in the everyday activities of life.

Occupational Therapy’s Role in Skilled Nursing Facilities

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